Highlights
- •Unloader bracing improves knee function in unicompartmental osteoarthritis of the knee demonstrating an immediate and late effect developing over time.
- •Bracing improves biochemical properties of damaged cartilage in terms of increasing collagen and proteoglycan levels or a decreasing edema of the damaged cartilage.
Abstract
Background
Unloading knee braces represent a conservative treatment option for non-pharmalogical
management of unicompartmental osteoarthritis of the knee. Though there is consensus
on the clinical effectiveness of unloading, the effect mechanism of bracing remains
part of a debate. Our study was designed to assess the effect of unloader bracing
on damaged cartilage via MRI cartilage mappings.
Methods
Fourteen patients (7 female, 7 male, mean age 43.1 ± 9.4 years) with unicompartmental
cartilage wear in knees with varus or valgus malalignment were enrolled. Clinical
scores, radiographs and MR-graphic properties (T2/T2* mapping, T1 Delayed Gadolinium
Enhanced MRI of the cartilage (dGEMRIC) mapping, high-resolution PDw sequences) of
knee cartilage were recorded before and three months after brace use.
Results
Bracing the knees for a mean of 14.4 ± 2.0 weeks (range 11 to 18 weeks) resulted in
significant pain reduction (VAS changed from 5.9 ± 2.0 to 2.0 ± 1.3, p < 0.001) and
improvement in knee function (KOOS increased from 42.1 ± 22.7 to 64.8 ± 18.7, p < 0.001).
In the affected cartilage regions T2 relaxation times significantly decreased from
56.1 ± 11.4 ms to 46.5 ± 11.2 ms (p < 0.05). No changes in T1-dGEMRIC and T2* relaxation
times, thickness or the extent of the damaged cartilage area could be detected.
Conclusions
Our results suggest, that unloader bracing improves the biochemical properties of
the damaged cartilage by increasing collagen and proteoglycan concentration as well
as decreasing the cartilage edema.
Keywords
Abbreviations:
GAG (glycosaminoglycanes), VAS (visual analogue scale), KOOS (Knee Injury and Osteoarthritis Outcome Score), MRI (magnetic resonance imaging), dGEMRIC (delayed gadolinium-enhanced MRI of cartilage)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 17, 2022
Accepted:
November 3,
2022
Received in revised form:
August 26,
2022
Received:
March 13,
2021
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
