As an orthotist, I am always keen to explore the impact of commonly used interventions on the management of musculoskeletal conditions that I treat.
This review is an update of an original review published in 2005, which examined the use of braces and orthotics in the management of osteoarthritis (OA) of the knee.
Here’s what they did
They searched the Cochrane register of controlled trials (Central), Medline and Embase up to March 2014 for RCT’s investigating all types of bracing for OA of the knee compared to active control or no intervention. Two independent authors selected trials and extracted data, assessing the information using the Cochrane risk of bias tool and the GRADE approach. They reviewed papers evaluating the benefits and harms of braces and foot/ankle orthoses with the treatment of OA of the knee.
Here’s what they found
Thirteeen studies were included in the review and these were categorised into:
- Brace versus no treatment;
- Foot/ankle orthosis versus no treatment, and
- Brace versus foot/ankle orthosis
Brace versus no treatment
Four studies compared knee brace and no treatment. Only one provided data after 12 months, which was of low quality. With 117 participants it showed no improvement in pain, function and QUALY (Quality of Life Years). There was significant drop out due to lack of effect over the 12 month period in both groups. The other three studies found some improvement in pain, function and QUALY.
Foot/ankle orthosis versus no treatment
One study showed a reduction in pain over nine months of wearing a laterally wedged insole compared to no insole but evidence was deemed low quality.
Three papers compared laterally wedged insoles to a neutral insole and found little effect on numerical pain scores and Western Ontario-McMaster Osteoarthritis (WOMAC) stiffness or function scores.
They found inconclusive evidence for the benefits of knee bracing in medial compartment OA on pain, stiffness, function and quality of life. Only one trial compared laterally wedged insole versus no treatment, leading the authors to conclude evidence is lacking.
Brace versus foot/ankle orthosis
There was low quality evidence comparing knee bracing to a lateral wedged insole, which found a lack of effect on pain scale or function scores but both groups showed some improvement.
The authors concluded
The optimal choice for an orthosis remains unclear, and long-term implications are lacking.
The Musculoskeletal Elf’s view
Interesting that a previous review examining the biomechanical effects of valgus knee bracing on medial compartment OA concluded knee bracing did influence the biomechanics of the knee and this review found nothing of statistical significance to enable them to conclude a positive benefit from any intervention on pain, function or QUALY. This was a very comprehensive review of current evidence available on the impact of orthotic treatment on OA of the knee. However, this review does highlight areas that require further study and also similar constructs to allow meta-analysis and pooling of data to occur.
What do you think?
Duivenvoorden, T., Brouwer, R. W., van Raaij, T. M., Verhagen, A. P., Verhaar, J. A., & Bierma‐Zeinstra, S. (2015). Braces and orthoses for treating osteoarthritis of the knee. The Cochrane Library [Abstract]