Download PDF
J Knee Surg 2022; 35(03): 232-241
DOI: 10.1055/s-0041-1741429
Special Focus Section

Bracing for the Patellofemoral Joint

Rachel Phillips
1   Department of Orthopedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
2   Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
,
Stephanie Choo
1   Department of Orthopedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
,
Clayton W. Nuelle
1   Department of Orthopedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Patellofemoral disorders are common causes of knee pain that result in frequent visitations to musculoskeletal care clinics. Patellar tendinopathy, patellar instability and patellar maltracking, and pain are some of the most common pathologies resulting in patellofemoral dysfunction. For each of these diagnoses, there are unique orthoses and braces available, some of which are uniquely designed to address the pathology involved. While the spectrum of patellofemoral disorders is wide ranging and can often be challenging to treat, bracing frequently plays a large role in the overall treatment algorithm. In this article, we summarized the current literature and treatment recommendations related to the most common types of patellar braces. We performed a thorough review of randomized controlled trials and up to date literature to reach well-informed conclusions on current best practice regarding the uses of patellar braces for patellofemoral disorders.

Keywords

knee pain - bracing - patellofemoral joint


Publication History

Received: 11 August 2021

Accepted: 16 November 2021

Article published online:
27 January 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Blønd L, Hansen L. Patellofemoral pain syndrome in athletes: a 5.7-year retrospective follow-up study of 250 athletes. Acta Orthop Belg 1998; 64 (04) 393-400
    PubMedGoogle Scholar
  • 2 Lankhorst NE, Bierma-Zeinstra SMA, van Middelkoop M. Factors associated with patellofemoral pain syndrome: a systematic review. Br J Sports Med 2013; 47 (04) 193-206
    CrossrefPubMedGoogle Scholar
  • 3 Rutland M, O'Connell D, Brismée J-MSP, Sizer P, Apte G, O'Connell J. Evidence-supported rehabilitation of patellar tendinopathy. N Am J Sports Phys Ther 2010; 5 (03) 166-178
    PubMedGoogle Scholar
  • 4 Rosen AB, Ko J. N Brown C. Single-limb landing biomechanics are altered and patellar tendinopathy related pain is reduced with acute infrapatellar strap application. Knee 2017; 24 (04) 761-767
    CrossrefPubMedGoogle Scholar
  • 5 de Vries A, Zwerver J, Diercks R. et al. Effect of patellar strap and sports tape on pain in patellar tendinopathy: a randomized controlled trial. Scand J Med Sci Sports 2016; 26 (10) 1217-1224
    CrossrefPubMedGoogle Scholar
  • 6 Fithian DC, Paxton EW, Stone ML. et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32 (05) 1114-1121
    CrossrefPubMedGoogle Scholar
  • 7 Ries Z, Bollier M. Patellofemoral instability in active adolescents. J Knee Surg 2015; 28 (04) 265-277
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y. Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am 2008; 90 (03) 463-470
    CrossrefPubMedGoogle Scholar
  • 9 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (01) 19-26
    CrossrefPubMedGoogle Scholar
  • 10 Johnson DS, Turner PG. Management of the first-time lateral patellar dislocation. Knee 2019; 26 (06) 1161-1165
    CrossrefPubMedGoogle Scholar
  • 11 Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports 2010; 20 (05) 725-730
    CrossrefPubMedGoogle Scholar
