Unloading knee brace is a cost-effective method to bridge and delay surgery in unicompartmental knee arthritis

Kinetic effects of unicompartmental unloader braces in medial knee osteoarthritis: A longitudinal study of joint load during level, stair, and slope walking

Knee osteoarthritis (KOA) impairs mobility, particularly in higher demanding tasks like stair climbing and slope walking. While unloader braces are well-studied for level walking (LVL), their effects on more complex locomotion tasks remain underexplored. This study analyzes how unloader braces influence knee joint kinetics and load distribution over various demanding tasks. Twenty participants with medial KOA were assessed at baseline (BAS) and after six weeks (FU) of using a valgus unloader brace. Musculoskeletal modeling was used in conjunction with a multifaceted statistical approach to investigate kinetic effects and load changes across locomotion tasks. Mixed-effects modeling analyzed overall trends, including main effects (locomotion tasks, time and braced vs. unbraced conditions) and their interactions. ANOVA with statistical parametric mapping (SPM) offered detailed insights into variations related to the brace or time throughout the stance phase for each locomotion task. ANOVA with SPM showed significant reductions in knee adduction moment (KAM) and medial compartment force (M-CF) across all tasks, with larger effect sizes during slope walking and stair climbing. Lateral compartment force (L-CF) increased during LVL and most higher-demanding tasks. FU values were generally lower than BAS, though inconsistently. Mixed-effects modeling found no significant main or interaction effects, likely due to its broader scope and increased variability from aggregated data and multiple interactions. While this study addresses a critical literature gap and provides valuable mid-term insights, longer-term studies with larger sample sizes are required to validate these findings and improve statistical power for detecting main and overarching trends.

Is biomechanical loading reduced in individuals with unilateral transtibial amputation during fast-paced walking when using different ankle/foot prostheses? A pragmatic randomized controlled trial

INTRODUCTION

Sound side loading is a risk factor for osteoarthritis development, which has been noted to reduce when using advanced prostheses during normal-paced walking in individuals with unilateral transtibial amputation (UTTA). However, descriptions of loading during fast-paced walking remain relatively unreported. Therefore, the aim of this study was to describe the biomechanical loading of individuals with UTTA while using different ankle/foot prostheses during fast-paced walking.

METHODS

 A blinded, randomized control trial was conducted in a group of K3-K4 ambulators, who used 3 different prosthetic feet (1. a solid ankle cushioned heel foot prosthesis [SACH], 2. a standard energy storage and return foot prosthesis [ESAR], and 3. a novel ESAR foot prosthesis [N-ESAR]) in a 2-week randomized crossover design. The spatiotemporal and kinetic data of the participants' fast walking pace were collected. Data were analyzed using a mixed model and one-way analysis of variances ( p < 0.05) and Cohen d .

RESULTS

Twenty individuals with UTTA (age: 40 ± 16 years; height: 1.76 ± 0.09 m; and BMI: 24.72 ± 3.63 kg/m 2 ) participated in this study. There were minimal changes in the spatiotemporal data between the different prosthetic feet. When the participants used the N-ESAR feet, they had a lower peak vertical ground reaction force ( p = 0.02) and external knee adduction moment ( p = 0.02) on the sound side, as well as a higher distal shank power on the prosthetic side ( p < 0.01).

CONCLUSION

Overall fast-paced walking resulted in higher sound side loading forces compared with normal-paced walking. However, use of the N-ESAR prosthesis reduced the biomechanical loading on the sound side in individuals with UTTA while walking at a fast pace compared with the ESAR and SACH prostheses. The percentage change in the biomechanical loading from normal- to fast-paced walking of the N-ESAR foot was also larger compared with the other prostheses, perhaps because of the individuals' ability to achieve a faster walking pace when using the N-ESAR prosthesis. Longitudinal intervention studies should be performed to further investigate the possible benefits of using advanced prostheses.

