|“There’s a pressing need for non-surgical interventions for knee osteoarthritis, and little attention has been paid to treatments particularly aimed at the kneecap (the patellofemoral joint), a major source of knee pain,” explained Dr. Michael Callaghan, research associate in rehabilitation science at the University of Manchester.|
Wearing a knee brace has been shown to “significantly improve the pain and symptoms” of a type of osteoarthritis affecting the kneecap, according to a new study presented at the American College of Rheumatology Annual Meeting in San Diego, October 2013.
University of Manchester 19 April 2013
Osteoarthritis of the knee affects around six million people in the UK and is increasing as the population ages and becomes more obese. Current treatments are limited to pain relief and joint replacement.
Arthritis Research UK funded researchers at The University of Manchester claim their findings, presented at the Osteoarthritis Research Society International meeting in Philadelphia, April 19, have enormous potential for treating this common joint condition effectively – as well as providing a simple and cheap alternative to painkillers.
Osteoarthritis of the knee affecting the kneecap – patellofemoral osteoarthritis – accounts for about 20% of patients with knee pain. They typically experience pain that is made worse by going up and down stairs, kneeling, squatting and prolonged sitting.
“There’s a pressing need for non-surgical interventions for knee osteoarthritis, and little attention has been paid to treatments particularly aimed at the kneecap (the patellofemoral joint), a major source of knee pain,” explained Dr. Michael Callaghan, research associate in rehabilitation science at the University of Manchester.
“We’ve shown that something as simple as a lightweight knee brace can dramatically improve the symptoms and function for people with this particular type of knee osteoarthritis.”
The research team conducted a randomised controlled trial of a lightweight lycra flexible knee brace fitted around the knee with a support strap for the kneecap. One hundred and 26 patients between the ages of 40 and 70 were treated over a 12-week period. All had suffered from arthritic knee pain for the previous three months.
They were randomly allocated to either immediate brace treatment or delayed treatment (i.e. after six weeks.) Both groups of patients eventually wore the brace for a period of 12 weeks and averaged roughly seven hours a day.
After six weeks of brace wearing there were significant improvements between the brace wearing group and the no treatment group in scores for pain, symptoms, knee stiffness, muscle strength and function. After 12 weeks there were significant improvements in these scores for all patients compared to when they started.
“Patients repeatedly told us that wearing the brace made their knee feel more secure, stable, and supported,” Dr Callaghan added. “Our theory is that these sensations gave the patient confidence to move the knee more normally and this helped in improving muscle strength, knee function and symptoms.”
Professor Alan Silman, medical director of Arthritis Research UK, which funded the trial, said: “Osteoarthritis of the knee is a painful disorder that affects millions of people in the UK, causing pain and reducing activities. We know that in patients with arthritis, the knee joint is frequently out of normal alignment, which might be an underlying cause of the problem, as well as making it worse.
“By using a simple brace, the researchers have been able not only to correct the alignment but achieve a very worthwhile benefit in terms of reducing pain and function. This approach is a real advance over relying on pain killers and has the potential to reduce the end for joint surgery and replacement, procedures often employed when the symptoms become uncontrollable.”
|The ROAM (Research into Osteoarthritis in Manchester project has run three trials at The University of Manchester and the University of Salford. The project is led by internationally renowned Boston-based osteoarthritis expert Professor David Felson, with funding of £1.8m from Arthritis Research UK.|
Source University of ManchesterA randomised trial of a brace for patellofemoral osteoarthritis targeting knee pain and bone marrow lesions, Callaghan MJ, Parkes MJ, Hutchinson CE, Gait AD, Forsythe LM, Marjanovic EJ, Lunt M, Felson DT. Ann Rheum Dis. 2015 Jun;74(6):1164-70. doi: 10.1136/annrheumdis-2014-206376. Epub 2015 Jan 16. ABSTRACT 1694 – 2013 ACR/ARHP Annual Meeting
|Effects of a Knee Brace With a Patellar Hole Versus Without a Patellar Hole in Patients With Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial, Added MAN, Added C, Kasawara KT, Rotta VP, de Freitas DG. Eval Health Prof. 2018 Dec;41(4):512-523. doi: 10.1177/0163278717714307. Epub 2017 Jun 30.
The immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence in patients with knee osteoarthritis, Cudejko T, van der Esch M, van der Leeden M, van den Noort JC, Roorda LD, Lems W, Twisk J, Steultjens M, Woodburn J, Harlaar J, Dekker J. Arthritis Res Ther. 2017 Dec 1;19(1):260. doi: 10.1186/s13075-017-1456-0.
The Effect of Knee Braces on Quadriceps Strength and Inhibition in Subjects With Patellofemoral Osteoarthritis, Callaghan MJ, Parkes MJ, Felson DT. J Orthop Sports Phys Ther. 2016 Jan;46(1):19-25. doi: 10.2519/jospt.2016.5093. Epub 2015 Nov 10.