  • 12 Sherman SL, Plackis AC, Nuelle CW. Patellofemoral anatomy and biomechanics. Clin Sports Med 2014; 33 (03) 389-401
    CrossrefPubMedGoogle Scholar
  • 13 Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE, Mendelsohn C. Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med 2000; 28 (04) 472-479
    CrossrefPubMedGoogle Scholar
  • 14 Nuelle CW, Nuelle JAV, Balldin BC. Open reduction internal fixation of a traumatic osteochondral lesion of the patella with bioabsorbable screw fixation. Arthrosc Tech 2019; 8 (11) e1361-e1365
    CrossrefPubMedGoogle Scholar
  • 15 Nuelle CW, Farr J. Internal fixation of osteochondritis dissecans lesions in the patellofemoral joint. J Knee Surg 2018; 31 (03) 206-211
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. Am Fam Physician 2007; 75 (02) 194-202
    PubMedGoogle Scholar
  • 17 Selfe J, Callaghan M, Witvrouw E. et al. Targeted interventions for patellofemoral pain syndrome (TIPPS): classification of clinical subgroups. BMJ Open 2013; 3 (09) e003795
    CrossrefPubMedGoogle Scholar
  • 18 Lun VMY, Wiley JP, Meeuwisse WH, Yanagawa TL. Effectiveness of patellar bracing for treatment of patellofemoral pain syndrome. Clin J Sport Med 2005; 15 (04) 235-240
    CrossrefPubMedGoogle Scholar
  • 19 Petersen W, Ellermann A, Rembitzki IV. et al. The Patella Pro study - effect of a knee brace on patellofemoral pain syndrome: design of a randomized clinical trial (DRKS-ID:DRKS00003291). BMC Musculoskelet Disord 2014; 15 (01) 200
    CrossrefPubMedGoogle Scholar
  • 20 Selfe J, Richards J, Thewlis D, Kilmurray S. The biomechanics of step descent under different treatment modalities used in patellofemoral pain. Gait Posture 2008; 27 (02) 258-263
    CrossrefPubMedGoogle Scholar
  • 21 Collins NJ, Barton CJ, van Middelkoop M. et al. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. Br J Sports Med 2018; 52 (18) 1170-1178
    CrossrefPubMedGoogle Scholar
  • 22 Finestone A, Radin EL, Lev B, Shlamkovitch N, Wiener M, Milgrom C. Treatment of overuse patellofemoral pain. Prospective randomized controlled clinical trial in a military setting. Clin Orthop Relat Res 1993; (293) 208-210
    PubMedGoogle Scholar
  • 23 Van Tiggelen D, Witvrouw E, Roget P, Cambier D, Danneels L, Verdonk R. Effect of bracing on the prevention of anterior knee pain–a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2004; 12 (05) 434-439
    CrossrefPubMedGoogle Scholar
  • 24 BenGal S, Lowe J, Mann G, Finsterbush A, Matan Y. The role of the knee brace in the prevention of anterior knee pain syndrome. Am J Sports Med 1997; 25 (01) 118-122
    CrossrefPubMedGoogle Scholar
  • 25 Rosen AB, Ko J, Simpson KJ, Brown CN. Patellar tendon straps decrease pre-landing quadriceps activation in males with patellar tendinopathy. Phys Ther Sport 2017; 24: 13-19
    CrossrefPubMedGoogle Scholar
  • 26 Mohd Sharif NA, Goh S-L, Usman J, Wan Safwani WKZ. Biomechanical and functional efficacy of knee sleeves: a literature review. Phys Ther Sport 2017; 28: 44-52
    CrossrefPubMedGoogle Scholar
  • 27 Callaghan MJ, Guney H, Reeves ND. et al. A knee brace alters patella position in patellofemoral osteoarthritis: a study using weight bearing magnetic resonance imaging. Osteoarthritis Cartilage 2016; 24 (12) 2055-2060
    CrossrefPubMedGoogle Scholar
  • 28 Becher C, Schumacher T, Fleischer B, Ettinger M, Smith T, Ostermeier S. The effects of a dynamic patellar realignment brace on disease determinants for patellofemoral instability in the upright weight-bearing condition. J Orthop Surg Res 2015; 10 (01) 126