Knee Bracing for Unicompartmental Osteoarthritis: A Service Evaluation

OBJECTIVES

This service evaluation examined the impact of offloader knee bracing for unicompartmental osteoarthritis (OA) on pain, quality of life (QoL) and activities of daily living (ADL).

DESIGN

The retrospective service evaluation was completed at two NHS community primary care clinics offering offloader knee bracing services. Between 2015 and 2023 patients prescribed offloader knee braces with unicompartmental osteoarthritis were invited to complete a Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, one, six and 12 months and at two and three years. KOOS data were analysed to assess the change in ADL, Pain and QoL domains from baseline to one, six and twelve months and up to three years using a paired t-test. Demographic data collected included age, sex, and type of OA.

RESULTS

Two hundred and forty-three patients were issued an offloader knee brace. There were statistically significant differences in pain and ADL for both braces at one and six months (p < 0.05). Participants issued with an ÖSSUR brace demonstrated statistically significant changes in pain and ADL for up to two years (p = 0.0101; p = 0.0153) and QoL up to one year (p = 0.0011). There was no statistically significant difference in either brace at three years. The ÖSSUR brace demonstrated a minimal clinically significant difference at one month for all domains, at one year for pain and ADL and two and three years for pain, ADL and QoL.

CONCLUSIONS

Results indicate that offloader knee bracing for unicompartmental knee OA could reduce patients' pain, ADL and QoL in the long term.

Functions and Effectiveness of Unloader, Patellofemoral, and Knee Sleeve Orthoses: A Review

Background

Knee orthoses have been extensively used as a nonsurgical approach to improving knee deficiencies. Currently, arthritic knee conditions remain the leading cause of disability, and this number is expected to increase. As the use of knee orthoses varies widely, so has their effectiveness which is still largely debatable. Here, we present the functions and effectiveness of the three most prominent knee orthotic models dedicated to supporting knee osteoarthritis-unloader, patellofemoral, and knee sleeves.

Purpose/Research Question

Considering the depth and diversity of the many clinical studies and documented laboratory reports published to date, this literature review was created to educate the clinician, patient, and researcher on common knee orthoses used for the management of arthritic knee conditions. In doing so, we discuss their design, biomechanical effects, and clinical efficacy, as well as broader outcomes, limitations, and recommendations for use.

Results/Synthesis

The knee orthoses discussed within the scope of this paper are dedicated to protecting the knee against strenuous compressive loads that may affect the patellofemoral and tibiofemoral joints of the knee. Since the knee has multiple axes of motion and articulating surfaces that experience different loads during functional activities, it can be implied that, to a large extent, knee brace designs can differ drastically. Unloader knee orthoses are designed to decrease tibiofemoral and patellofemoral joint pressures. Patellofemoral knee orthoses are designed to decrease strain on the patellofemoral and quadriceps tendons while stabilizing the patella. Knee sleeves are designed to stabilize movements, reduce pain in joints, and improve proprioception across the knee joint.

Conclusion

Although patients often report benefits from wearing braces, these benefits have not been confirmed by clinicians and scientific investigators. Results from these three orthosis types show that clinical efficacy is still elusive due to the different methodologies used by researchers.

Layman Summary

Knee orthoses also referred to as knee brace are commonly used for support and stability of the knee. Unloader knee braces are designed to relieve and support those suffering from knee osteoarthritis by improving physical impairment and reducing pain. Patellofemoral knee braces aim to help patients manage patellofemoral pain syndrome. Rehabilitative compression sleeves, also known as knee sleeves, are often used to assist patients suffering from knee pain and laxity. Important findings on the three knee braces discussed show discrepancies in results. Their effectiveness and validity are yet to be understood.

