Does knee malalignment predict the efficacy of realignment therapy for patients with knee osteoarthritis?

Abstract

Baseline knee alignment did not predict the efficacy of 12 weeks realignment therapy in participants with medial tibiofemoral OA. [Correction added on 27 August 2015, after first online publication: 'did predict' has been corrected to 'did not predict' in the conclusions of the abstract section.].

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

“…Eight clinical measures, 36 biomechanical measures from unbraced walking, and the moment applied by the brace were analyzed to identify characteristics associated with reductions in medial compartment contact force using valgus unloader bracing as a treatment for knee osteoarthritis. Using stepwise linear regression, it was determined that the braces Brace thought to modify frontal plane alignment 5,30 Medial joint space Brace thought to increase medial joint space 8…”

“…These results support previous findings that static alignment is not related to the effectiveness of bracing. 5 In that study, the long-term effectiveness of bracing was assessed based on changes in WOMAC scores after 12 weeks of bracing and baseline WOMAC scores were the best predictor of bracing success. In the current study, the immediate effect of bracing on medial compartment loading was evaluated and static alignment was again found to play no role.…”

“…Despite the theoretical benefits of unloader braces, results have been highly variable. 4 Some have found positive changes in a variety of outcome measures, including pain and function, [5][6][7] medial joint space, 8 knee adduction moment, 9,10 and in vivo medial compartment loading. 11 Others, however, have found little or no benefit to unloader bracing, 12,13 especially over other conservative treatments such as physiotherapy 14 and these differences have been found regardless of compliance issues.…”

“…13,17 However, it was found that frontal plane alignment is not related to reductions in pain after 12 weeks of bracing. 5 Many brace designs provide a mechanism for modifying the valgus alignment of the brace thereby changing the abduction moment applied. Although increasing the applied moment has been found to decrease the knee adduction moment and medial compartment load, 9,11,18 this does not fully explain the variability in response to bracing; therefore, a need to identify characteristics of good bracing candidates still exists.…”

Methods for evaluating effects of unloader knee braces on joint health: a review

“…The authors found that a positive relationship existed between brace wear usage and activity level, and improvements in WOMAC pain, stiffness, and function. Rezaeian et al [41] studied the unloading effect of a valgus brace by comparing the patients' pain and function from WOMAC scores with the alignment angle and reported that the WOMAC scores (pain and function) were better biomarkers than the alignment angle. Kirane et al (2010) used KOOS scores to study the effectiveness of the unloader brace on knee pain, structure, and function in medial various knee OA and observed a significant reduction in knee pain and functional improvement [11][12][13].…”