Best Type of Knee Brace for Support and Stability
Tibiofemoral knee braces are strongly recommended for patients with knee osteoarthritis who experience significant impact on ambulation, joint stability, or pain requiring an assistive device, provided they can tolerate the associated inconvenience of bracing. 1
Types of Knee Braces and Their Indications
Tibiofemoral Knee Braces
- Strongly recommended for knee osteoarthritis affecting ambulation, stability, or causing significant pain 1
- Available in several designs:
- Modern designs incorporate lightweight materials and breathable fabrics to improve compliance 1
Patellofemoral Braces
- Conditionally recommended for patellofemoral knee osteoarthritis 1
- Designed to resist lateral displacement of the patella and maintain alignment 1
- Typically incorporate elastic materials like neoprene with straps or buttresses 1
- Effective for:
- Patellar subluxation/dislocation
- Patellar translation
- Chondromalacia of the patella
- Tendonitis 1
- Patients report subjective improvements in pain and disability 1
Functional Knee Braces
- Designed for knee instability following ligament injuries (particularly ACL) 1
- Indicated for:
- Support after ACL surgery
- Mild to moderate PCL or MCL instability 1
- Help control knee hyperextension and augment proprioception 1
- Limited evidence for long-term benefit in ACL reconstruction 2
Prophylactic Knee Braces
- Not routinely recommended for athletic competition 1
- Insufficient evidence of efficacy in reducing ligamentous knee injuries 1
- Strength training, conditioning, and technique refinement are more important for injury prevention 1
Effectiveness and Biomechanical Benefits
- Tibiofemoral braces can increase medial condylar separation by approximately 1.2 mm and change tibiofemoral coronal angle by about 2.2° 1
- Custom-made hinged knee braces with knee flexion support can significantly decrease knee adduction moment and increase knee flexion during swing phase 3
- Unloader braces with valgus and external rotation functions (VER-braces) and functional knee braces (ACL-braces) can significantly reduce peak knee adduction moment during terminal stance 4
- Patellofemoral braces improve patellar tracking through medially directed force 1
Fitting Considerations
For Tibiofemoral/Realigning Braces
- Select the longest brace that fits the patient's leg for maximum protection 1
- Try several different braces to determine best fit 1
- Custom braces are more expensive but provide few additional benefits over properly fitted off-the-shelf models 1
- Ensure proper hinge placement relative to femoral condyles for optimal performance 1
For Patellofemoral Braces
- Measure leg circumference according to manufacturer guidelines (typically 3 inches above and below mid-patella) 1
- Select corresponding brace size 1
- Position buttress supports properly and align patella in center of cutout if applicable 1
- Secure straps with moderate tension 1
- Regularly inspect for migration, loosening, or material fatigue 1
Limitations and Considerations
- Braces may increase energy expenditure and decrease agility during athletic activities 1
- Some patients report skin irritation with prolonged use 1
- Effectiveness depends on proper application and regular maintenance 1
- Optimal management requires clinicians familiar with various brace types and expertise in fitting 1
- Coordination of care between primary care providers, specialists, and brace providers is important 1
Conclusion for Best Type Selection
For maximum support and stability:
- For tibiofemoral osteoarthritis: A rigid realigning brace (double upright with hinge) provides maximum stability but consider patient tolerance and compliance 1
- For patellofemoral issues: A patellofemoral brace with lateral hinge and adjustable patellar buttress offers best support for active individuals 1
- For ligamentous instability: A functional knee brace appropriate to the specific ligament injury 1