Effects of medical interventions on health-related quality of life in chronic disease - systematic review and meta-analysis of the 19 most common diagnoses

Introduction

The demographic shift leads to a tremendous increase in age-related diseases, which are often chronic. Therefore, a focus of chronic disease management should be set on the maintenance or even improvement of the patients' quality of life (QoL). One indicator to objectively measure QoL is the EQ-5D questionnaire, which was validated in a disease- and world region-specific manner. The aim of this study was to conduct a systematic literature review and meta-analysis on the QoL across the most frequent chronic diseases that utilized the EQ-5D and performed a disease-specific meta-analysis for treatment-dependent QoL improvement.

Materials and methods

The most common chronic disease in Germany were identified by their ICD-10 codes, followed by a systematic literature review of these ICD-10 codes and the EQ-5D index values. Finally, out of 10,016 independently -screened studies by two persons, 538 studies were included in the systematic review and 216 studies in the meta-analysis, respectively.

Results

We found significant medium to large effect sizes of treatment effects, i.e., effect size >0.5, in musculoskeletal conditions with the exception of fractures, for chronic depression and for stroke. The effect size did not differ significantly from zero for breast and lung cancer and were significantly negative for fractures.

Conclusion

Our analysis showed a large variation between baseline and post-treatment scores on the EQ-5D health index, depending on the health condition. We found large gains in health-related quality of life mainly for interventions for musculoskeletal disease.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020150936, PROSPERO identifier CRD42020150936.

Design and evaluation of an offloading orthosis for medial knee osteoarthritis

Knee osteoarthritis is an incurable degenerative joint disease that affects millions of people. Characterized by stiffness and knee pain in the early stages, it can cause loss of function and mobility. Most treatment options are either not sustainable, invasive, or costly. Alternatively, offloading knee orthoses are a cost-effective option that provides immediate pain relief when worn. Offloading knee orthoses, however, have low patient compliance rates. To improve patient compliance and optimize patient benefit, current orthosis designs must be enhanced to improve comfort, increase the perceived effect, and be adjustable to the patient. Consequently, this research presents the design, fabrication, and testing of a new offloading knee orthosis joint. The novel modular orthosis features an offloading mechanism intended to relieve the load on the joint solely during stance phase and reduce the moment during swing phase when offloading is not needed. Three-point bending tests of the experimental prototype demonstrated an offloading moment of 3.36 Nm, creating a noticeable offloading effect during stance, and reduced the moment to less than 0.5 Nm after 35° of knee flexion, thus, potentially increasing comfort during swing phase and sitting when offloading forces are not needed.

Combined Rehabilitation Protocol in the Treatment of Osteoarthritis of the Knee: Comparative Study of Extremely Low-Frequency Magnetic Fields and Soft Elastic Knee Brace Effect

The investigation of this observational case-control study aimed at determining the effectiveness of a combined treatment of extremely low-frequency electromagnetic fields (ELF) with a soft elastic knee brace versus ELF alone in knee osteoarthritis (KOA) with respect to a reduction in pain and functional recovery. We hypothesized that the combined use of ELF and a soft elastic knee brace may provide better results. Thirty-five patients (N = 35, divided into Group 1 = ELF and Group 2 = ELF with the soft elastic knee brace) were analyzed. The rehabilitative protocol consisted of 10 sessions of antiphlogistic and antiedema programs (first cycle) for 2 weeks, followed by twelve sessions of bone repair and connective tissue repair programs (second cycle) in patients with knee osteoarthritis (KOA) for 4 weeks. Patient evaluations were conducted at baseline (T0) and after 2 (T1) and 4 (T2) weeks of treatment. A follow-up evaluation was conducted 6 weeks after treatment (T3). The LIMFA© Therapy System was used to create multifrequency magnetoelectric fields with an intensity of 100 µT and a low-frequency field. The Incrediwear Cred 40 knee sleeve (Incred) was used for alleviating knee pain. The Visual Analogue Scale (VAS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Lysholm score (Ls) were used as outcome measures. The results showed that pain at rest (Vr), pain in motion (Vm), KOOS, and Ls were significantly affected by ELF over time. In conclusion, Group 2 had a better response in terms of pain resolution at rest (p < 0.05) and a concurrent better response at T3 in terms of functional recovery (p < 0.05).

