Effects of a knee valgus unloader brace on medial femoral articular cartilage deformation following walking in varus-aligned individuals

• Published in: The knee Vol. 26; no. 5; pp. 1067 - 1072
• Main Authors: Pfeiffer, Steven J., Valentine, Joshua A., Goodwin, Johnathan S., Nissman, Daniel B., Blackburn, Troy, Pietrosimone, Brian
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-10-2019; Elsevier Limited
• Subjects: Adolescent; Adult; Arthritis; Biomechanical Phenomena; Biomechanics; Body mass index; Braces - adverse effects; Cartilage; Cartilage (articular); Cartilage, Articular - diagnostic imaging; Cartilage, Articular - physiopathology; Cross-Over Studies; Female; Femur; Gait - physiology; Genu Valgum - diagnosis; Genu Valgum - physiopathology; Genu Valgum - therapy; Healthy Volunteers; Humans; Knee; Knee Joint - diagnostic imaging; Knee Joint - physiopathology; Male; Range of Motion, Articular - physiology; Ultrasonography; Ultrasound; Valgus unloader brace; Walking; Walking - physiology; Weight-Bearing - physiology; Young Adult; United States > US; Cartilage; Walking; Ultrasound; Valgus unloader brace
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2019.06.014

Knee varus alignment may increase loading in the medial tibiofemoral compartment, which can increase strain on the articular cartilage. Knee valgus unloader braces seek to reduce loading through the medial femoral compartment, but their effects on cartilage characteristics during dynamic tasks have not been evaluated.
To determine the effects of a knee valgus unloader brace on medial femoral articular cartilage deformation following a single 5000-step walking protocol in individuals with varus-knee alignment.
Twenty-four healthy individuals (63% female, BMI = 22 ± 3 kg/m2, age = 21 ± 3 years) completed two testing sessions (braced and unbraced) separated by one week. During both sessions, femoral cartilage ultrasound images were acquired prior to and following a 5000-step treadmill walking protocol at self-selected speed. Percent change scores in medial cartilage cross-sectional area (MCCA) were calculated and used as the primary outcome, and compared between the braced and unbraced conditions.
There was no difference in percent change of MCCA between conditions (braced = −2.77%, unbraced = −3.15%, p = 0.699). Individuals whose cartilage deformed more than a previously established minimal detectable change (MDC ≥ 1.58 mm2) deformed less during the braced condition (braced = −2.94%, unbraced = −6.34%, p = 0.028), compared to individuals who did not deform greater than the MDC (n = 15, braced = −2.67%, unbraced = −1.23%, p = 0.210).
There was no significant difference in MCCA percent change between the braced and unbraced conditions across the entire cohort; yet a valgus unloader braces may serve as a potential intervention strategy for reducing articular cartilage deformation in certain varus-aligned individuals who normally undergo measurable deformation during walking.