The Journal of Bone and Joint Surgery (American). 2006;88:2645-2652.
doi:10.2106/JBJS.D.02787
© 2006 The Journal of Bone and Joint Surgery, Inc.
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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 and 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{at}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

Investigation performed at the Motion Analysis Laboratory, Section of Orthopaedic Surgery and Rehabilitation Medicine, Department of Surgery, The University of Chicago, Chicago, Illinois

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.

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.


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