Are All Unloader Braces Created Equal? Recommendations for Evidence-Based Implementation of Unloader Braces for Patients with Unicompartmental Knee OA

Unicompartmental knee osteoarthritis (UKOA) is a complex issue that is estimated to affect roughly 28% of patients with knee OA, and can result in severe cartilage degeneration, meniscus deficiency, and concomitant varus or valgus malalignment. This malalignment results in abnormally high joint reaction forces in the affected compartment, which can elicit pain, cause dysfunction, and exacerbate joint degradation. For more than two decades, the use of knee unloader braces has been advocated as a cost-effective option for symptomatic management of UKOA.During bipedal ambulation with a normal lower extremity mechanical axis, ground reaction forces create a knee adduction moment (KAM) such that the medial compartment of the knee experiences approximately 60% of joint loading and the lateral compartment experiences approximately 40% of joint loading. UKOA disrupts the mechanical axis, altering KAM and joint loading and causing pain, dysfunction, and disease progression. In theory, knee unloader braces were designed to mitigate the symptoms of UKOA by normalizing KAM via shifts in the lever arms about the knee. However, studies vary, and suggest that push-mechanism knee unloaders do not consistently provide significant biomechanical benefits for medial or lateral UKOA. Current evidence suggests that pull-mechanism unloaders may be more effective, though contrasting data have also been reported, such that further validation is necessary. The purpose of our study was to synthesize current best evidence for use of knee unloader braces for management of UKOA to suggest evidence-based best practices as well as gaps in knowledge to target for future studies. Unloader bracing for patients with UKOA appears to be a cost-effective treatment option for patients with medial UKOA who have insurance coverage. Pull-mechanism unloader bracing should be considered in conjunction with other nonoperative management therapies for those who are willing to adhere to consistent brace use for weight-bearing activities.

Advantages and challenges of stem cell therapy for osteoarthritis (Review)

Osteoarthritis (OA) is a degenerative disorder of the cartilage and is one of the leading causes of disability, particularly amongst the elderly, wherein patients with advanced-stage OA experience chronic pain and functional impairment of the limbs, thus resulting in a significantly reduced quality of life. The currently available treatments primarily revolve around symptom management, and is thus palliative rather than curative. The aim of the present review is to briefly discuss the limitations of some of the currently available treatments for patients with OA, and highlight the value of the potential use of stem cells in cellular therapy, which is widely regarded as the breakthrough that can address the present unmet medical needs for treatment of degenerative diseases, such as OA. The advantages of stem cell therapy, particularly mesenchymal stem cells, and the challenges involved are also discussed in this review.

Hip and Knee Bracing: Categorization, Treatment Algorithm, and Systematic Review

Hip and knee braces or orthoses are often used to provide support after surgery and to prevent or reduce the severity of injuries. The braces are used for stabilization, immobilization, mechanical correction, and rehabilitation. Hip braces consist of stabilization and unloader variations, whereas knee braces are composed of knee sleeves and patellofemoral, prophylactic, unloader, and functional braces. Indications vary widely and depend on the type of brace. Hip braces can treat osteoarthritis to instability after total hip arthroplasty. Knee brace indications range from mild arthralgias to instability and osteoarthritis. Although braces are routinely used clinically, high-level evidence is sparse for their use. With this review, the different types and uses of hip and knee braces have been defined, and their indications exemplified in hopes of spurring future research.

Can an OA Knee Brace Effectively Offload the Medial Condyle? An In Vivo Fluoroscopic Study

BACKGROUND

Previous studies evaluating the effectiveness of OA offloading knee braces focused on qualitative results. The objective of this study was to analyze the effectiveness of an off-loading knee brace with respect to in vivo three-dimensional knee kinematics to quantitatively measure the changes in medial joint space and relative bone alignment when wearing the brace.

