title: A randomised trial of a brace for patellofemoral osteoarthritis targeting knee pain and bone marrow lesions.
abstract: OBJECTIVE
  Braces used to treat (PF) osteoarthritis (OA) may reduce contact stress across the PF joint. We hypothesised that in PF OA, braces would decrease knee pain and shrink PF bone marrow lesions (BMLs).
  
  
  METHODS
  Eligible subjects had painful PF OA. Subjects were randomly allocated to brace or no brace for 6 weeks. Knee MRIs were acquired at baseline and 6 weeks. We measured BMLs on post-contrast fat suppressed sagittal and proton density weighted axial images. The primary symptom outcome was change in pain at 6 weeks during a preselected painful activity, and the primary structural outcome was BML volume change in the PF joint. Analyses used multiple linear regression.
  
  
  RESULTS
  We randomised 126 subjects aged 40-70 years (mean age 55.5  years; 72 females (57.1%)). Mean nominated visual analogue scale (0-10 cm) pain score at baseline was 6.5 cm. 94 knees (75%) had PF BMLs at baseline. Subjects wore the brace for a mean of 7.4 h/day. 6 subjects withdrew during the trial. After accounting for baseline values, the brace group had lower knee pain than the control group at 6 weeks (difference between groups -1.3 cm, 95% CI -2.0 to -0.7; p<0.001) and reduced PF BML volume (difference -490.6 mm(3), 95% CI -929.5 to -51.7; p=0.03) but not tibiofemoral volume (difference -53.9 mm(3), 95% CI -625.9 to 518.2; p=0.85).
  
  
  CONCLUSIONS
  A PF brace reduces BML volume in the targeted compartment of the knee, and relieves knee pain.
  
  
  BACKGROUND
  UK. ISRCTN50380458.
authors.affiliation: Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Callaghan
authors.affiliation: Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Matthew J
authors.identifier: http://orcid.org/0000-0002-1574-9933
authors.initials: MJ
authors.lastname: Parkes
authors.affiliation: Department of Imaging Sciences, University of Manchester, Manchester, UK Department of Health Sciences, University of Warwick, UK.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Hutchinson
authors.affiliation: Department of Imaging Sciences, University of Manchester, Manchester, UK.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Gait
authors.affiliation: Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Forsythe
authors.affiliation: Department of Imaging Sciences, University of Manchester, Manchester, UK.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Marjanovic
authors.affiliation: Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Lunt
authors.affiliation: Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK Manchester Academic Health Science Centre, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, Manchester, UK Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Felson
mesh_terms: D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000209:etiology / Q000628:therapy*; D001853:Bone Marrow / Q000473:pathology*; D001855:Bone Marrow Diseases / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D001915:Braces; D005260:Female; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000473:pathology / Q000628:therapy*; D010147:Pain Measurement; D057071:Patellofemoral Joint / Q000473:pathology*
keywords: Knee Osteoarthritis; Rehabilitation; Treatment