From the Guidelines
For patients with patellofemoral pain syndrome, a true pull brace is generally more effective than a hinge knee brace due to its specific design to address patellar maltracking, and should be used in conjunction with a comprehensive treatment approach including quadriceps and hip strengthening exercises, as supported by the most recent evidence 1. The main difference between a true pull brace and a hinge knee brace for treating patellofemoral pain syndrome (PFPS) lies in their design and function. A true pull brace specifically targets patellar tracking by applying a medial force to realign the patella within the femoral groove, directly addressing the common lateral maltracking that contributes to PFPS. These braces typically feature a C-shaped buttress or strap that pulls the patella medially during knee flexion and extension. In contrast, a hinge knee brace primarily provides overall knee joint stability through rigid side supports and a mechanical hinge that controls range of motion, but offers less specific control of patellar movement. Some key points to consider when choosing between these braces include:
- The effectiveness of either brace depends on proper sizing and fit, with true pull braces requiring precise placement of the buttress or strap against the lateral edge of the patella to achieve optimal realignment.
- Both types should be used as part of a comprehensive treatment approach that includes physical therapy focusing on quadriceps and hip strengthening exercises to address the underlying biomechanical factors contributing to PFPS, as recommended by experts 1.
- Education should underpin any/all interventions, adjusted to reflect the needs of the person, and may seek to challenge inaccurate beliefs, build confidence and understanding of the diagnosis, explore the concept of pain not correlating with damage, develop insight into the recovery journey and expected timeframes, aid in managing load(s), or promote autonomy and reduce fear 1.
- The most recent evidence suggests that hip and knee strengthening exercises are effective in improving patellofemoral pain outcomes, and should be prescribed relative to specific severity and irritability, with a greater focus on hip exercises in people with poor tolerance to loaded knee flexion 1.
From the Research
Difference between True Pull Brace and Hinge Knee Brace
- The true pull brace and hinge knee brace are two types of knee orthoses used to treat patellofemoral pain syndrome (PFPS) 2.
- However, there is limited evidence to support the use of either type of brace for treating PFPS, with most studies being of low quality 3, 2.
- A systematic review found that knee orthoses, including knee braces and sleeves, did not reduce knee pain or improve knee function in the short term (under three months) in adults with PFPS who were also undergoing an exercise program 2.
Comparison of Knee Orthoses
- A study compared the effects of a knee brace, knee sleeve, and patellar strap on PFPS, but found no significant differences between the groups in terms of pain or function 2.
- Another study found that a patellar brace that applies medially directed force on the patella may be effective in reducing pain and improving function in patients with PFPS, but more research is needed to confirm these findings 3.
Treatment Options for Patellofemoral Pain Syndrome
- Physical therapy, including quadriceps-strengthening exercises, is a recommended treatment for PFPS, with strong evidence supporting its effectiveness in reducing pain and improving function 4.
- Hip strengthening and physiotherapy treatment programs aimed at restoring muscle balance between the vastus medialis oblique and vastus lateralis may also be beneficial for patients with PFPS 5.
- However, the use of knee braces or nonsteroidal anti-inflammatory drugs is not routinely recommended, and surgery should only be considered after failure of a comprehensive rehabilitation program 6.