METHODS

Twenty subjects diagnosed with medial compartmental joint space narrowing and varus deformity due to OA were recruited. During fluoroscopic surveillance, subjects performed normal gait on a treadmill with and without the brace. Images were sequenced at heel-strike and mid-stance during the weight-bearing portion of gait. 3D-to-2D image registration was performed on each subject using 3D bone models derived from CT segmentation and 3D ultrasound scans.

RESULTS

Medial joint space was to increase when the brace was applied in all subjects (1.6 ± 0.7 mm at heel-strike, 1.6 ± 0.8 mm at mid-stance) and was statistically significant (P < .001). It was also found that sixteen of the twenty subjects experienced a medial joint space increase of more than 1.0 mm during heel-strike while thirteen of twenty experienced this change at mid-stance. While wearing the brace, over half of the subjects experienced a valgus correction to their alignment.

CONCLUSIONS

All subjects in this study experienced a positive change in the medial joint space when wearing the offloading knee brace. In addition, many subjects also saw joint space values representative of previously documented, nonosteoarthritic subjects and valgus changes in bone alignment more akin to the normal knee.

Can Medical Cannabis Therapies be Cost-Effective in the Non-Surgical Management of Chronic Knee Pain?

Introduction:

Chronic knee pain is a common musculoskeletal condition, which usually leads to decreased quality of life and a substantial financial burden. Various non-surgical treatments have been developed to relieve pain, restore function and delay surgical intervention. Research on the benefits of medical cannabis (MC) is emerging supporting its use for chronic pain conditions. The purpose of this study was to evaluate the cost-effectiveness of MC compared to current non-surgical therapies for chronic knee pain conditions.

Methods:

We conducted a cost-utility analysis from a Canadian, single payer perspective and compared various MC therapies (oils, soft gels and dried flowers at different daily doses) to bracing, glucosamine, pharmaceutical-grade chondroitin oral non-steroidal anti-inflammatory drugs (NSAIDs), and opioids. We estimated the quality-adjusted life years (QALYs) gained with each treatment over 1 year and calculated incremental cost-utility ratios (ICURs) using both the mean and median estimates for costs and utilities gained across the range of reported values. The final ICURs were compared to willingness-to-pay (WTP) thresholds of $66 714, $133 428 and $200 141 Canadian dollars (CAD) per QALY gained.

Results:

Regardless of the estimates used (mean or median), both MC oils and soft gels at both the minimal and maximal recommended daily doses were cost-effective compared to all current knee pain therapies at the lowest WTP threshold. Dried flowers were only cost-effective up to a certain dosage (0.75 and 1 g/day based on mean and median estimates, respectively), but all dosages were cost-effective when the WTP was increased to $133 428/QALY gained.

Conclusion:

Our study showed that MC may be a cost-effective strategy in the management of chronic knee pain; however, the evidence on the medical use of cannabis is limited and predominantly low-quality. Additional trials on MC are definitely needed, specifically in patients with chronic knee pain.

Biomechanical Study of a Tricompartmental Unloader Brace for Patellofemoral or Multicompartment Knee Osteoarthritis

Objective: Off-loader knee braces have traditionally focused on redistributing loads away from either the medial or lateral tibiofemoral (TF) compartments. In this article, we study the potential of a novel "tricompartment unloader" (TCU) knee brace intended to simultaneously unload both the patellofemoral (PF) and TF joints during knee flexion. Three different models of the TCU brace are evaluated for their potential to unload the knee joint. Methods: A sagittal plane model of the knee was used to compute PF and TF contact forces, patellar and quadriceps tendon forces, and forces in the anterior and posterior cruciate ligaments during a deep knee bend (DKB) test using motion analysis data from eight participants. Forces were computed for the observed (no brace) and simulated braced conditions. A sensitivity and validity analysis was conducted to determine the valid output range for the model, and Statistical Parameter Mapping was used to quantify the effectual region of the different TCU brace models. Results: PF and TF joint force calculations were valid between ~0 and 100 degrees of flexion. All three simulated brace models significantly (p < 0.001) reduced predicted knee joint loads (by 30-50%) across all structures, at knee flexion angles >~30 degrees during DKB. Conclusions: The TCU brace is predicted to reduce PF and TF knee joint contact loads during weight-bearing activity requiring knee flexion angles between 30 and 100 degrees; this effect may be clinically beneficial for pain reduction or rehabilitation from common knee injuries or joint disorders. Future work is needed to assess the range of possible clinical and prophylactic benefits of the TCU brace.

