Introduction
Methods
Search details
Inclusion and exclusion criteria
Analysis
References | Number, brace, methods, disease | Primary outcome measure |
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Arazpour et al. [1] | 7 patients, conventional valgus brace, gait analysis, patients with medial OA | The knee adduction moment was significantly reduced (p = 0.001) |
Della Croce et al. [4] | 18, pneumatic unloading knee brace, gait analysis, patients with medial OA | A 7.6 % decrease in net peak knee adduction moment with the brace uninflated and 26.0 % with the brace inflated |
Dessery et al. [5] | 24, custom valgus knee brace (three point bending brace, valgus and external rotation brace, ACL brace), gait analysis, patients with medial OA | The valgus unloader brace and ACL-brace 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) |
Draganich et al. [6] | 10, conventional brace, custom brace, gait analysis, patients with medial OA | The custom-brace significantly decreased peak adduction moments during gait and stair stepping, compared with baseline and off-the-shelf bracing |
Fantini Pagani et al. [9] | 16, conventional valgus unloader brace, gait analysis, healthy volunteers | The first and second peak knee adduction moments also decreased during walking with different orthosis adjustments (changes from 5 to 33 %). During running, a significant reduction was observed only between the conditions without orthosis and 8° valgus adjustments (change of 11 %) |
Fantini Pagani et al. [10] | 10, conventional valgus brace, gait analysis, patients with medial OA | For the second peak knee adduction moment, decreases of 18, 21, and 7 % were observed between baseline and test conditions for the orthosis in 4° valgus, in 8° valgus, and insole, respectively. |
Fantini Pagani et al. [11] | 14, ankle–foot orthosis, gait analysis, healthy subjects with knee varus alignment | Significant decreases in knee adduction moment, in the frontal plane were observed with the ankle–foot orthosis in all three different adjustments |
Fu et al. [13] | 10, conventional valgus knee brace, gait analysis, patients with medial OA | Gait analysis indicated statistically significant reductions in peak and mean knee adduction moments in all orthotic groups when compared with a flat insole |
Johnson et al. [19] | 10, conventional valgus brace, gait analysis, patients with medial OA | The mean improvement in knee adduction moment was a decrease of 0.2255 Nm/kg (range 0.56–0.564 Nm/kg), showing a mean improvement of 48 % (range 16–76 % of original peak moment) |
Jones et al. [19] | 28, conventional valgus brace, gait analysis, patients with medial OA | The valgus knee brace, reduced the early stance EKAMexternal knee adduction moment by 7 % |
Laroche et al. [24] | 20, valgus and external rotation brace, gait analysis, patients with medial OA | Knee adduction moments significantly decreased in the terminal stance and push off |
Lamberg et al. [23] | 15, conventional valgus knee brace, gait analysis, patients with medial OA | Second peak knee adduction moment were reduced (p < 0.05) at post and final compared to baseline (26 %) |
Lindenfeld et al. [26] | 11, custom valgus knee brace, gait analysis, patients with medial OA | 9 of 11 patients had a decrease in the adduction moment when wearing the brace, with the moment decreasing by as much as 32 % |
Moyer et al. [29] | 16, custom valgus knee brace, gait analysis, patients with medial OA | Valgus bracing reduced knee adduction moment. The reduction in knee adduction moment was greatest when using the knee brace and a foot orthotic |
Orishimo et al. [30] | 12, conventional valgus knee brace, gait analysis, normally aligned patients | Peak knee adduction moment and knee adduction impulse decreased with increasing brace tension (main effect of brace, p < 0.001) |
Ota et al. [31] | 15, custom made valgus brace, gait analysis, patients with medial OA | The peak KAM with KBF was significantly smaller than those with the KB (p = 0.004, the difference between these conditions of KAM: 0.06 Nm/kg) |
Pollo et al. [32] | 11, conventional valgus knee brace, gait analysis, patients with medial OA | Valgus bracing reduced the adduction moment about the knee by an average of 13 % (7.1 Nm) |
Ramsey et al. [34] | 16, custom valgus knee brace, gait analysis, patients with medial OA | Knee adduction excursions were significantly reduced with the use of bracing, with excursions reported to be lowest at 4° of valgus correction |
Self et al. [35] | 5, custom made valgus knee brace, gait analysis, patients with medial OA | The Monarch brace significantly reduced the varus moment at 20 and 25 % of stance |
Schmalz et al. [36] | 16, conventional valgus brace, gait analysis, patients with medial OA | The mean maximum value of the orthotic valgus moment was 0.053 Nm/kg, which represents approximately 10 % of the external genu varus moment without the brace |
References | Number, brace, methods | Primary outcome measure |
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Duivenvoorden et al. [7] | 80, conventional knee unloader brace, gait analysis, patients with medial OA | No reduction of knee adduction moment, in the brace group at baseline and after 6 weeks |
Ebert et al. [8] | 20, conventional knee unloader brace, gait analysis, normally aligned knees | Valgus bracing increased knee adduction moments |
Gaasbeek et al. [14] | 15, conventional knee unloader brace, gait analysis, patients with medial OA | Gait analysis showed that the brace had a tendency of lowering peak varus moment about the knee. This effect was more profound in the presence of higher initial varus deformity angle of the knee |