Clinical assessment of effusion in knee osteoarthritis-A systematic review, Maricar N, Callaghan MJ, Parkes MJ, Felson DT, O’Neill TW. Semin Arthritis Rheum. 2016 Apr;45(5):556-63. doi: 10.1016/j.semarthrit.2015.10.004. Epub 2015 Oct 22. Review.
Synovial tissue volume: a treatment target in knee osteoarthritis (OA), O’Neill TW, Parkes MJ, Maricar N, Marjanovic EJ, Hodgson R, Gait AD, Cootes TF, Hutchinson CE, Felson DT. Ann Rheum Dis. 2016 Jan;75(1):84-90. doi: 10.1136/annrheumdis-2014-206927. Epub 2015 Jun 26.
Sensitivity to Change of Patient-Preference Measures for Pain in Patients With Knee Osteoarthritis: Data From Two Trials, Parkes MJ, Callaghan MJ, O’Neill TW, Forsythe LM, Lunt M, Felson DT. Arthritis Care Res (Hoboken). 2016 Sep;68(9):1224-31. doi: 10.1002/acr.22823. Epub 2016 Jul 28.
The effect of different types of insoles or shoe modifications on medial loading of the knee in persons with medial knee osteoarthritis: a randomised trial, Jones RK, Chapman GJ, Parkes MJ, Forsythe L, Felson DT. J Orthop Res. 2015 Nov;33(11):1646-54. doi: 10.1002/jor.22947. Epub 2015 Jun 3.
Factors associated with arthrogenous muscle inhibition in patellofemoral osteoarthritis, Callaghan MJ, Parkes MJ, Hutchinson CE, Felson DT. Osteoarthritis Cartilage. 2014 Jun;22(6):742-6. doi: 10.1016/j.joca.2014.03.015. Epub 2014 Mar 29.
Osteoarthritis: priorities for osteoarthritis research: much to be done, Felson DT. Nat Rev Rheumatol. 2014 Aug;10(8):447-8. doi: 10.1038/nrrheum.2014.76. Epub 2014 May 20.
The current and future status of biomarkers in osteoarthritis, Felson DT. J Rheumatol. 2014 May;41(5):834-6. doi: 10.3899/jrheum.140094. No abstract available. Full text
The relationship between reductions in knee loading and immediate pain response whilst wearing lateral wedged insoles in knee osteoarthritis, Jones RK, Chapman GJ, Forsythe L, Parkes MJ, Felson DT. J Orthop Res. 2014 Sep;32(9):1147-54. doi: 10.1002/jor.22666. Epub 2014 Jun 6.
Osteoarthritis as a disease of mechanics, Felson DT. Osteoarthritis Cartilage. 2013 Jan;21(1):10-5. doi: 10.1016/j.joca.2012.09.012. Epub 2012 Oct 4. Review.
A new approach to prevention of knee osteoarthritis: reducing medial load in the contralateral knee, Jones RK, Chapman GJ, Findlow AH, Forsythe L, Parkes MJ, Sultan J, Felson DT. J Rheumatol. 2013 Mar;40(3):309-15. doi: 10.3899/jrheum.120589. Epub 2013 Jan 15.
Predictors of response to intra-articular steroid injections in knee osteoarthritis–a systematic review, Maricar N, Callaghan MJ, Felson DT, O’Neill TW. Rheumatology (Oxford). 2013 Jun;52(6):1022-32. doi: 10.1093/rheumatology/kes368. Epub 2012 Dec 22. Review.
Where and how to inject the knee–a systematic review, Maricar N, Parkes MJ, Callaghan MJ, Felson DT, O’Neill TW. Semin Arthritis Rheum. 2013 Oct;43(2):195-203. doi: 10.1016/j.semarthrit.2013.04.010. Review. Erratum in: Semin Arthritis Rheum. 2015 Apr;44(5):e18.
Lateral wedge insoles as a conservative treatment for pain in patients with medial knee osteoarthritis: a meta-analysis, Parkes MJ, Maricar N, Lunt M, LaValley MP, Jones RK, Segal NA, Takahashi-Narita K, Felson DT. JAMA. 2013 Aug 21;310(7):722-30. doi: 10.1001/jama.2013.243229.
Bone marrow lesions in knee osteoarthritis change in 6-12 weeks, Felson DT, Parkes MJ, Marjanovic EJ, Callaghan M, Gait A, Cootes T, Lunt M, Oldham J, Hutchinson CE. Osteoarthritis Cartilage. 2012 Dec;20(12):1514-8. doi: 10.1016/j.joca.2012.08.020. Epub 2012 Sep 1.
Bracing Improves Pain and Bone Marrow Lesions in Patients with Osteoarthritis of the Knee in Newswise
Activity, Brace May Ease Arthritis Pain in WebMD
Bracing improves pain and bone marrow lesions in patients with osteoarthritis of the knee in Science Daily