High Boron Silicon Nanotubes Combined with Tai Chi Exercise Rehabilitation Therapy in the Treatment of Knee Arthritis Patients

Tai Chi exercise is gentle, convenient, and easy to learn. It is more economical than traditional medical treatments, and it is regarded as the first choice for rehabilitation therapy by patients with knee arthritis. This article aims to study Tai Chi exercise rehabilitation therapy combined with high boron silicon nanotubes to treat knee arthritis patients. This article mainly introduces the treatment of knee arthritis patients with Tai Chi, which is reflected in the improvement of patients’ walking ability and stability, and explores a three-dimensional motion model to provide better help for patients with knee joints. The article uses data mining methods to collect data on the gene expression of human knee joints and analyzes the causes of knee arthritis caused by its internal structure. The experimental results of this paper show that, under Taijiquan exercise rehabilitation treatment, the time needed by knee arthritis patients to get up and run is reduced by 14%, the standing time of one leg is significantly improved, the fall rate is reduced by 13%, and the body’s static balance ability is improved.

Three-month efficacy of three knee braces in the treatment of medial knee osteoarthritis in a randomized crossover trial

Immediate biomechanical and functional effects of knee braces are often reported, however, the duration and type of knee brace treatment for knee osteoarthritis (KOA) remain unclear. The objective was to evaluate usage, comfort, pain, and knee adduction moment (KAM) of three knee braces each worn 3 months by patients. Twenty-four patients with KOA were assigned in a randomized crossover trial a valgus three-point bending system brace (V3P-brace), an unloader brace with valgus and external rotation functions (VER-brace) and a stabilizing brace used after ligament injuries (ACL-brace). Functional questionnaires and gait assessment were carried out before and after each brace wear period of 3 months. A Friedman test was applied between brace wear diary recordings. Repeated measures analyses of variance contrasted the factors brace type (ACL, V3P, and VER), time (pre and post) and wear (without and with) on comfort, pain, function, and KAM. Brace usage was similar, but the V3P-brace was slightly less worn. Discomfort was significantly lowered with the VER-brace. All knee braces relieved pain and symptoms from 10% to 40%. KAM angular impulse was reduced with the three braces, but the VER-brace obtained the lowest relative reduction of 9%. The interaction between time and wear indicated that part of the KAM reduction with brace wear was maintained post treatment. All three knee braces have great benefits for pain and function among the medial KOA population. The VER-brace offers additional advantages on daily use, comfort and KAM, which could improve compliance to brace treatment.

The effect of a knee brace in dynamic motion-An instrumented gait analysis

Background

Osteoarthritis (OA) is a common problem in the older population. To reduce pain and stress in the affected knee joint compartment, a functional knee brace is often prescribed by physicians to protect it from high loads.

Objectives

An instrumented gait analysis should evaluate how the 4-point knee orthosis for varus or valgus load relief (M.4s OA) changes the kinematics of the knee, especially in the frontal plane.

Methods

17 healthy participants took part and were analyzed with an inertial sensor system (MyoMotion) giving continuous, objective information on the anatomical angles. The measurements were made both without wearing a knee brace and with the brace in different settings.

Results

The results show a significant reduction in the maximum knee abduction and raised knee adduction. The knee brace, with a strong adjustment in varus or valgus orientation, caused a shift of maximum ab-/adduction in the proposed direction in 69% and 75% of the dynamic tests, respectively. The knee motion in the frontal plane shows individual movement patterns.

