Unloader Braces for Medial Compartment Knee Osteoarthritis: Implications on on Mediating Progression (original) (raw)
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Unloader Braces for Medial Compartment Knee Osteoarthritis: Implications on Mediating Progression
Background: For persons with unicompartment knee osteoarthritis (OA), off-unloader braces are a mechanical intervention designed to reduce pain, improve physical function, and possibly slow disease progression. Pain relief is thought to be mediated by distracting the involved compartment via external varus or valgus forces applied to the knee. In so doing, tibiofemoral alignment is improved, and load is shifted off the degenerative compartment, where exposure to potentially damaging and provocative mechanical stresses are reduced.
Archives of Orthopaedic and Trauma Surgery, 2016
Purpose There is a lack of consensus regarding biomechanical effects of unloader braces for the treatment of medial osteoarthritis (OA) of the knee. The purpose of this study was to perform a systematic review of studies examining the biomechanical effect of unloader braces. Methods A systematic search for articles about the biomechanical effect of unloader braces was performed. Primary outcome measure was the influence of the brace on the knee adduction moment. Data sources were Pubmed central and google scholar. Results Twenty-four articles were included. Twenty articles showed that valgus unloader braces significantly decrease the knee adduction moment. Seven of those studies reported a decrease of pain in braced patients (secondary outcome measure). Positive effects on the knee adduction moment could be found for custom made braces for conventional knee braces and for a foot ankle orthosis. Four studies could not show any effect of knee unloader braces on the knee adduction moment although one of these studies found decreased pain in braced patients. One of these studies examined healthy patients with a neutral axis. Conclusion This systematic review could demonstrate evidence that unloader braces reduce the adduction moment of the knee. Foresighted, a systematic review about the clinical effect of unloader braces is required.
Archives of Orthopaedic and Trauma Surgery, 2018
Background The use of an unloader brace is a non-surgical treatment option for patients with medial osteoarthritis (OA). However, many patients do not adhere to brace treatment, because of skin irritation due to the pads at the level of the joint space and bad fit. A new concept to unload the medial compartment of the knee is a foot ankle brace with a lever arm pressing the thigh in valgus. The aim of this prospective randomized trial was to examine the outcomes of patients with medial OA after treatment with a conventional knee unloader brace (Unloader One ®) and the new foot ankle orthosis (Agilium FreeStep ®). Methods For this multicenter trial, 160 patients (> 35 years) with medial OA were randomly allocated to treatment with a conventional knee unloader brace (Unloader One ®) or treatment with the new knee OA ankle brace (Agilium FreeStep ®). The primary outcome measure was pain (numerical analog scale) at baseline (T0), 8 weeks (T1), and 6 months (T2). Secondary outcome measures were knee function (Knee Injury and Osteoarthritis Outcome Score, KOOS), side effects, additional interventions, and compliance. Results In both groups, walking pain improved between T0 and T1 and also between T0 and T2 without a significant group difference. For pain at sports, both groups showed a significant improvement between T0 and T2 without a significant group difference. The KOOS subscales symptoms, pain, activity, sport, and quality of life increased significantly in both treatment groups without any significant group differences at T 0, T1, and T2. There was also no significant group difference in additional interventions and weekly or daily brace use. In the Agilium FreeStep ® group (23.5%), significantly less patients reported bruises in contrast to the Unloader One ® group (66.7%). Discussion The results of this clinical trial show that the foot ankle brace is as effective as a conventional knee unloader brace for the treatment of medial knee OA with regard to clinical outcome. The rate of side effects such as bruises was significantly lower in the Agilium FreeStep ® group. Trial registration DRKS00009215, 13.8.2015.
BMC Musculoskeletal Disorders, 2021
Background The Knee valgus brace is one of the accepted conservative interventions for patients with medial compartment knee osteoarthritis to correct the knee varus and increase functional activity level. Nevertheless, comprehensive overview of the effects of using this brace on self-reported pain activity level over time is not available. Thus, this study aimed to systematically review the effect of using this brace on pain and activity levels in the last 20 years in patients with medial compartment knee osteoarthritis. Methods Five databases were searched to find articles from the year 2000 to the end of November 2020: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PubMed, Web of Science, and Scopus. Two reviewers independently evaluated the available articles for eligibility and assessed quality. The risk of bias in each study was assessed by two reviewers independently according to the Strengthening the Reporting of Observational Studies in Epidemiology tool ...
