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Sinn oder Unsinn der „unloader braces“

Sense or nonsense of unloader braces

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Zusammenfassung

Hintergrund

Valgisierende Orthesen stellen eine kostengünstige Alternative in der Behandlung der medialen Gonarthrose dar. Sie helfen zum einen in der präoperativen Diagnostik als Entscheidungshilfe, ob ein Patient aller Voraussicht nach von einer valgisierenden Osteotomie des Tibiakopfes profitiert. Darüber hinaus ist ein direkter klinischer Nutzen in Form einer Schmerzlinderung und Besserung der Kniegelenkfunktion in einigen Arbeiten gezeigt worden.

Diskussion

Die genauen Wirkungsmechanismen werden kontrovers diskutiert. Es wird eine Verringerung der mechanischen Last im medialen Kompartiment des Kniegelenks durch Verringerung des Varus, sowie eine Reduktion des gesteigerten Muskeltonus angenommen.

Schlussfolgerung

Ein langfristiger Nutzen der entlastenden Kniegelenkorthesen ist jedoch umstritten, da zum einen der degenerative Gelenkverschleiß fortschreitet, zum anderen aufgrund des oft fehlenden Tragekomforts der Orthesen die Bereitschaft zum Tragen der Orthese mit der Zeit abnimmt.

Abstract

Background

Unloader knee braces are a viable and cost-effective alternative in for treatment of medial osteoarthritis of the knee in selected patients. They provide the potential to predict which patients could benefit from a high tibial osteotomy (HTO) and which patients should better be treated which a unicondylar or bicondylar knee replacement.

Discussion

A direct clinical benefit in pain reduction as well as improved knee function has been shown in several clinical studies; however, the underlying mechanism remains uncertain. A potential reduction of the load in the medial compartment of the knee joint by reducing the varus or valgus deformity as well as a reduction of enhanced muscle contraction is discussed.

Conclusion

Despite the promising short-term results, possible long-term benefits of unloader braces are controversial. As possible reasons, natural progression of the underlying osteoarthritis as well as compliance of the patients to wear the braces diminishes significantly with time.

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Einhaltung ethischer Richtlinien

Interessenskonflikt

O. Lorbach, P. Mosser und D. Pape geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klink für Orthopädie und orthopädische Chirurgie, Universität des Saarlandes, Kirrberger Straße, Geb. 38, 66421, Homburg(Saar), Deutschland

    Olaf Lorbach & Philipp Mosser

  2. Centre de l’Appareil Locomoteur de Medecine du Sport et de Prevention Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg

    Dietrich Pape

Authors
  1. Olaf Lorbach
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  2. Philipp Mosser
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  3. Dietrich Pape
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Correspondence to Olaf Lorbach.

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Lorbach, O., Mosser, P. & Pape, D. Sinn oder Unsinn der „unloader braces“. Orthopäde 43, 984–987 (2014). https://doi.org/10.1007/s00132-014-3030-7

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  • DOI: https://doi.org/10.1007/s00132-014-3030-7

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