Background: A recent development in valgus-producing knee braces has
been the adjustable "unloader" brace. The purpose of this study
was to compare the effectiveness of off-the-shelf and custom-made
patient-adjustable, valgus-producing knee unloader braces in relieving pain,
reducing stiffness, and improving function and in reducing varus angulation
and the peak adduction moments about the knee during gait and stair-stepping
in patients with painful varus gonarthrosis of the knee.
Methods: Ten adult patients served as their own controls for the
measurement of baseline values and then wore each of the two braces, one after
the other, for four to five weeks in a random order. Pain, stiffness, and
function were assessed with the Western Ontario and McMaster Universities
Osteoarthritis Index. Gait and stair-stepping were evaluated with a
three-dimensional motion analysis system and multicomponent force platform.
Full-length (hip, knee, and ankle) standing anteroposterior radiographs were
used to determine alignment of the knee.
Results: Both braces significantly reduced pain and stiffness (p
< 0.05), with the custom brace reducing stiffness significantly more than
the off-the-shelf brace (p = 0.030). The custom brace significantly improved
function (p = 0.010) and reduced the peak knee adduction moments during gait
(p = 0.033) and stair-stepping (p = 0.002) compared with baseline values and
compared with the off-the-shelf brace (p = 0.029 and p = 0.027, respectively).
The custom brace significantly reduced varus angulation of the knee by
1.5° compared with baseline (p = 0.001) and by 1.3° compared with the
off-the-shelf brace (p = 0.009). The off-the-shelf brace did not significantly
reduce the varus angle.
Conclusions: We investigated only the short-term effects of custom
and off-the-shelf patient-adjustable valgus-producing knee
"unloader" braces and found that patients with varus gonarthrosis
of the knee may benefit significantly with respect to pain relief and reduced
stiffness from use of either brace. However, such patients may experience
additional significant benefit in improved function and reduced stiffness,
varus angulation, and medial compartment loading of the knee from use of the
custom-made patient-adjustable brace.
Level of Evidence: Therapeutic Level II. See Instructions
to Authors for a complete description of levels of evidence.