title: The effects of a varus unloader brace for lateral tibiofemoral osteoarthritis and valgus malalignment after anterior cruciate ligament reconstruction: a single case study.
abstract: We investigated the immediate effects of a varus knee brace on knee symptoms and knee-joint biomechanics in an individual with predominant lateral tibiofemoral joint osteoarthritis (TFJOA) and valgus malalignment after anterior cruciate ligament (ACL) reconstruction. A varus unloader brace was prescribed to a 48-year-old male with predominant lateral radiographic and symptomatic TFJOA and valgus malalignment eight-years following ACL reconstruction. During a step-down task, the participant rated knee pain, task-difficulty, knee-stability and knee-confidence on four separate visual analogue scales. Quantitative gait analysis was conducted during self-selected walking trials under three test conditions in a randomized order: (i) no brace; (ii) brace without frontal plane adjustment (no varus re-alignment); and (ii) brace with frontal plane adjustment (varus re-alignment). Post-processing of gait data involved calculation of knee kinematics and net joint moments for the reconstructed limb. The participant reported improved pain (3%), task difficulty (41%), stability (46%) and confidence (49%) when performing the step-down task with the brace. The varus brace resulted in immediate reductions in knee abduction angle (24%) and internal rotation angle (56%), and increased knee adduction moment (18%). These findings provide preliminary evidence for potentially beneficial effects of bracing on knee-symptoms and biomechanics in individuals with lateral TFJOA after reconstruction.
authors.affiliation: The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: H F
authors.initials: HF
authors.lastname: Hart
authors.forename: D C
authors.initials: DC
authors.lastname: Ackland
authors.forename: A G
authors.initials: AG
authors.lastname: Schache
authors.forename: M G
authors.initials: MG
authors.lastname: Pandy
authors.forename: N J
authors.initials: NJ
authors.lastname: Collins
authors.forename: K M
authors.initials: KM
authors.lastname: Crossley
mesh_terms: D059549:Anterior Cruciate Ligament Reconstruction; D001696:Biomechanical Phenomena / Q000502:physiology; D001915:Braces; D005684:Gait / Q000502:physiology*; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D016896:Treatment Outcome