Biomechanical effect of unloader braces for medial osteoarthritis of the knee: a systematic review (CRD 42015026136)

Abstract

PurposeThere 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.MethodsA 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.ResultsTwenty-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.ConclusionThis 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.

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

“…Emerging studies paid attention to the changes of force lines in knee joint. Unbalance of weight bearing will somehow change the knee force lines and cause lower limb abnormality, leading to progress of KOA [10][11]. Theoretically, the valgus knee bracing can optimize the direction of force line in knee joint, further reducing pain symptoms and improving joint function [12][13].…”

“…Valgus knee bracing is found to effectively correct the lower limb force lines, release pain feelings and improve joint functions of KOA patients by optimizing their biomechanical axis [10][11][12][13]. Kirkley et al [14] showed that valgus knee bracing can effectively reduce the pain symptom and joint mobility of KOA patients.…”

Identification of good candidates for valgus bracing as a treatment for medial knee osteoarthritis

“…Baseline scores are associated with improvements in WOMAC scores due to bracing 5 Kinematics and kinetics Related to severity 33 and progression 1,34 of knee osteoarthritis and often used to assess brace performance 35,36…”

Current advances in therapies for osteoarthritis

“…Unloader knee braces have been used in osteoarthritis to modulate mechanical stress on the symptomatic joint compartment [23]; however, there has been a lack of consensus regarding the biomechanical and clinical effects of these devices [24]. Petersen et al [24] performed a systematic review of studies that have examined the biomechanical effect of these braces.…”

“…Petersen et al [24] performed a systematic review of studies that have examined the biomechanical effect of these braces. Twenty of 24 reviewed articles indicated that valgus unloader braces were associated with a significant reduction in the knee adduction moment in patients with osteoarthritis and seven of these articles reported decreased pain in bracetreated patients.…”