TITLE

A Mechanical Theory for the Effectiveness of Bracing for Medial Compartment Osteoarthritis of the Knee

AUTHOR(S)
Ramsey, Dan K.; Briem, Kristin; Axe, Michael J.; Snyder-Mackler, Lynn
PUB. DATE
November 2007
SOURCE
Journal of Bone & Joint Surgery, American Volume;Nov2007, Vol. 89-A Issue 11, p2398
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
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. Methods: Sixteen subjects with radiographic evidence of knee malalignment and medial compartment osteoarthritis were recruited and fitted with a custom Generation II Unloader brace. Gait analysis was performed without use of the brace and with the brace in neutral alignment and in 4° of valgus alignment. A two-week washout period separated the brace conditions. Muscle cocontraction indices were derived for agonist and antagonist muscle pairings. Pain, instability, and functional status were obtained with use of self-reported questionnaires, and the results were compared. Results: The scores for pain, function, and stability were worst when the knee was unsupported (the baseline and washout conditions). At baseline, nine of the sixteen patients reported knee instability and five of the nine complained that it affected their activities of daily living. Poor knee stability was found to be correlated with low ratings for the activities of daily living, quality of life, and global knee function and with increased pain and symptoms. Knee function and stability scored best with the brace in the neutral setting compared with the brace in the valgus setting. The cocontraction of the vastus lateralis-lateral hamstrings was significantly reduced from baseline in both the neutral (p = 0.014) and valgus conditions (p = 0.023), and the cocontraction of the vastus medialis-medial hamstrings was significantly reduced with the valgus setting (p = 0.068), as a result of bracing. Patients with greater varus alignment had greater decreases in vastus lateralis-lateral hamstring muscle cocontraction. Conclusions: When knees with medial compartment osteoarthritis are braced, neutral alignment performs as well as or better than valgus alignment in reducing pain, disability, muscle cocontraction, and knee adduction excursions. Pain relief may result from diminished muscle cocontractions rather than from so-called medial compartment unloading. Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.
ACCESSION #
27429998

 

Related Articles

  • THE EFFECTIVENESS OF SELF-ADJUSTABLE CUSTOM AND OFF-THE-SHELF BRACING IN THE TREATMENT OF VARUS GONARTHROSIS. Draganich, Louis; Reider, Bruce; Rimington, Todd; Piotrowski, Gary; Mallik, Krishna; Nasson, Scott // Journal of Bone & Joint Surgery, American Volume;Dec2006, Vol. 88-A Issue 12, p2645 

    Background: A recent development in valgus-producing knee braces has been the adjustable "unloader" brace. The purpose of this study was to compare the effectiveness of off-the-shelf and custom-made patient-adjustable, valgus-producing knee unloader braces in relieving pain, reducing stiffness,...

  • Neutral bracing produces more stability in medial knee OA cases than valgus bracing. Rapp, Susan M. // Orthopedics Today;Apr2008, Vol. 28 Issue 4, p44 

    The article discusses a study funded by the National Institutes of Health at the University of Delaware. The study made a comparison between neutral bracing and valgus bracing with medial compartment osteoarthritis. According to the study, neutral bracing has as good as or better result than...

  • IN VIVO THREE-DIMENSIONAL DETERMINATION OF THE EFFECTIVENESS OF THE OSTEOARTHRITIC KNEE BRACE: A MULTIPLE BRACE ANALYSIS. Nadaud, Matthew C.; Komistek, Richard D.; Mahfouz, Mohamed R.; Dennis, Douglas A.; Anderle, Matthew R. // Journal of Bone & Joint Surgery, American Volume;Dec2005 Supplement 2, Vol. 87-A, p114 

    The article presents information related to the usage of knee braces in osteoarthritis. Previous kinematic studies on the effects of knee braces have concentrated primarily on the anterior cruciate ligament and the effects of bracing to stabilize the knee that has a deficiency of this ligament....

  • Abstracts. Thompson, Clint // Journal of Athletic Training (National Athletic Trainers' Associ;Apr-Jun99, Vol. 34 Issue 2, p206 

    Reprints the abstract of the study `Migration and Design Characteristics of Functional Knee Braces,' by B. Brownstein which appeared in the 1998 issue of the `Journal of Sport Rehabilitation.'

  • Bracing for the Truth. Barclay, Megan // Physical Therapy Products;Nov2010, Vol. 21 Issue 8, p18 

    The article discusses the mechanics of iliotibial band (ITB) syndrome and the issue whether or not bracing can be effective for the syndrome. The syndrome is considered as the most common cause of lateral knee pain among runners. It notes that knee brace are usually used for patella tendinitis...

  • Medial Knee Osteoarthritis Treated by Insoles or Braces: A Randomized Trial. Van Raaij, Tom M.; Reijman, Max; Brouwer, Reinoud W.; Bierma-Zeinstra, Sita M. A.; Verhaar, Jan A. N. // Clinical Orthopaedics & Related Research;Jul2010, Vol. 468 Issue 7, p1926 

    There is controversial evidence regarding whether foot orthoses or knee braces improve pain and function or correct malalignment in selected patients with osteoarthritis (OA) of the medial knee compartment. However, insoles are safe and less costly than knee bracing if they relieve pain or...

  • Neutral Bracing Provides Same Stability As Valgus Bracing. Rapp, Susan M. // O&P Business News;4/1/2008, Vol. 17 Issue 7, p56 

    The article highlights the medical study conducted at the University of Delaware on the difference of the two styles of knee bracing in subjects with medial compartment osteoarthritis (OA). According to the author, the study shows that there has been a decrease in contraction and symptoms in any...

  • Bracing improves clinical outcomes but does not affect the medial knee joint space in osteoarthritic patients during gait. Haladik, Jeffrey; Vasileff, William; Peltz, Cathryn; Lock, Terrence; Bey, Michael // Knee Surgery, Sports Traumatology, Arthroscopy;Nov2014, Vol. 22 Issue 11, p2715 

    Purpose: Osteoarthritis (OA) of the knee is commonly treated through the use of medial compartment unloading braces which have been shown to improve clinical symptoms. The objective of this study was to assess the effects of a medial compartment unloading brace on biomechanical measurements and...

  • Representative Stresses Importance of Communicating Effectiveness of Braces in Treatment of Knee OA. Hoydicz, Jennifer // O&P Business News;10/1/2010, Vol. 19 Issue 12, p17 

    The article offers information on the brace and support industry discussed at the 2010 American Orthotic and Prosthetic Association (AOPA) National Assembly. It discusses the importance of communicating the efficiency of osteoarthritis (OA) braces which were said to be the fastest rising sector...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics