1
|
Dzidotor GK, Moorhead JB, Ude CC, Ogueri KS, Ghosh D, Laurencin CT. Functions and Effectiveness of Unloader, Patellofemoral, and Knee Sleeve Orthoses: A Review. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2024; 10:147-171. [PMID: 38983777 PMCID: PMC11233114 DOI: 10.1007/s40883-023-00313-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/18/2023] [Accepted: 07/06/2023] [Indexed: 07/11/2024]
Abstract
Background Knee orthoses have been extensively used as a nonsurgical approach to improving knee deficiencies. Currently, arthritic knee conditions remain the leading cause of disability, and this number is expected to increase. As the use of knee orthoses varies widely, so has their effectiveness which is still largely debatable. Here, we present the functions and effectiveness of the three most prominent knee orthotic models dedicated to supporting knee osteoarthritis-unloader, patellofemoral, and knee sleeves. Purpose/Research Question Considering the depth and diversity of the many clinical studies and documented laboratory reports published to date, this literature review was created to educate the clinician, patient, and researcher on common knee orthoses used for the management of arthritic knee conditions. In doing so, we discuss their design, biomechanical effects, and clinical efficacy, as well as broader outcomes, limitations, and recommendations for use. Results/Synthesis The knee orthoses discussed within the scope of this paper are dedicated to protecting the knee against strenuous compressive loads that may affect the patellofemoral and tibiofemoral joints of the knee. Since the knee has multiple axes of motion and articulating surfaces that experience different loads during functional activities, it can be implied that, to a large extent, knee brace designs can differ drastically. Unloader knee orthoses are designed to decrease tibiofemoral and patellofemoral joint pressures. Patellofemoral knee orthoses are designed to decrease strain on the patellofemoral and quadriceps tendons while stabilizing the patella. Knee sleeves are designed to stabilize movements, reduce pain in joints, and improve proprioception across the knee joint. Conclusion Although patients often report benefits from wearing braces, these benefits have not been confirmed by clinicians and scientific investigators. Results from these three orthosis types show that clinical efficacy is still elusive due to the different methodologies used by researchers. Layman Summary Knee orthoses also referred to as knee brace are commonly used for support and stability of the knee. Unloader knee braces are designed to relieve and support those suffering from knee osteoarthritis by improving physical impairment and reducing pain. Patellofemoral knee braces aim to help patients manage patellofemoral pain syndrome. Rehabilitative compression sleeves, also known as knee sleeves, are often used to assist patients suffering from knee pain and laxity. Important findings on the three knee braces discussed show discrepancies in results. Their effectiveness and validity are yet to be understood.
Collapse
Affiliation(s)
- Godwin K. Dzidotor
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
- Department of Chemical and Biomolecular Engineering, University of Connecticut, Mansfield Rd, Storrs, CT, USA
| | - Jeffrey B. Moorhead
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
| | - Chinedu C. Ude
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
- Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA
| | - Kenneth S. Ogueri
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
- Institute of Materials Science, University of Connecticut, Mansfield Rd, Storrs, CT, USA
- Department of Materials Science and Engineering, University of Connecticut, Mansfield Rd, Storrs, CT, USA
| | - Debolina Ghosh
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
| | - Cato T. Laurencin
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
- Department of Chemical and Biomolecular Engineering, University of Connecticut, Mansfield Rd, Storrs, CT, USA
- Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA
- Institute of Materials Science, University of Connecticut, Mansfield Rd, Storrs, CT, USA
- Department of Materials Science and Engineering, University of Connecticut, Mansfield Rd, Storrs, CT, USA
- Department of Biomedical Engineering, University of Connecticut, Mansfield Rd, Storrs, CT, USA
- Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT, USA
| |
Collapse
|
2
|
Imboden M, Séguin É, Doumit M. Design and evaluation of an offloading orthosis for medial knee osteoarthritis. Med Eng Phys 2023; 121:104063. [PMID: 37985029 DOI: 10.1016/j.medengphy.2023.104063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023]
Abstract
Knee osteoarthritis is an incurable degenerative joint disease that affects millions of people. Characterized by stiffness and knee pain in the early stages, it can cause loss of function and mobility. Most treatment options are either not sustainable, invasive, or costly. Alternatively, offloading knee orthoses are a cost-effective option that provides immediate pain relief when worn. Offloading knee orthoses, however, have low patient compliance rates. To improve patient compliance and optimize patient benefit, current orthosis designs must be enhanced to improve comfort, increase the perceived effect, and be adjustable to the patient. Consequently, this research presents the design, fabrication, and testing of a new offloading knee orthosis joint. The novel modular orthosis features an offloading mechanism intended to relieve the load on the joint solely during stance phase and reduce the moment during swing phase when offloading is not needed. Three-point bending tests of the experimental prototype demonstrated an offloading moment of 3.36 Nm, creating a noticeable offloading effect during stance, and reduced the moment to less than 0.5 Nm after 35° of knee flexion, thus, potentially increasing comfort during swing phase and sitting when offloading forces are not needed.
