Beneficial effects of a brace for patellofemoral OA: results of a randomised trial

Abstract

OA who progressed to total knee arthroplasty (TKA) and those that did not. Methods: 50 patients with moderate medial compartment knee OA underwent gait analysis at baseline. Ground reaction forces (sampled at 1000 Hz) and segment motions (sampled at 100 Hz) were recorded during self-selected walking. Three-dimensional knee angles and moments were calculated using inverse dynamics. All waveforms were time-normalized to percent of gait cycle, and moment waveforms were amplitude-normalized to body mass. Amplitude and temporal waveform characteristics were determined using Principal Component Analysis (PCA) for each waveform separately (6 in total). During follow up phone interviews 5-8 years later, 25 patients reported undergoing TKA surgery. Unpaired Student's t-tests were used to test for differences in all baseline demographic and waveform characteristics (PC scores) between the group that had TKA and the group that did not (a¼0.05). Results: There were no between-group differences in age (59 years in TKA group vs. 57 years in no-TKA group), mass (93.5 kg vs. 93.8 kg), body mass index (30.6 kg/m2 vs. 30.8 kg/m2), and gait speed (1.23 m/s vs. 1.27 m/s), with similar radiographic disease severity (Kellgren-Lawrence score) distribution at baseline. The mean time between baseline and follow up was 7.8 yrs for each group. The group that progressed to TKA had a significantly higher overall magnitude of the KAM (Fig 1, PC1, p < 0.05), less of a difference between the first peak KAM and the mid-stance KAM (Fig 1, PC2, p < 0.05), more tibial external rotation during mid-stance (PC4, p<0.05), and a trend toward reduced early stance knee flexion and late stance knee extension moments (PC2, p¼0.073) than the no-TKA group at baseline. Conclusions: The KAM findings suggest that the group that went on to TKA had higher overall medial compartment loading throughout the gait cycle at baseline (PC1), and a reduced ability to unload the medial compartment during mid-stance (PC2). These results support a cumulative rather than an impulse loading mechanism for progression. Furthermore, increased tibial external rotation (PC4) and a trend toward altered sagittal plane moment characteristics (PC2) were found in those that progressed. Together these findings indicate that dynamic frontal, transverse, and sagittal plane mechanical features are related to knee OA progression and should be considered in future prediction models of progression.

One-Year Results of Bracing for Patello-Femoral Osteoarthritis. Prospective Randomized Study

“…20 Treating PFOA by bracing reduces pain, bone marrow lesions and improves function at short term. 8,10,11 The purpose of this study was to verify the long-term effects (one year) of the usage of two PF braces that had no significant difference in results at short term. Both braces led to reduced medication consumption in the first month and some stopped taking medication based on the results obtained at the third month follow-up.…”

“…7 Treating PFOA with medially directed tape and braces improves pain and bone marrow lesions. [8][9][10][11][12] The use of a brace to stabilize the knee with medial, lateral, superior and inferior compression bands also improved pain not differently from a sleeve with patella hole. 11 The aim of this study is to verify the long-term effects of these two braces 11 in pain and function of patients with PFOA.…”

“…Treating PFOA with medially directed tape and braces improves pain and bone marrow lesions. 8 ), ( 9 ), ( 10 ), ( 11 ), ( 12 The use of a brace to stabilize the knee with medial, lateral, superior and inferior compression bands also improved pain not differently from a sleeve with patella hole. 11 …”

Effectiveness of knee bracing in osteoarthritis: pragmatic trial in a multidisciplinary clinic

“…Their primary outcome measure was pain experienced during subjects' nominated aggravating activities on a 100‐mm VAS scale, including stair ascent or decent, squatting or slope walking. They were able to demonstrate a significant beneficial effect of a patellofemoral brace on pain …”

“…Treatments for patellofemoral OA involve realignment of the patella within the trochlear groove. While previous studies have demonstrated short‐term pain reduction with patellar taping, there are very few trials looking at the efficacy of patellofemoral bracing . Hunter et al .…”