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Methods for evaluating effects of unloader knee braces on joint health: a review

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Abstract

The paper aims to provide a state-of-the-art review of methods for evaluating the effectiveness and effect of unloader knee braces on the knee joint and discuss their limitations and future directions. Unloader braces are prescribed as a non-pharmacological conservative treatment option for patients with medial knee osteoarthritis to provide relief in terms of pain reduction, returning to regular physical activities, and enhancing the quality of life. Methods used to evaluate and monitor the effectiveness of these devices on patients’ health are categorized into three broad categories (perception-, biochemical-, and morphology-based), depending upon the process and tools used. The main focus of these methods is on the short-term clinical outcome (pain or unloading efficiency). There is a significant technical, research, and clinical literature gap in understanding the short- and long-term consequences of these braces on the tissues in the knee joint, including the cartilage and ligaments. Future research directions may complement existing methods with advanced quantitative imaging (morphological, biochemical, and molecular) and numerical simulation are discussed as they offer potential in assessing long-term and post-bracing effects on the knee joint.

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Abbreviations

OA:

Osteoarthritis

JSN:

Joint space narrowing

KAM:

Knee adduction moment

ECM:

Extracellular matrix

EMG:

Electromyograms

VAS:

Visual Analogue Scale

KOOS:

Knee Osteoarthritis Outcome Score

QOLS:

Quality of Life Scale

WOMAC:

Western Ontario and McMaster Universities’ Arthritis Index

IPAQ:

International Physical Activity Questionnaire

IKDC:

International Knee Documentation Committee

JSW:

Joint space width

MJSW:

Minimum JSW

K–L:

Kellgren–Lawrence

WORMS:

Whole-Organ Magnetic Resonance Imaging Score

BLOKS:

Boston Leeds Osteoarthritis Knee Score

MOAK:

Osteoarthritis Knee Score

MOCART:

Magnetic resonance observation of the cartilage repair tissue

dGEMRIC:

Delayed gadolinium enhanced MRI of cartilage

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Acknowledgments

KS and YHDL would like to acknowledge the funding support by the Changi General Hospital - Singapore University of Technology and Design under the Health Tech Innovation Fund, award no: CGH-SUTD-2015-003. The funding agency had no role in study design, data collection and analysis, the decision to publish, or preparation of the manuscript.

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  1. Rizuwana Parween and Karupppasamy Subburaj have been contributed equally.

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  1. Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372, Singapore

    Rizuwana Parween, Duraisamy Shriram, Rajesh Elara Mohan & Karupppasamy Subburaj

  2. Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore

    Yee Han Dave Lee

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Parween, R., Shriram, D., Mohan, R.E. et al. Methods for evaluating effects of unloader knee braces on joint health: a review. Biomed. Eng. Lett. 9, 153–168 (2019). https://doi.org/10.1007/s13534-019-00094-z

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