Do laterally wedged insoles and valgus knee braces really unload the medial compartment of the knee? results of a RCT

Duivenvoorden, Tijs; Raaij, Tom van; Horemans, Herwin; Brouwer, Reinoud W; Bos, Koen; Zeinstra, S. Bierma; Verhaar, J.A.; Reijman, Max

doi:10.1016/j.joca.2014.02.864

Cited by 3 publications

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“…As the shape and strap tension of the brace used in our study were set for maximal coronal torque, the maximal biomechanical effect of this brace was assessed. While the lack of detection of a biomechanical effect was consistent with the results of a recent study , this finding differed from the results of another study, in which the ratio of lateral to medial bone mineral density was reportedly increased with the use of a similar valgus brace, suggesting a shift in load from the medial to the lateral bone . Those findings support the possibility that realignment bracing may have potential to alter the mediolateral distribution of tibiofemoral loading, although possibly not with the brace or in the subjects in our study.…”

Section: Discussionsupporting

confidence: 84%

Effect of a Realigning Brace on Tibiofemoral Contact Stress

Segal

Stockman

Findlay

et al. 2015

Arthritis Care & Research

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Objective. To determine the degree to which focally elevated tibiofemoral joint contact stress is reduced by using a frontal plane realigning brace. Methods. Fifteen volunteers (9 women) with unicompartmental tibiofemoral osteoarthritis underwent weight-bearing radiographic imaging at 15-208 and 5-108 of knee flexion with and without an UnloaderOne knee brace. Discrete element analysis was used to estimate compartment-specific contact stress distributions. Paired t-tests were used to assess the differences in mean contact stress and contact stress distributions, comparing the braced and unbraced conditions. Results. The mean 6 SD age was 56.1 6 6.4 years and body mass index was 28.4 6 4.5 kg/m 2 . Twelve of 15 participants were fit with braces set to unload the medial compartment. For the 15-208 condition, the mean contact stress in the compartment of interest did not significantly change (0.08 6 0.35 MPa; P 5 0.410). Also at 5-108 flexion, the mean contact stress in the compartment of interest did not significantly change with use of the brace (0.24 6 0.45 MPa; P 5 0.175). Conclusion. This is the first study of the effects of a frontal plane realignment brace on in vivo articular contact stress in native human knees. Using the off-the-shelf brace tested, there were no changes in compartmental tibiofemoral contact stress distributions at either 15-208 or 5-108 of knee flexion, revealing no redistribution of contact stress away from the compartment of interest. These findings indicate that the brace that was studied was ineffective for redistributing tibiofemoral contact stress. Further research is necessary to determine whether double-upright or customized frontal plane braces are effective in redistributing compartmental articular contact stress.

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