Background: Evidence that knee braces used for the treatment of osteoarthritis mediate pain relief and improve function by unloading the joint (increasing the joint separation) remains inconclusive. Alternatively, valgus-producing braces may mediate pain relief by mechanically stabilizing the joint and reducing muscle cocontractions and joint compression. In this study, therefore, we sought to examine the degree to which so-called unloader braces control knee instability and influence muscle cocontractions during gait.
The Journal of Bone and Joint Surgery (American), 2007
Background-Evidence that knee braces used for the treatment of osteoarthritis mediate pain relief and improve function by unloading the joint (increased joint separation) remains inconclusive. Alternatively, valgus braces may mediate pain relief by mechanically stabilizing the joint and reducing muscle co-contractions and joint compression. This study therefore sought to examine the degree to which unloader knee braces control knee instability and influence muscle co-contractions during gait. Methods-Sixteen subjects with radiographic evidence of medial compartment knee osteoarthritis and malalignment were recruited and fitted with a custom Generation II Unloader Brace. Gait analysis was performed with the knee unbraced and with the brace in neutral alignment and 4° valgus. A two week washout period separated brace conditions. Muscle cocontraction indices were derived for agonist and antagonist muscle pairings. Pain, instability and functional status were assessed using self-report questionnaires. Repeated-measures ANOVA's, correlations and regression analysis were used for statistical analysis. Results-The scores for pain, function and stability were worst when the knee was unsupported (baseline and washout). At baseline, 9 of 16 subjects reported knee instability, of which 5 complained it affected activities of daily living. Poor knee stability was significantly correlated with decreased activities of daily living, quality of life, global knee function and higher pain and symptoms. Knee function and stability scored highest with the neutral brace compared to the valgus brace. Vastus lateralis-lateral hamstring and vastus medialis-medial hamstring muscle cocontractions were significantly reduced as a result of bracing. Subjects with greater varus alignment exhibited greater decreases in vastus lateralis-lateral hamstrings co-contraction. Conclusion-Neutral alignment performed as well or better than valgus alignment, in reducing pain, disability, muscle co-contraction, and knee adduction excursions. Pain relief may result from diminished muscle co-contractions rather than so called medial compartment unloading.
Scientific Reports, 2018
Evidence is still inconclusive for the benefits of bracing in patients with knee osteoarthritis. To assess the effect of REBEL RELIEVER unloading knee brace in conservative treatment of knee osteoarthritis, a randomized controlled trial was conducted in 67 patients with symptomatic medial knee osteoarthritis, who randomly received 6-week treatment with either REBEL RELIVER unloading knee brace + usual care (Brace group, N = 32) or usual care alone (Control group, N = 35). Primary outcome was the global last 24h-pain relief (100-mm visual analogic scale [VAS]) at 6 weeks. Secondary endpoints included pain on motion (100-mm VAS), function (Lequesne index), safety and observance. At 6 weeks, mean [SD] last 24h-pain decreased significantly more in Brace group versus Control group (−41.35 [3.37] vs −15.37 [3.23], difference −25.98, 95% CI −41.64 to −10.33, P < 0.0001). Higher mean [SD] pain on motion decrease (−51.91 [3.49] vs −19.91 [3.34], difference −32.01, 95% CI −48.21 to −15.80,...
Identification of good candidates for valgus bracing as a treatment for medial knee osteoarthritis
Journal of Orthopaedic Research, 2017
Valgus unloader braces are a conservative treatment option for medial compartment knee osteoarthritis that aim to unload the damaged medial compartment through application of an external abduction moment. Patient response to bracing is highly variable, however. While some experience improvements in pain, function, and joint loading, others receive little to no benefit. The objective of this work was to analyze clinical measures and biomechanical characteristics of unbraced walking to identify variables that are associated with the mechanical effectiveness of valgus unloader bracing. Seventeen patients with medial knee osteoarthritis walked overground with and without a valgus unloader brace. A musculoskeletal model was used to estimate the contact forces in the medial compartment of the tibiofemoral joint and brace effectiveness was defined as the decrease in peak medial contact force between unbraced and braced conditions. Stepwise linear regression was used to identify clinical and biomechanical measures that predicted brace effectiveness. The final regression model explained 77% of the variance in brace effectiveness using two variables. Bracing was more effective for those with greater peak external hip adduction moments and for those with higher Kellgren-Lawrence grades, indicating more severe radiographic osteoarthritis. The hip adduction moment was the best predictor of brace effectiveness and was well correlated with several other measures indicating that it may be functioning as a "biomarker" for good bracing candidates. Clinical Significance: The ability to predict good candidates for valgus bracing may improve issues of patient compliance and could enable the ability to train patients to respond better to bracing.