Is there a difference in outcome between two types of valgus unloading braces? A randomized controlled trial
Purpose The short-term clinical and radiographic outcomes of two different valgus unloading braces were compared in patients with medial knee osteoarthritis (OA) and a varus leg alignment.
Methods A RCT was performed in 100 patients (50 Bledsoe Thruster brace, 50 SofTec OA brace) with symptomatic medial knee OA and a varus leg alignment. Outcomes were the visual analogue scale pain and satisfaction, Dutch Western Ontario and McMaster Universities Osteoarthritis Index, SF-12, 6-Minutes Walking Test, hip-knee-ankle alignment, analgesic use, complications and compliance after a follow-up of 2 and 12 weeks.
Results The clinical and radiographic outcomes were not significant different between both groups. Almost all clinical outcomes improved in both groups at follow-up compared to baseline. 24% of the patients discontinued using the brace.
Conclusions No significant differences in clinical and radiographic outcomes were found between both groups after 2 and 12 weeks follow-up. Both braces were effective in the treatment of varus medial knee OA. Complications and compliance remains a problem.
Briggs KK, Matheny LM, Steadman JR. Improvement in quality of life with use of an unloader knee brace in active patients with OA: a prospective cohort study. J Knee Surg 2012;25:417-422.
Brouwer RW, van Raaij TM, Verhaar JA, Coene LN, Bierma-Zeinstra SM. Brace treatment for osteoarthritis of the knee: a prospective randomized multi-centre trial. Osteoarthritis Cartilage 2006;14(8):777-783.
Chew KT, Lew HL, Date E, Fredericson M. Current evidence and clinical applications of therapeutic knee braces. Am J Phys Med Rehabil 2007;86(8):678-686.
Dessery Y, Belzile EL, Turmel S, Corbeil P. Comparison of three knee braces in the treatment of medial knee osteoarthritis. Knee 2014;21:1107-1114.
Dugdale TW, Noyes FR, Styer D. Preoperative Planning for High Tibial Osteotomy. Clin Orthop Relat Res 1992;1274:248-264.
Duivenvoorden T, Brouwer RW, van Raaij TM, Verhagen AP, Verhaar JA, Bierma-Zeinstra. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database Syst Rev 2015;16(3)CD004020.
Gaasbeek RD, Groen BE, Hampsink B, van Heerwaarden RJ, Duysens J. Valgus bracing in patients with medial compartment osteoarthritis of the knee. A gait analysis study of a new brace. Gait Poisture 2007;26(1):3-10.
Giori NJ. Load-shifting brace treatment for osteoarthritis of the knee: a minimum 2 1/2-year follow-up study. J Rehabil Res Dev 2004;41(2):187-194.
Haladik JA, Vasileff WK, Peltz CD, Lock TR, Bey MJ. Bracing improves clinical outcomes but does not affect the medial knee joint space in osteoarthritic patients during gait. Knee Surg Sports Trauma Arthrosc 2014;22(11):2715-2720.
Hewett TE, Noyes FR, Barber-Westin SD, Heckmann TP. Decrease in knee joint pain and increase in function in patients with medial compartment arthrosis: a prospective analysis of valgus bracing. Orthopedics 1998;21(2):131-138.
Horlick SG, Loomer RL. Valgus knee bracing for medial gonarthrosis. Clinical Journal of Sports Medicine 1993;3(4):251-255.
Hunter D, Gross KD, McCree P, Li L, Hirko K, Harvey WF. Realignment treatment for medial tibiofemoral osteoarthritis: randomised trial. Ann Rheum Dis 2012;71:1658-1665.
Hurley ST, Harfield Murdock GL, Stanish WD, Hubley-Kozey CL. Is there a dose response for valgus unloader brace usage on knee pain, function, and muscle strength? Arch Phys Med Rehabil 2012;93:496-502.
Iorio R, Healy WL. Unicompartmental arthritis of the knee. J Bone Joint Surg Am 2003;85:1351-1364.
Johnson AJ, Starr R, Kapadia BH, Bhave A. Gait and clinical improvements with a novel knee brace for knee OA. J Knee Surg 2013;26:173-178.
Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957;16: 494-502.
Komistik RD, Dennis DA, Northcut EJ, Wood A, Parker AW, Traina SM. An in vivo analysis of the effectiveness of the osteoarthritic knee brace during heel-strike of gait. J Arthroplasty 1999;14(6):738-742.
Larsen BL, Jacofsky MC, Brown JA, Jacofsky DJ. Valgus bracing affords short-term treatment solution across walking and sit-to-stand activities. J Arthroplasty 2013;28:792-797.
Moyer RF, Birmingham TB, Bryant DM, Giffin JR, Marriot KA, Leitch KM. Biomechanical effects of valgus knee bracing: a systematic review and meta-analysis. Osteoartritis cartilage 2015;23:178-188.
Moyer RF, Birmingham TB, Bryant DM, Giffin JR, Marriott KA, Leitch KM. Valgus bracing for knee osteoarthritis: a meta-analysis of randomized trials. Arthritis Care Res 2015;67(4):493-501.
Nadaud MC, Komistek RD, Mahfouz MR, Dennis DA, Anderle MR. In vivo three-dimensional determination of the effectiveness of the osteoarthritic knee brace: a multiple brace analysis. J Bone Joint Surg Am 2005;87(Suppl 2):114-119.
Pollo FE, Jackson RW. Knee bracing for unicompartmental osteoarthritis. J Am Acad Orthop Surg 2006;14(1):5-11.
Ramsey DK, Russell ME. Unloader braces for medial compartment knee osteoarthritis: implications on mediating progression. Sports Health 2009;1(5):416-426.
Rannou F, Poiraudeau S, Beaudreuil J. Role of bracing in the management of knee osteoarthritis. Curr Opin Rheumatol 2010;22:218-222.
Roorda LD, Jones CA, Waltz M, Lankhorst GJ, Bouter LM, Van der Eijken JW et al. Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty. Ann Rheum Dis 2004;63:36–42.
Sattari S, Ashrai AR. Comparison the effect of 3 point valgus stress knee support and lateral wedge insoles in medial compartment knee osteoarthritis. Iran Red Crescent Med J 2011;13(9):624-8.
Segal L, Day SE, Chapman AB, Osborne RH. Can we reduce disease burden from osteoarthritis? Med J Aust 2004;180:S11-7.
Self BP, Greenwald RM, Pflaster DS. A biomechanical analysis of a medial unloading brace for osteoarthritis in the knee. Arthritis Care Res 2000;13(4):191-7.
Sharma L, Sonf J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The Role of Knee Alignment in Disease Progression and Functional Decline in Knee Osteoarthritis JAMA 2001;11;286(2):188-195.
Shelburne KB, Torry MR, Steadman JR, Pandy MG. Effects of foot orthoses and valgus bracing on the knee adduction moment and medial joint load during gait. Clin Biomech 2008;23(6):814-21.
Squyer E, Stamper DL, Hamilton DT, Sabin JA, Leopold SS. Unloader knee braces for osteoarthritis: Do patients actually wear them? Clin Orthop Relat Res 2013;471:1982-91.
Van Raaij TM, Reijman M, Brouwer RW, Bierma-Zeinstra SMA, Verhaar JAN. The effect of laterally wedged insoles compared to valgus bracing in the treatment of medial compartmental osteoarthritis of the knee: a prospective randomized trial. Clin Orthop Relat Res 2010;468:1926-32.
Wilson B, Rankin H, Barnes L. Long-term results of an unloader brace in patients with unicompartmental knee osteoarthritis. Orthopedics 2011;34(8):e334-7.
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