Realignment treatment for medial tibiofemoral osteoarthritis: randomised trial

Hunter, David J.; Gross, K.D.; McCree, Paula; Li, Ling; Hirko, Kelly A.; Harvey, William F.

doi:10.1136/annrheumdis-2011-200728

Cited by 35 publications

(43 citation statements)

References 46 publications

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“…Data from 445 patients that met the American College of Rheu- (42,43,46). Two studies (n ϭ 191 subjects) compared a valgus knee brace group and a control group that did not use an orthosis (41,44).…”

Section: Resultsmentioning

confidence: 99%

“…Two studies (n ϭ 191 subjects) compared a valgus knee brace group and a control group that did not use an orthosis (41,44). Five studies (n ϭ 295 subjects) compared a valgus knee brace group and a control group that used a control orthosis (neutral knee brace, neoprene knee sleeve, or shoe insert) (41)(42)(43)45,46). One study had 3 treatment groups and was included in both of the additional analyses (41).…”

Section: Resultsmentioning

confidence: 99%

“…The consensus ratings are reported in the online supplement (see Supplementary Appendix B, available in the online version of this article at http:// onlinelibrary.wiley.com/doi/10.1002/acr.22472/abstract). One study had low risk of bias in all categories (46). No studies were excluded from the meta-analysis based on quality.…”

Section: Resultsmentioning

confidence: 99%

“…Instructions varied widely and included wearing the brace all day (40), only during activity (41)(42)(43), as needed (45), or a minimum of 4 hours per day (46). One article indicated that a technician or therapist fit the brace and gave patients donning and doffing instructions, but did not specify type or frequency of use (44).…”

Section: Resultsmentioning

confidence: 99%

“…use at the longest followup period, ranging from 45-58% and 71-100% of patients, respectively (39,(42)(43)(44)(45)(46). Three articles reported complications experienced by patients (44 -46).…”

Section: Resultsmentioning

confidence: 99%

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Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

Moyer

Birmingham

Bryant

et al. 2015

Arthritis Care & Research

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Objective. To evaluate the effects of valgus knee bracing on pain and function, and compliance and complications, in patients with medial knee osteoarthritis (OA). Methods. A meta-analysis of randomized controlled trials that compared changes in patient-reported pain and/or function in patients with medial knee OA was performed. Seven databases were searched from their inception to January 2014. Two reviewers independently determined study eligibility, rated risk of bias, and extracted data. Pooled estimates and 95% confidence intervals (95% CIs) for standardized mean differences (SMDs) for the improvement in pain (and function) were calculated. Event rates (proportions) were calculated for studies that reported complications.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

Moyer

Birmingham

Bryant

et al. 2015

Arthritis Care & Research

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Braces and orthoses for treating osteoarthritis of the knee

Duivenvoorden

Brouwer

Raaij

et al. 2015

Cochrane Database of Systematic Reviews

130

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Evidence was inconclusive for the benefits of bracing for pain, stiffness, function and quality of life in the treatment of patients with medial compartment knee OA. On the basis of one laterally wedged insole versus no treatment study, we conclude that evidence of an effect on pain in patients with varus knee OA is lacking. Moderate-quality evidence shows lack of an effect on improvement in pain, stiffness and function between patients treated with a laterally wedged insole and those treated with a neutral insole. Low-quality evidence shows lack of an effect on improvement in pain, stiffness and function between patients treated with a valgus knee brace and those treated with a laterally wedged insole. The optimal choice for an orthosis remains unclear, and long-term implications are lacking.

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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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Realignment treatment for medial tibiofemoral osteoarthritis: randomised trial

Abstract: Multi-modal realignment treatment decreases pain in persons with medial tibiofemoral OA.

Cited by 35 publications

References 46 publications

Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

Braces and orthoses for treating osteoarthritis of the knee

Effect of a Realigning Brace on Tibiofemoral Contact Stress

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