Collapse
Affiliation(s)
- Madeleine Imboden
- Department of Mechanical Engineering, University of Ottawa, 161 Louis-Pasteur, Colonel By Hall, Ottawa, ON, K1N 6N5, Canada
| | - Émélie Séguin
- Department of Mechanical Engineering, University of Ottawa, 161 Louis-Pasteur, Colonel By Hall, Ottawa, ON, K1N 6N5, Canada.
| | - Marc Doumit
- Department of Mechanical Engineering, University of Ottawa, 161 Louis-Pasteur, Colonel By Hall, Ottawa, ON, K1N 6N5, Canada
| |
Collapse
|
3
|
Bishop EL, Kuntze G, Clark ML, Ronsky JL. Tricompartment offloader knee brace reduces sagittal plane knee moments, quadriceps muscle activity, and pain during chair rise and lower in individuals with knee osteoarthritis. Med Eng Phys 2023; 114:103975. [PMID: 37030895 DOI: 10.1016/j.medengphy.2023.103975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 02/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
The Levitation tricompartment offloader (TCO) knee brace provides an assistive knee extension moment with the goal of unloading all three compartments of the knee and reducing pain for individuals with multicompartment knee osteoarthritis (OA). This study aimed to determine the effect of the TCO brace on sagittal plane knee moments, quadriceps muscle activity, and pain in individuals with multicompartment knee OA. Lower limb kinematics, kinetics, and electromyography data were collected during a chair rise and lower to determine differences between bracing conditions. TCO brace use significantly decreased the peak net knee external flexion moment in high power mode, providing extension assistance during chair rise [p<0.001; mean difference (MD) (98.75% CI) -0.8 (-1.0, -0.6)%BWxH] and bodyweight support during chair lower [p<0.001; -1.1 (-1.6, -0.7)%BWxH]. Quadriceps activation intensity was significantly reduced with brace use by up to 67% for the vastus medialis [Z = -2.55, p = 0.008] and up to 39% for the vastus lateralis [Z = -2.67, p = 0.004]. Participants reported significantly reduced knee pain with the TCO brace worn in high power mode compared to the no brace condition [p = 0.014; MD (97.5% CI) -18.8 (-32.22, -2.34) mm]. These results support the intended mechanism of joint unloading via extension assistance with the TCO brace. The observed biomechanical changes were accompanied by immediate reductions in user reported pain levels, and support the use of the TCO for conservative management to reduce knee pain in patients with multicompartment knee OA.
Collapse
Affiliation(s)
- Emily L Bishop
- Department of Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.
| | - Gregor Kuntze
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada; Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Marcia L Clark
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Janet L Ronsky
- Department of Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
4
|
Osteoarthritis year in review 2021: mechanics. Osteoarthritis Cartilage 2022; 30:663-670. [PMID: 35081453 DOI: 10.1016/j.joca.2021.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/09/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) has a complex, heterogeneous and only partly understood etiology. There is a definite role of joint cartilage pathomechanics in originating and progressing of the disease. Although it is still not identified precisely enough to design or select targeted treatments, the progress of this year's research demonstrates that this goal became much closer. On multiple scales - tissue, joint and whole body - an increasing number of studies were done, with impressive results. (1) Technology based instrument innovations, especially when combined with machine learning models, have broadened the applicability of biomechanics. (2) Combinations with imaging make biomechanics much more precise & personalized. (3) The combination of Musculoskeletal & Finite Element Models yield valid personalized cartilage loads. (4) Mechanical outcomes are becoming increasingly meaningful to inform and evaluate treatments, including predictive power from biomechanical models. Since most recent advancements in the field of biomechanics in OA are at the level of a proof op principle, future research should not only continue on this successful path of innovation, but also aim to develop clinical workflows that would facilitate including precision biomechanics in large scale studies. Eventually this will yield clinical tools for decision making and a rationale for new therapies in OA.
Collapse
|
5
|
Preliminary Evaluation of a New Orthotic for Patellofemoral and Multicompartment Knee Osteoarthritis. Rehabil Res Pract 2021; 2021:5923721. [PMID: 34540291 PMCID: PMC8441257 DOI: 10.1155/2021/5923721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/20/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose Traditional knee osteoarthritis (OA) braces are usually indicated for a minority of patients with knee OA, as they are only suitable for those with unicompartmental disease affecting the tibiofemoral joint. A new assistive brace design is intended for use in a wider range of knee OA patients with heterogeneous symptoms characteristic of patellofemoral, tibiofemoral, or multicompartmental knee OA. The purpose of this case series was to explore whether the use of this novel “tricompartment offloader” (TCO) brace was associated with clinically relevant improvements in pain and function. Materials and Methods A retrospective analysis of individuals with knee OA (n = 40) was conducted to assess pain, function, physical activity, and use of medication and other treatments before and after brace use. Validated outcome measures including the Visual Analog Scale (VAS) and Lower Extremity Functional Scale (LEFS) were used to assess pain and physical function (primary outcome measures). Exploratory measures were used to quantify physical activity levels and use of medication and other treatments (secondary outcome measures). Results Average total pain (VAS) scores decreased by 36.6 mm and physical function (LEFS) scores increased by 16.0 points following the use of the TCO brace. Overall, 70% of the participants indicated increased weekly physical activity and 60% reported a decrease in their use of at least one other treatment. Conclusions Results from this case series suggest that the TCO brace shows strong potential to fill a conservative treatment gap for patients with heterogeneous symptoms of knee OA that are characteristic of patellofemoral or multicompartment disease. Further investigation is warranted.
Collapse
|