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

  • Rizuwana ParweenEmail author
  • Duraisamy Shriram
  • Rajesh Elara Mohan
  • Yee Han Dave Lee
  • Karupppasamy Subburaj
Review Article


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.


Unloader knee brace Knee osteoarthritis Quantitative imaging Finite element modelling Post-bracing effects 





Joint space narrowing


Knee adduction moment


Extracellular matrix




Visual Analogue Scale


Knee Osteoarthritis Outcome Score


Quality of Life Scale


Western Ontario and McMaster Universities’ Arthritis Index


International Physical Activity Questionnaire


International Knee Documentation Committee


Joint space width


Minimum JSW




Whole-Organ Magnetic Resonance Imaging Score


Boston Leeds Osteoarthritis Knee Score


Osteoarthritis Knee Score


Magnetic resonance observation of the cartilage repair tissue


Delayed gadolinium enhanced MRI of cartilage



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.

Authors’ contributions

All the authors participated in the design of the study, drafted the manuscript, and read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Korean Society of Medical and Biological Engineering 2019

Authors and Affiliations

  • Rizuwana Parween
    • 1
    Email author
  • Duraisamy Shriram
    • 1
  • Rajesh Elara Mohan
    • 1
  • Yee Han Dave Lee
    • 2
  • Karupppasamy Subburaj
    • 1
  1. 1.Engineering Product DevelopmentSingapore University of Technology and DesignSingaporeSingapore
  2. 2.Changi General HospitalSingaporeSingapore

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