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.

doi:10.2106/jbjs.e.00482

Cited by 19 publications

(34 citation statements)

References 32 publications

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“…20,54,64 Komistek et al 54 reported that off-loading knee braces mediate condylar separation, as evidenced by average changes in condylar separation (1.2 mm) and angle (2.2°) at heel strike. However, among obese patients, a lack of subjective pain relief was noted and found to correlate with the absence of condylar separation.…”

Section: Kinematics and Kineticsmentioning

confidence: 99%

“…However, among obese patients, a lack of subjective pain relief was noted and found to correlate with the absence of condylar separation. Nadaud et al 64 measured changes in condylar separation, comparing 5 brace designs. Based on 3-dimensional knee models derived from computed tomographic scans that were overlaid onto fluoroscopic images, comparative analysis revealed that 4 of 5 patients achieved some degree of unloading, whereas 1 experienced no benefit from any of the braces.…”

Section: Kinematics and Kineticsmentioning

confidence: 99%

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Unloader Braces for Medial Compartment Knee Osteoarthritis: Implications on Mediating Progression

Ramsey

Russell

2009

Sports Health

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Background:For persons with unicompartment knee osteoarthritis (OA), off-unloader braces are a mechanical intervention designed to reduce pain, improve physical function, and possibly slow disease progression. Pain relief is thought to be mediated by distracting the involved compartment via external varus or valgus forces applied to the knee. In so doing, tibiofemoral alignment is improved, and load is shifted off the degenerative compartment, where exposure to potentially damaging and provocative mechanical stresses are reduced.Objectives:To provide a synopsis of the evidence documented in the scientific literature concerning the efficacy of off-loader knee braces for improving symptomatology associated with painful disabling medial compartment knee OA.Search Strategy:Relevant peer-reviewed publications were retrieved from a MEDLINE search using the terms with the reference terms osteoarthritis, knee, and braces (per Medical Subject Headings), plus a manual search of bibliographies from original and review articles and appropriate Internet resources.Results:For persons with combined unicompartment knee OA and mild to moderate instability, the strength of recommendation reported by the Osteoarthritis Research Society International in the ability of off-loader knee braces to reduce pain, improve stability, and diminish the risk of falling was 76% (95% confidence interval, 69%-83%). The more evidence the treatment is effective, the higher the percentage.Conclusions:Given the encouraging evidence that off-loader braces are effective in mediating pain relief in conjunction with knee OA and malalignment, bracing should be fully used before joint realignment or replacement surgery is considered. With the number of patients with varus deformities and knee pain predicted to increase as the population ages, a reduction of patient morbidity for this widespread chronic condition in combination with this treatment modality could have a positive impact on health care costs and the economic productivity and quality of life of the affected individuals.

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Section: Kinematics and Kineticsmentioning

confidence: 99%

Section: Kinematics and Kineticsmentioning

confidence: 99%

Unloader Braces for Medial Compartment Knee Osteoarthritis: Implications on Mediating Progression

Ramsey

Russell

2009

Sports Health

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“…But after wearing the brace, the knee joints are stabilized, and the activation of the VMO significantly decreased in both the stance phase and the swing phase. Up until now, the existing studies analyzed the size of the external moment that occurs at the time of use of the off-loading brace by using the 3-D gait analysis system with the patients of degenerative arthritis of the knee as the subject,15,16 or mainly checked the changes in pain following the load decrease of the medial side knee joints by measuring the widening of the space in the medial compartment of knee joints using fluoroscopy 12,28. However, this study analyzed the changes of the activity of the muscles around the femoral region after using the off-loading knee brace with normal people as the subject, and it is thought that in the state where the knee joint load is large and unstable, the brace significantly decreased the activation of the VMO.…”

Section: Discussionmentioning

confidence: 99%

Effects of the Off-Loading Brace on the Activation of Femoral Muscles -A Preliminary Study-

et al. 2011

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ObjectiveTo provide the off-loading knee brace was designed relief for the pain associated with osteoarthritis by reduce loads on the degenerative compartment of the knee. This study examined the effects of the off-loading knee brace on activation of femoral muscles during squatting, slow and fast walking exercise in healthy young individuals.MethodTen healthy male subjects without a history of knee pain were recruited. Each subject was asked to do squatting, slow and fast walking exercises with a brace secured to the dominant leg. The same exercises were repeated without the brace. Surface electromyographic (sEMG) data was collected from the vastus medialis oblique (VMO), vastus lateralis (VL) and biceps femoris (BF) muscles from the dominant side of the leg. All dynamic root mean squre (RMS) values of sEMG were standardized to static RMS values of the maximal isometric contraction and expressed as a percentage of maximal activity.ResultsWe found that VMO activity was significantly decreased with application of the off-loading knee brace during squatting and fast walking exercise. However there were no significant differences in VMO activity with application of the off-loading knee brace during slow walking exercise.ConclusionThese results suggest that the external moment of the brace which effectively stabilized the patella in the movement in which the knee joints become relatively unstable. The brace could be useful in the short term, but for long-term use, weakening of the VMO is predicted. Therefore the program of selective muscular strength strengthening for the VMO should be emphasized.

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“…Both braces improved confidence and function during gait [30 ]. In a three-dimensional determination of the effectiveness of five different braces, all braces were most effective at off-loading the knee at heel strike and least effective at midstance [31 ]. Four of five patients achieved at least some off-loading on the medial condyle, while one patient did not experience any benefit from the five different braces at all.…”

Section: Unloading By Footwear and Bracingmentioning

confidence: 93%

Unloading joints to treat osteoarthritis, including joint distraction

Lafeber

Intema

Roermund

et al. 2006

Current Opinion in Rheumatology

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To improve patient function and possibly reduce disease progression, a biomechanical approach should be considered in treating patients with osteoarthritis. Further research (appropriate high-quality clinical trials) and analysis (clinical as well as preclinical and fundamental) are still necessary, however, to understand, validate, and refine the different approaches of unloading to treat osteoarthritis.

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In Vivo Three-Dimensional Determination of the Effectiveness of the Osteoarthritic Knee Brace: A Multiple Brace Analysis

Cited by 19 publications

References 32 publications

Unloader Braces for Medial Compartment Knee Osteoarthritis: Implications on Mediating Progression

Unloader Braces for Medial Compartment Knee Osteoarthritis: Implications on Mediating Progression

Effects of the Off-Loading Brace on the Activation of Femoral Muscles -A Preliminary Study-

Unloading joints to treat osteoarthritis, including joint distraction

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