Unloading knee braces in the management of knee osteoarthritis : a literature review.
Mr Brice LAVRARDa
a Hopital Sébastopol, CHU Reims
Introduction. Osteoarthritis is the eleventh cause of years lived with disability. The non-pharmacological care management of knee osteoarthritis is of major importance according to the international published recommendations (OARSI, EULAR); unloading knee braces are functional devices designed to decrease load across the knee.
Methods. We performed a literature review from Medline data base until September 2014. Papers in English and in French have been selected and analyzed if they studied clinical and biomechanical effects of unloading knee braces. The key terms included: "osteoarthritis, knee osteoarthritis, braces, knee braces". The references mentioned in these papers have been screened.
Results. 24 studies have been selected, two of them were randomized controlled clinical trials, with a total number of patients of 665 (mean age 57.5y, 177 women). GII Unloader® Knee Brace was the most used (10/24). 17 trials investigated the effects on pain, function and disability. VAS-pain and WOMAC were significantly improved. Walking speed increase has been reported in two studies. Effects on proprioception seemed to be positive and two studies reported a decrease of muscular co-contraction. Seven trials showed a decrease of the external knee adduction moment. A decrease of varus angulation and an increase of condylar separation have been reported. We noticed a poor compliance due to the large volume of the brace and just one case of deep venous thrombosis has been shown.
Discussion/Conclusion. Few studies were controlled and randomized, and methodological quality was weak in lot of them. Biomechanical effects of the unloading knee braces remain unclear. It would be interesting to evaluate their effect on the osteoarthritis disease progression.