Comparison of three knee braces in the treatment of medial knee osteoarthritis

Background: Conservative orthotic treatments rely on different mechanisms, such as three-point bending systems or hinges forcing external rotation of the leg and knee stabilization, to alter the biomechanics of the lower limbs and thus reduce knee loading on the affected compartment in patients with knee osteoarthritis (KOA). No previous study had compared the effects of these mechanisms on external loading and leg kinematics in patients with KOA. Methods: Twenty-four patients with medial KOA (Kellgren-Lawrence grade II or III) wore three custom knee braces: a valgus brace with a three-point bending system (V3P-brace), an unloader brace with valgus and external rotation functions (VER-brace) and a functional knee brace used in ligament injuries (ACL-brace). Pain relief, comfort, lower extremity kinematics and kinetics during walking were compared with and without each knee brace. Results: Knee pain was alleviated with all three braces (p < 0.01). The VER- and ACL-braces allowed a significant reduction in peak knee adduction moment (KAM) during terminal stance from 0.313 to 0.280 Nm/Bw*Ht (p < 0.001) and 0.293 to 0.268 (p < 0.05), respectively, while no significant reduction was observed with the V3P-brace (p = 0.52). Reduced knee adduction and lower ankle and knee external rotation were observed with the V3P-brace but not with the VER-brace. The ACL-brace did not modify lower limb kinematics. Conclusions: No difference between the knee braces was found for pain reduction, discomfort or KAM. The VER-brace was slightly more comfortable, which could ensure better compliance with treatment over the long term. (C) 2014 Elsevier B.V. All rights reserved.