Application of an Unloader Knee Brace in the Treatment of Osteoarthritis
ABSTRACT
Background: Osteoarthritis (OA) is a debilitating condition that affects a large and diverse cross-section of American society. Historically, treatments for OA have focused on providing symptomatic relief and improving ability to complete activities of daily living (ADLs). These treatments range from NSAID use and physical therapy, to total knee arthroplasty, an invasive and expensive procedure. Although firm data is lacking, many OA patients report subjective symptomatic improvement in symptoms by wearing a knee brace on the affected joint. Recently, several manufacturers have developed a new knee brace designed to reposition the knee in such a way as to “unload” the medial compartment. For patients with OA of the medial compartment, can an unloader knee brace reduce pain and improve function?
Methods: An exhaustive search using MEDLINE-Ovid, Web of Science, and Google Scholar was performed using keywords: brace, osteoarthritis, knee, unload, and unloader. These were screened with eligibility criteria. The resulting studies were then appraised and assessed for quality with GRADE.
Results: Current clinical trials were found to include two studies relating to the use of an unloader knee brace to treat OA. One open-label prospective study of 20 patients with symptomatic medial knee OA showed that 76% of patients were able to achieve a reduction in pain and improvement in function in activities of daily living (ADLs) at 1 year using the PROTEOR unloader brace. A second prospective cohort study examined the effects of the Bespoke unloader Knee Brace for 7 patients with knee OA. This study demonstrated that through the use of the Bespoke unloader knee brace patients found their external knee adduction moment was significantly reduced, speed of walking significantly increased, knee ROM was reduced, and an increase in step length was also observed. However, this study used evidence from prior research to infer that their results should equate to improvements in pain and improved ADLs.
Conclusion: Unloader knee braces are a viable treatment option for patients with OA of the medial compartment of the knee. Better studies are needed to confirm if this treatment option will provide long-term relief. Although strong data is still lacking to confirm the complete success of this treatment, it is low risk and low cost. Therefore, it is recommended that they be used in clinical practice for patients with knee OA refractory to acetaminophen and NSAIDs.
Keywords: Brace, osteoarthritis, and unloader knee brace.
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REVIEWED STUDIES:
Ornetti et al. Clinical Effectiveness and Safety of a Distraction-Rotation Knee Brace for Medial Knee Osteoarthritis. Annals of Physical and Rehabilitation Medicine. Vol. 58(3)126-131 doi:10.1016/j.rehab.2015.03.004.
Arazpour et al. The influence of a bespoke unloader knee brace on gait in medial compartment osteoarthritis: A pilot study. Prosthetics and Orthotics International 2014, Vol. 38(5) 379–386. DOI: 10.1177/0309364613504780.
AUTHOR: Alexander J. Friedman is currently completing his second year in the School of PA Studies at Pacific University, Oregon. He will graduate with an MS in Physician Assistant Studies in August, 2016.