What is the best brace for patellofemoral pain syndrome?

Best Brace for Patellofemoral Pain Syndrome

For patellofemoral pain syndrome, a patellofemoral brace with an adjustable patellar buttress that applies a medially directed force to the lateral border of the patella is the most effective option, particularly for active individuals. 1

Types of Patellofemoral Braces and Their Effectiveness

Patellofemoral braces generally fall into two main categories:

1. Sleeve-style braces with patellar stabilization:

   • Typically made of neoprene with a patellar cutout
   • May include straps or buttresses to stabilize the patella
   • Increase contact area in the patellofemoral joint 2
   • Help the patella engage the trochlear groove earlier during knee flexion 2
   • Good for basic support and mild cases

2. Wrap-style braces with dynamic patellar stabilization:

   • Apply active, medially displacing force to the lateral border of the patella
   • Maintain constant pressure during knee movement
   • Reduce peak pressure by shifting pressure to regions with thicker articular cartilage 2
   • More effective for pain reduction in moderate to severe cases
   • Better for cases with patellar maltracking or lateral displacement

Selection Criteria for Optimal Brace

For most patients with patellofemoral pain syndrome:

• Off-the-shelf versions can be successfully fitted without customization 3
• More active individuals should consider a patellofemoral brace with a lateral hinge and adjustable patellar buttress 3
• Wrap-style braces are superior for reducing peak pressure on the patellofemoral joint 2

Proper Fitting Instructions

Proper fitting is crucial for effectiveness:

1. Measure leg circumference according to manufacturer guidelines:

   • 3 inches above and below mid-patella, OR
   • Around center of knee joint with leg relaxed and extended 3

2. Select appropriate brace size based on measurements

3. Position the brace correctly:

   • Pull brace onto affected leg
   • Position buttress support(s) for medial or lateral placement as needed
   • Align patella in center of cutout if applicable
   • Secure counterbalancing straps with moderate tension 3

4. Regular maintenance:

   • Periodically inspect for migration, strap loosening, or material fatigue
   • Tighten straps regularly to prevent unwanted migration 1
   • Consider shaving leg hair to improve skin contact 1

Evidence for Effectiveness

While the evidence is mixed, patients consistently report subjective improvements in pain and disability with brace wear 3. A dynamic patellar stabilizing brace that applies an active, medially displacing force has shown effectiveness in:

• Treatment of patellar subluxation
• Management of patellofemoral arthritis
• Symptom elimination with prolonged use in some cases 4

Comprehensive Management Approach

For optimal outcomes, the brace should be used as part of a comprehensive treatment plan:

• Combine bracing with supervised physiotherapy 5
• Include quadriceps strengthening, especially vastus medialis
• Incorporate flexibility improvements and technique refinement 3
• Consider shoe orthotics for recalcitrant cases 3

Common Pitfalls to Avoid

1. Relying solely on bracing: Braces are an adjunct to, not a replacement for, proper rehabilitation

2. Improper fitting: Effectiveness depends on correct application and use

3. Prolonged use without rehabilitation: May lead to increased energy expenditure and decreased agility 1

4. Ignoring underlying biomechanical issues: Address hip, knee, and foot kinematic factors that contribute to PFPS

5. False sense of security: Braces may give patients unwarranted confidence to return to activities too quickly

Remember that while patellofemoral braces are inexpensive and subjectively helpful components of anterior knee pain therapy, their mechanism of action likely involves improving patellar tracking through a medially directed force, along with changes in regional temperature, neurosensory feedback, or circulation 3.