Scientific Articles   |    
The Effectiveness of Self-Adjustable Custom and Off-the-Shelf Bracing in the Treatment of Varus Gonarthrosis
Louis Draganich, PhD1; Bruce Reider, MD1; Todd Rimington, BA1; Gary Piotrowski, BS1; Krishna Mallik, MD2; Scott Nasson, MD3
1 Section of Orthopaedic Surgery and Rehabilitation Medicine, Department of Surgery (L.D., B.R., and G.P.) and Pritzker School of Medicine (T.R.), The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637. E-mail address for L. Draganich: ldragani@surgery.bsd.uchicago.edu
2 Department of Orthopaedic Surgery, Medical College of Ohio, Dowling Hall, Room 2401, 3065 Arlington Avenue, Toledo, OH 43614-5807
3 Department of Orthopaedic Surgery, National Naval Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889
View Disclosures and Other Information
In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from dj Orthopedics, Inc., Vista, California. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Motion Analysis Laboratory, Section of Orthopaedic Surgery and Rehabilitation Medicine, Department of Surgery, The University of Chicago, Chicago, Illinois

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Dec 01;88(12):2645-2652. doi: 10.2106/JBJS.D.02787
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


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.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Results provided by:
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    OH - University Hospitals Case Medical Center
    VA - OrthoVirginia
    NY - Modern Chiropractic Care, P.C.