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

Abstract

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.

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

“…24 The literature review also noted that the use of knee braces is surprisingly low given that they are part of the NICE guidelines for recommended management of knee OA. 24,26 Although previous studies have questioned the effectiveness of knee braces in the treatment of OA, the findings of the current study support their use, particularly in patients with low-grade OA. 8,12…”

Design Evaluation of a Novel Multicompartment Unloader Knee Brace

“…Other unloading braces are typically focused on providing unicompartmental offloading of the TF joint [23][24][25][26][27][32][33][34] without addressing PF compartment loading. An important limitation of unicompartment offloaders is that as the offloading benefit is realized by one side of the TF joint, the opposite TF compartment experiences an increase in loading.…”

“…1(a)) [28]. Unicompartment offloader braces are a cost-effective treatment method that can decrease pain, joint stiffness, and drug dosage, while increasing quality of life [30][31][32][33][34]. Unfortunately, because a low percentage (4%) of patients have unicompartmental TFOA [4], traditional unloader braces are not indicated for most patients with knee OA who are likely to have patellofemoral or multicompartmental disease [4,5].…”

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 the knee joint. An unbalance of weightbearing will somehow change the knee force lines and cause lower limb abnormality, leading to the progress of KOA [10,11]. Theoretically, the valgus knee bracing can optimize the direction of force line in the 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.…”