Braces and orthoses for treating osteoarthritis of the knee

BACKGROUND: Patients with osteoarthritis of the knee can be treated with a brace or orthosis (insole). The main purpose of these aids is to reduce pain, improve physical function and, possibly, to slow disease progression. This review was originally published in Issue 1, 2005. OBJECTIVES: To assess the effectiveness of a brace or orthosis in the treatment of osteoarthritis of the knee. SEARCH STRATEGY: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE (Current contents, Health STAR) up to October 2002 in the original review and in this update until May 2007. Reference lists of identified trials were screened. SELECTION CRITERIA: Randomised and controlled clinical trials investigating all types of braces and orthoses for osteoarthritis of the knee. DATA COLLECTION AND ANALYSIS: Three reviewers independently selected trials, extracted data and assessed trial quality. Due to the heterogeneity of the studies, pooling of outcomes was not possible. MAIN RESULTS: Five studies (n=589) were included: two knee brace and three orthoses studies. In the longer follow-up studies (1 to 2 years) many patients stopped their brace or insole treatment.The pain and function scores of a brace and a neoprene sleeve group showed greater improvement at six months compared with a control group. In a second brace study, the pain and function scores were improved in the brace group compared with the controls, but only the walking distance was significantly longer. In one study there was a significantly less intake of NSAIDs and significantly better compliance in a lateral wedge group compared with a neutral wedge group, but there were no significant differences in function scores at 6 and 24 months.In another insole study at 6 months follow up, the pain score was significantly improved in the strapped insole group compared with the traditional lateral wedge group (relative percentage difference (RPD=29%). The femorotibial angle was significantly improved in the strapped insole group at 6 and 24 months (RPDs at both timepoints= -1.1%). The pain and function scores were not significantly different at 24 months. AUTHORS' CONCLUSIONS: Based on two brace and three insole studies, we conclude that there is 'silver' level evidence (www.cochranemsk.org) that a brace and a lateral wedge insole have small beneficial effect. There is 'silver' level evidence that strapped insoles correct leg alignment. However, long-term adherence to brace and insole treatment is low. There is no evidence whether a brace is more effective than an insole.