Is valgus unloader bracing effective in normally aligned individuals: implications for post-surgical protocols following
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KNEE
Is valgus unloader bracing effective in normally aligned individuals: implications for post-surgical protocols following cartilage restoration procedures Karl F. Orishimo • Ian J. Kremenic • Steven J. Lee • Malachy P. McHugh • Stephen J. Nicholas
Received: 9 April 2012 / Accepted: 30 July 2012 Ó Springer-Verlag 2012
Abstract Purpose Utilizing valgus unloader braces to reduce medial compartment loading in patients undergoing cartilage restoration procedures may be an alternative to nonweightbearing post-operative protocols in these patients. It was hypothesized that valgus unloader braces will reduce knee adduction moment during the stance phase in healthy subjects with normal knee alignment. Methods Gait analysis was performed on twelve adult subjects with normal knee alignment and no history of knee pathology. Subjects were fitted with an off-the-shelf adjustable valgus unloader brace and tested under five conditions: one with no brace and four with increasing valgus force applied by the brace. Frontal and sagittal plane knee angles and external moments were calculated during stance via inverse dynamics. Analyses of variance were used to assess the effect of the brace conditions on frontal and sagittal plane joint angles and moments. Results With increasing tension in the brace, peak frontal plane knee angle during stance shifted from 1.6° ± 4.2° varus without the brace to 4.1° ± 3.6° valgus with maximum brace tension (P = 0.02 compared with the no brace condition). Peak knee adduction moment and knee adduction impulse decreased with increasing brace tension (main effect of brace, P \ 0.001). Gait velocity and sagittal plane knee biomechanics were minimally affected. Conclusion The use of these braces following a cartilage restoration procedure may provide adequate protection of the repair site without limiting the patient’s mobility.
K. F. Orishimo (&) I. J. Kremenic S. J. Lee M. P. McHugh S. J. Nicholas Nicholas Institute of Sports Medicine and Athletic Trauma, 100 E. 77th St., 2nd Floor, New York, NY 10075, USA e-mail: [email protected]
Level of evidence study, Level II.
Therapeutic prospective comparative
Keywords Knee adduction moment Valgus unloader brace Gait analysis
Introduction Due to limited healing abilities and the propensity to further degenerate, large osteochondral lesions are often treated by surgical intervention (i.e. mosaicplasty, microfracture or autologous chondrocyte implantation) [1, 4, 14, 22, 26]. Following cartilage restoration procedures, reduced loading at the repair site is essential for healing and graft incorporation [6, 12]. Typical protocols recommend 6–12 weeks of non- or partial weightbearing [6, 12]. Patients undergoing these procedures are often young and lead a physically active lifestyle, which could lead to difficulty in maintaining the required limited weightbearing status [7]. Non-compliance with the post-operative protocol could overload the repair and jeopardize the success of the procedure. Additionally, some patients, when faced with prolonged l
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