What are the functions of knee braces, and can they help with knee osteoarthritis?

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Knee Braces for Arthritis: Functions and Effectiveness

Knee braces can be a useful nonoperative treatment for knee osteoarthritis, particularly for patients with predominantly medial or lateral compartment involvement, by reducing pain and improving function through load redistribution and enhanced joint stability. 1

What Knee Braces Do

Knee braces serve four principal biomechanical functions 1:

  • Maintain joint alignment by correcting varus or valgus malalignment
  • Stabilize the joint by compensating for ligamentous laxity
  • Reduce articular contact stress by redistributing loads from the more affected compartment to the healthier one
  • Enhance proprioception and joint position sense, even in simple knee sleeves that don't affect alignment 1

The mechanism works by applying an external abduction or adduction moment to shift approximately 70-80% of the load that normally passes through the medial compartment during gait 1. This load redistribution is achieved primarily through direct application of corrective forces rather than through gait modifications 2.

Evidence for Effectiveness in Osteoarthritis

Pain and Function Benefits

For unicompartmental knee OA (medial or lateral), realigning knee braces demonstrate meaningful clinical benefits 1:

  • Valgus/varus realigning braces reduce pain more effectively than simple knee sleeves or foot orthoses alone 3
  • Braces with valgus and external rotation functions show superior biomechanical outcomes, reducing the knee adduction moment by approximately 10% (0.1-0.3 times body weight) 2
  • Functional improvements include increased walking distance, improved range of motion, and enhanced gait speed 4

Important Nuances and Caveats

The evidence reveals several critical considerations:

Type of brace matters significantly. Simple knee sleeves provide symptomatic relief and proprioceptive benefits without affecting alignment 1. Rigid realigning braces (valgus/varus unloader braces) are more effective for moderate-to-severe unicompartmental OA by mechanically redistributing joint loads 1.

Patient selection is crucial. Braces work best for patients with:

  • Predominantly medial OR lateral compartment involvement (not both)
  • Malalignment of >5° (varus or valgus) 1
  • Ligamentous laxity contributing to instability 1

Avoid immobilizer/"rest" braces for chronic knee OA, as they weaken the natural muscle brace around the knee 1.

Laterally Wedged Insoles

The Osteoarthritis Research Society International and American College of Rheumatology recommend laterally wedged insoles for medial compartment knee OA 1. However, evidence is mixed:

  • Full-length wedged insoles (not heel wedges) may reduce the knee adduction moment by 6-8% 1
  • Pain relief is inconsistent across studies 1
  • Higher wedge angles (10° vs 5°) provide greater realignment but are less well-tolerated due to increased discomfort 1
  • Patient-specific factors (subtalar joint alignment, disease severity) significantly affect outcomes 1

Combined Treatment Approach

Recent evidence suggests that valgus/external rotation braces alone may be more effective than combining them with foot orthoses 3, 5. The combined treatment did not substantially improve outcomes beyond the brace alone, while increasing discomfort 3.

Clinical Algorithm for Brace Selection

For medial compartment OA:

  1. Start with a valgus realigning brace (preferably with external rotation function) for moderate-to-severe disease with malalignment
  2. Consider simple knee sleeves for mild disease or when proprioceptive enhancement is the primary goal
  3. Reserve laterally wedged insoles as an adjunct or alternative when braces are not tolerated

For lateral compartment OA:

  • Use varus realigning braces following the same principles

Contraindications:

  • Bicompartmental disease (both medial and lateral involvement)
  • Unstable knees requiring surgical intervention
  • Multi-directional instability 6

Common Pitfalls

Compliance issues are significant—newer lightweight, single-upright designs with breathable fabrics improve tolerance and adherence compared to older bulky models 1. Brace providers should emphasize proper fitting and gradual accommodation periods.

False expectations about disease modification: While braces may theoretically slow progression by reducing aberrant loading 1, definitive evidence for disease-modifying effects remains limited 7.

Quality of life considerations: Some evidence suggests braces may slightly worsen quality of life despite functional improvements, likely due to discomfort and lifestyle restrictions 7.

References

1
Guideline

bracing and orthoses: a review of efficacy and mechanical effects for tibiofemoral osteoarthritis.

PM&R (The Journal of Injury Function & Rehabilitation), 2012

3
Research

Knee braces and foot orthoses multimodal 3-month treatment of medial knee osteoarthritis in a randomised crossover trial.

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2024

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.