Hewett et al. [16] | 18, conventional knee unloader brace, gait analysis, patients with medial OA | Results while wearing a brace showed no significant change in the adduction moment |
References | Secondary outcome measures |
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Arazpour et al. [1] | Speed of walking significantly increased (p < 0.001) Reduction in knee range of motion (p = 0.002) Increase in step length (p < 0.001) |
Dessery et al. [5] | Knee pain was alleviated with all three braces (p < 0.01) |
Fantini Pagani et al. [11] | Significant decreases in knee lever arm, and joint alignment in the frontal plane were observed with the ankle–foot orthosis in all three different adjustments. No significant differences could be found in any parameter while using the laterally wedged insoles |
Fu et al. [13] | Compared with pretreatment, the lateral-wedged insole, lateral-wedged insole with arch support, and valgus knee brace groups demonstrated significant reductions in WOMAC pain score (19.1 %, p = 0.04; 18.2 %, p = 0.04; and 20.4 %, p = 0.02, respectively). The valgus knee brace with lateral-wedged insole with arch support group demonstrated an additive effect with a statistically significant reduction in WOMAC total score (−26.7 %, p = 0.01). Compliance with treatment for the isolated insole groups were all over 90 %, but compliance for the valgus knee brace-associated groups was only around 50 % |
Johnson et al. [18] | All but one of the compliant patients reported a decrease of at least two pain points after 3 months of use. There was one additional intervention in the brace cohort versus a statistical increase of 10 in the nonbrace cohort. All patients who were compliant with the brace showed an increase in thigh girth measurements, compared with none in the nonbrace cohort. Braced patients experienced retained improvements in at least one gait parameter including improved walking speed, total range of motion, and improved knee-angle at heel strike |
Jones et al. [19] | Lateral wedged insole significantly increased walking speed, reduced the early stance EKAM 12 %, and the knee adduction angular impulse by 8.6 and 16.1 % respectively. The lateral wedged insole significantly reduced the early stance EKAM compared to the valgus knee brace (p = 0.001). The valgus knee brace significantly reduced the knee varus angle compared to the baseline and lateral wedged insole. Improvements in pain and function subscales were comparable for the valgus knee brace and lateral wedged insole. There were no significant differences between the two treatments in any of the clinical outcomes; however the lateral wedged insoles demonstrated greater levels of acceptance by patients |
Laroche et al. [24] | VAS-pain and WOMAC significantly decreased at W5. Walking speed was not significantly modified by knee bracing at W0, but increased significantly at W5 |
Lindenfeld et al. [26] | No apparent gait adaptations were observed. Scores from an analog pain scale decreased 48 % with brace wear, and function with activities of daily living increased 79 % |
Orishimo et al. [30] | With increasing tension in the brace, peak frontal plane knee angle shifted significantly from 1.6° ± 4.2° varus without the brace to 4.1° ± 3.6° valgus with maximum brace tension |
Ota et al. [31] | The peak knee flexion angles during swing phase with KBF were also significantly larger than those with the KB (p = 0.004, the difference between these conditions of knee flexion angle: 1.5°) |
Pollo et al. [32] | The medial compartment load at the knee decreased by an average of 11 % (114 N) Pain and activity level improved in all subjects with valgus bracing |
Ramsey et al. [34] | Knee function and stability scored best with the brace in the neutral setting compared with the brace in the valgus setting. The cocontraction of the vastus lateralis-lateral hamstrings was significantly reduced from baseline in both the neutral (p = 0.014) and valgus conditions (p = 0.023), and the cocontraction of the vastus medialis-medial hamstrings was significantly reduced with the valgus setting (p = 0.068), as a result of bracing. Patients with greater varus alignment had greater decreases in vastus lateralis-lateral hamstring muscle cocontraction |
Schmalz et al. [36] | Use of the tested brace also decreased the magnitude of gait asymmetry between the braced and contralateral legs during walking (horizontal ground reaction force, external knee flexion moment), presumably because the subjects’ need to walk abnormally to shield the knee from pain was reduced |
References | Secondary outcome measures |
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Duivenvoorden et al. [7] | No reduction ground reaction force was seen in the brace group at baseline and after 6 weeks |
Gaasbeek et al. [14] | Bracing led to a small decrease in knee extension at the end of the swing phase and increase of walking velocity |
Hewett et al. [16] | Before brace wear, 78 % had pain with activities of daily living, but after the first evaluation, only 39 % continued to have such pain, and at the second evaluation, only 31 % were so affected. Before brace wear, patients had a walking tolerance of 51 min prior to the onset of pain symptoms. At the first evaluation, patients could walk 138 min without pain, and after 1 year, they could walk 107 min without pain. Before brace wear, 78 % rated their overall knee condition as fair or poor whereas at the first evaluation, only 33 % continued to provide this rating |