Bracing improves pain and bone marrow lesions in patients with osteoarthritis of the knee

Use of a patellofemoral knee brace can improve pain symptoms and bone marrow lesions in patients with a type of osteoarthritis of the knee, according to new research findings presented at the American College of Rheumatology Annual Meeting in San Diego, October 2013.

American College of Rheumatology, ACR via Newswise October 18, 2013

Osteoarthritis, or OA as it is commonly called, is the most common joint disease affecting middle-age and older people. It is characterized by progressive damage to the joint cartilage – the cushioning material at the end of long bones – and causes changes in the structures around the joint. These changes can include fluid accumulation, bony overgrowth, and loosening and weakness of muscles and tendons, all of which may limit movement and cause pain and swelling.

Knee osteoarthritis is a common form of osteoarthritis and is caused by cartilage breakdown in the knee joint. Factors that increase the risk of knee osteoarthritis include being overweight, age, injury or stress to the joints, and family history.

Researchers at the University of Manchester, the University of Warwick in the United Kingdom and Boston University studied the effects of six weeks of patellofemoral knee brace use in 126 OA patients between the ages of 40 and 70. The patients included in the study all had KL grade two or three patellofemoral OA, and their average pain score at the beginning of the study was 64.6. Ninety patients who had MRI scans at the beginning of the study showed patellofemoral bone marrow lesions – damage that is caused in part by focal stress on this joint. Patients in the bracing group wore a BIOSKIN patellar tracking Q brace for an average of 7.3 hours a day; the patients in the control group wore no brace.

The study’s aim was to measure the effects of a patellofemoral brace on knee pain and bone marrow lesions, as these braces have been shown to increase contact area in the joint, decreasing focal stress and possibly correcting joint malalignment.

Patients were given both questionnaires to measure symptoms like pain and tenderness, and MRI scans to measure their bone marrow lesions at the beginning and end of the six-week period. The patients who wore the knee brace showed significant reduction in patellofemoral joint pain, as well as a decrease in the volume of bone marrow lesions in their patellofemoral joint. However, the brace did not improve bone marrow lesions in the tibiofemoral joint. The researchers concluded that bracing is effective at reducing both pain and lesions in patellofemoral osteoarthritis, and that further trials of OA treatments could use bone marrow lesions as a way to measure outcomes and efficacy.

“This research is important for two reasons,” explains William F. Harvey, MD, MSc; assistant professor of medicine; clinical director, Division of Rheumatology; Tufts Medical Center; and a researcher who has collaborated with the study’s lead investigator on a previous clinical trial of a patellofemoral brace. “There is a desperate need for effective non-pharmacologic treatments that avoid all the potential side effects of treatment with medications. Additionally, this treatment is one of only a very few that have demonstrated the ability to improve both pain and the underlying structure of the joint in persons with knee osteoarthritis.”

Patients should talk to their rheumatologists to determine their best course of treatment.

Source American College of Rheumatology, ACR via Newswise

References

A randomised trial of a brace for patellofemoral osteoarthritis targeting knee pain and bone marrow lesions, Michael J Callaghan, Matthew J Parkes, Charles E Hutchinson, Andrew D Gait, Laura M Forsythe, Elizabeth J Marjanovic, Mark Lunt, David T Felson. Annals of the Rheumatic Diseases 2015; 741164-1170 doi:10.1136/annrheumdis-2014-206376.

Also see
Bracing lessened patellofemoral pain in OA Rheumatology News
Inflammation Causes Painful Sensitization in Knee Osteoarthritis The American Journal of Orthopedics
Inflammation Plays an Unsuspected Role in Knee OA Pain Medscape Multispecialty