    CrossrefPubMedGoogle Scholar
  • 29 Draper CE, Besier TF, Santos JM. et al. Using real-time MRI to quantify altered joint kinematics in subjects with patellofemoral pain and to evaluate the effects of a patellar brace or sleeve on joint motion. J Orthop Res 2009; 27 (05) 571-577
    CrossrefPubMedGoogle Scholar
  • 30 Bohnsack M, Halcour A, Klages P. et al. The influence of patellar bracing on patellar and knee load-distribution and kinematics: an experimental cadaver study. Knee Surg Sports Traumatol Arthrosc 2008; 16 (02) 135-141
    CrossrefPubMedGoogle Scholar
  • 31 Muhle C, Brinkmann G, Skaf A, Heller M, Resnick D. Effect of a patellar realignment brace on patients with patellar subluxation and dislocation. Evaluation with kinematic magnetic resonance imaging. Am J Sports Med 1999; 27 (03) 350-353
    CrossrefPubMedGoogle Scholar
  • 32 Powers CM, Ward SR, Chan L-D, Chen Y-J, Terk MR. The effect of bracing on patella alignment and patellofemoral joint contact area. Med Sci Sports Exerc 2004; 36 (07) 1226-1232
    CrossrefPubMedGoogle Scholar
  • 33 Selfe J, Thewlis D, Hill S, Whitaker J, Sutton C, Richards J. A clinical study of the biomechanics of step descent using different treatment modalities for patellofemoral pain. Gait Posture 2011; 34 (01) 92-96
    CrossrefPubMedGoogle Scholar
  • 34 Warden SJ, Hinman RS, Watson Jr MA, Avin KG, Bialocerkowski AE, Crossley KM. Patellar taping and bracing for the treatment of chronic knee pain: a systematic review and meta-analysis. Arthritis Rheum 2008; 59 (01) 73-83
    CrossrefPubMedGoogle Scholar
  • 35 Saltychev M, Dutton RA, Laimi K, Beaupré GS, Virolainen P, Fredericson M. Effectiveness of conservative treatment for patellofemoral pain syndrome: a systematic review and meta-analysis. J Rehabil Med 2018; 50 (05) 393-401
    CrossrefPubMedGoogle Scholar
  • 36 Karimzadehfini A, Zolaktaf V, Vahdatpour B. Restorative effects of exercise rehabilitation and bracing on females with lateral displacement of patella. Adv Biomed Res 2014; 3 (01) 165
    CrossrefPubMedGoogle Scholar
  • 37 Yamamoto GJ, Ocampos GP, Luzo MCM, da Silva CAC, de Farias FES, de Rezende MU. Randomized prospective study on the treatment of femoro-patellar osteoarthritis using bracing. Acta Ortop Bras 2019; 27 (02) 85-91
    CrossrefPubMedGoogle Scholar
  • 38 Askenberger M, Bengtsson Moström E, Ekström W. et al. Operative repair of medial patellofemoral ligament injury versus knee brace in children with an acute first-time traumatic patellar dislocation: a randomized controlled trial. Am J Sports Med 2018; 46 (10) 2328-2340
    CrossrefPubMedGoogle Scholar
  • 39 Wilson NA, Mazahery BT, Koh JL, Zhang LQ. Effect of bracing on dynamic patellofemoral contact mechanics. J Rehabil Res Dev 2010; 47 (06) 531-541
    CrossrefPubMedGoogle Scholar
  • 40 Miller MD, Hinkin DT, Wisnowski JW. The efficacy of orthotics for anterior knee pain in military trainees. A preliminary report. Am J Knee Surg 1997; 10 (01) 10-13
    PubMedGoogle Scholar
  • 41 Swart NM, van Linschoten R, Bierma-Zeinstra SMA, van Middelkoop M. The additional effect of orthotic devices on exercise therapy for patients with patellofemoral pain syndrome: a systematic review. Br J Sports Med 2012; 46 (08) 570-577
    CrossrefPubMedGoogle Scholar
  • 42 Crossley K, Bennell K, Green S, McConnell J. A systematic review of physical Interventions for patellofemoral pain syndrome. Clin J Sport Med 2001; 11 (02) 103-110
    CrossrefPubMedGoogle Scholar