Conclusion

The use of the brace leads to significant changes in the knee’s movement. Patient-specific movement patterns may explain different effects of functional knee braces on individual persons. Inertial sensors have been shown to be a low-cost, easy-to-use option for individual movement analysis and further personalized therapy.

Valgus knee bracing may have no long-term effect on pain improvement and functional activity in patients with knee osteoarthritis: a meta-analysis of randomized trials

Background

Knee osteoarthritis (KOA), with a high incidence in old-age population, adversely affects their life quality. The valgus knee bracing is an important physical therapy for KOA, but its clinical effects on pain release and functional improvement remained unclear. This meta-analysis is to systematically evaluate the clinical outcomes of valgus knee bracing in patients with KOA.

Methods

A meta-analysis of clinical randomized controlled trials (RCTs) on pain and functional changes in patients with KOA after using valgus knee braces. The search period was ranged from the inception of the database to May 2020. The enrolled research databases included PubMed, Embase, and Web of Science databases. Two investigators independently formulated inclusion criteria and exclusion criteria and screened and determined the final enrolled literature. Then the outcome indicators were extracted and organized from the included literature, and the risk of bias was assessed by Cochrane Handbook 5.0.1.

Results

A total of 10 articles were included in this study, including 739 patients. Eight articles were related to the visual analog scale (VAS) pain score, and the results showed that RR = − 0.29, 95% CI − 0.73, 0.15], P = 0.20; four articles were related to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score, and the results showed that RR = − 0.15, 95% CI [− 0.41, 0.11], P = 0.26; two articles were related to the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the results showed that RR = 0.58, 95% CI [− 4.25, 5.42], P = 0.81; and three articles were related to the KOOS Activities of Daily Living (KOOS-ADL), and the results showed that RR = 0.04, 95% CI [− 0.62, 0.69], P = 0.91. These results indicated that the valgus knee bracing has no statistical significance in pain and functional activity improvement of patients with KOA. The subgroup analysis showed that the follow-up time was the source of the heterogeneity of the VAS pain score.

Conclusion

Our current evidence suggests that valgus knee bracing may not improve pain release and function activates in KOA patients in the long-term period, but only being beneficial to the short-term rehabilitation.

Effect of Germanium-Embedded Knee Sleeve on Osteoarthritis of the Knee

Background

Knee osteoarthritis (OA) affects an estimated 1 in 5 individuals older than 45 years of age in the United Kingdom. Previous studies have suggested that germanium-infused garments may provide improved clinical outcomes in OA. Germanium-embedded (GE) knee sleeves embrace this fabric technology.

Purpose

To assess the outcomes of GE knee sleeves for patients with knee OA.

Study Design

Cohort study; Level of evidence, 2.

Methods

This study was undertaken at a hospital in the United Kingdom. Patients who had radiographic features of OA, experienced knee pain for at least 6 months, and opted for nonsurgical intervention were included. Patients were recruited over 3 months. The University of California, Los Angeles activity score, Lysholm score, visual analog scale (VAS) score, and Oxford Knee Score (OKS) were collected at monthly intervals for 6 months. Patients were followed to determine their compliance with wearing the knee sleeves at all times, as advised, and whether any adverse effects had occurred.

Results

A total of 50 participants were recruited for the study; 4 participants were excluded due to pain and were converted to surgical management. Therefore, 46 patients were analyzed and placed into 2 groups according to severity of OA, as classified by the Kellgren-Lawrence system: group A had grade 1 or 2 OA, and group B had grade 3 or 4 OA. There were 25 patients in group A and 21 in group B. Improvements were seen in OKS, VAS, and Lysholm scores in both groups. Clinically significant improvements were seen in group A only for OKS (mean increase, 14), VAS (mean decrease, 4.1), and Lysholm (mean increase, 17.2) scores. These results were also statistically significant (OKS, P = 5.8 × 10^-7; VAS, P = 7.7 × 10^-12; Lysholm, P = 4.2 × 10^-11). The data from this study demonstrated that GE knee sleeves gave better outcomes for patients with grades 1 and 2 OA compared with patients with more advanced disease, which is consistent with previous studies. A total of 3 patients reported skin irritation, which resolved with simple skin ointment application. No patients reported infection, deep vein thrombosis, or circulation problems.

Conclusion

GE knee sleeves could play an important role in optimizing nonsurgical management of patients with knee OA, especially patients with grades 1 and 2 OA, as demonstrated by the clinically significant improvements.

An Update on Unloading Knee Braces in the Treatment of Unicompartmental Knee Osteoarthritis from the Last 10 Years: A Literature Review

Background  The incidence of osteoarthritis is increasing and it is one of the most common causes of chronic conditions. Total knee replacement is the mainstay of treatment for end-stage knee osteoarthritis; however, with long waiting lists and high levels of dissatisfaction, a treatment like knee braces could potentially delay surgery. Unicompartmental knee osteoarthritis is associated with misalignment of the knee, and unloader bracing has been recommended by various guidelines to correct this misalignment. The aim of this report was to provide an update of evidence from the past 10 years on knee braces.

Methods  MEDLINE/EMBASE search was performed from the past 10 years.

Results  We reviewed the evidence from 14 published articles. Almost all articles supported knee brace use and showed it to decrease pain, improve function, and improve the quality of life of patients. One study in 2017 followed patients for long term and found knee bracing to be more cost effective than total knee replacement, and could replace the need for surgery. Several minor complications were reported with bracing, like soft tissue irritation, which could be due to poor fitting. A management strategy for this could be regular follow-up at a nurse-led clinic.

Conclusions  Unloader braces are an economical and effective treatment for unicompartmental knee osteoarthritis. They can significantly improve a patient's quality of life and potentially delay the need for surgery. Patients should be managed with a multidisciplinary approach with conservative management and knee bracing, before surgery is considered.

Effectiveness of Valgus Offloading Knee Braces in the Treatment of Medial Compartment Knee Osteoarthritis: A Systematic Review

CONTEXT:

Knee osteoarthritis affects 9.3 million adults over age 45 years in the United States. There is significant disability associated with this condition. Given the potential complications and the significant cost to the health care system with the dramatic increase in total knee arthroplasties performed for this condition, assessment of the efficacy of nonoperative modalities, such as offloading knee braces, is essential as part of optimizing nonoperative treatment for this condition.

OBJECTIVE:

To determine the effectiveness of valgus offloader braces in improving clinical outcomes for patients with medial compartment knee osteoarthritis.

DATA SOURCES:

Three databases (PubMed, MEDLINE, and EMBASE) were searched from database inception through July 28, 2017.

STUDY SELECTION:

Studies reporting outcomes of valgus offloader knee braces in the treatment of medial compartment knee osteoarthritis were included.

STUDY DESIGN:

Systematic review.

LEVEL OF EVIDENCE:

Level 4.

DATA EXTRACTION:

Data pertaining to demographics, descriptive statistics, and clinical outcomes were extracted from the included studies. The methodological quality of included studies was evaluated.

RESULTS:

A total of 31 studies were included, with a total of 619 patients. The majority of studies reported improved pain outcomes using valgus offloader braces. However, variable results were reported as to whether valgus offloader braces significantly improved functional outcomes and stiffness. Offloader bracing was more effective at reducing pain when compared with neutral braces or neoprene sleeves.

CONCLUSION:

Valgus offloader bracing is an effective treatment for improving pain secondary to medial compartment knee osteoarthritis. The literature remains unclear on the effectiveness of valgus offloader braces with regard to functional outcomes and stiffness. Larger prospective randomized trials with consistent outcome assessment tools and consideration of patient compliance would be beneficial to more accurately determine treatment effects of valgus offloader bracing.