Is a knee brace recommended for an adult patient with knee osteoarthritis (OA)?

Should Someone Wear a Brace for Knee OA?

Yes, tibiofemoral knee braces are strongly recommended for patients with knee osteoarthritis when the disease causes sufficient impact on ambulation, joint stability, or pain to warrant use of an assistive device. 1

Type-Specific Brace Recommendations

Tibiofemoral Braces (Strong Recommendation)

• Tibiofemoral braces are strongly recommended for unicompartmental knee OA, particularly when malalignment is present and the disease significantly impacts walking ability, joint stability, or pain levels. 1, 2
• These braces work by redistributing mechanical loads across joint compartments, which can significantly reduce pain and improve function with minimal adverse effects. 1, 3
• Brace modalities have demonstrated significant pain and functional improvements and can prolong the time to total knee arthroplasty. 3
• Optimal management requires clinicians who are familiar with various brace types and have expertise in proper fitting. 1

Patellofemoral Braces (Conditional Recommendation)

• Patellofemoral braces are conditionally recommended for patellofemoral knee OA when disease causes sufficient impact on ambulation, stability, or pain. 1, 2
• The recommendation is conditional due to variability in results across trials and the difficulty some patients have tolerating the inconvenience and burden of these braces. 1
• Patellofemoral braces with adjustable patellar buttresses may be better tolerated than rigid extension splints. 4

Important Caveats and Contraindications

What NOT to Use

• Lateral and medial wedged insoles are conditionally recommended against, as the available literature does not demonstrate clear efficacy. 1, 4
• Modified shoes are conditionally recommended against for knee OA. 1
• The 2009 AAOS guideline found insufficient evidence to recommend for or against braces with valgus- or varus-directing forces for medial unicompartmental OA. 1

Patient Tolerance Considerations

• Bracing is associated with inconvenience and burden that some patients cannot tolerate. 1
• Coordination of care between primary care providers, specialists, and brace providers is essential for optimal outcomes. 1
• Having sample devices in clinic for patients to try can improve compliance. 4

Alternative Mechanical Interventions

When Braces Are Not Tolerated

• Canes or walkers are strongly recommended when knee disease significantly impacts ambulation, joint stability, or pain, providing mechanical unloading without the burden of wearing a brace. 1, 4
• Kinesiotaping is conditionally recommended as it permits range of motion while providing support, in contrast to braces that maintain fixed positions. 1, 4
• Knee sleeves may effectively reduce pain through improved proprioception and warmth, though they don't provide mechanical stability. 4

Integration with Comprehensive Treatment

Bracing Should Not Be Used Alone

• Bracing works best when combined with core non-pharmacological interventions, including exercise programs, weight loss, and patient education. 2, 3
• Quadriceps strengthening with concurrent hamstring stretching is more important than any passive modality alone for long-term outcomes. 4
• Exercise programs, including strengthening and aerobic fitness training, should be implemented simultaneously with bracing. 2
• Weight loss is recommended if BMI >25, as even modest reduction can significantly improve pain and function. 2

Pharmacological Adjuncts

• Topical NSAIDs are recommended as first-line pharmacological management for localized knee pain when used with bracing. 2
• Intra-articular corticosteroid injections are recommended for acute flares with effusion, providing relief for up to 3 months. 2

Clinical Decision Algorithm

Step 1: Assess whether disease causes sufficient impact on ambulation, joint stability, or pain to warrant an assistive device. 1

Step 2: Determine compartment involvement:

• For tibiofemoral/unicompartmental OA with malalignment → strongly recommend tibiofemoral brace 1, 2
• For patellofemoral OA → conditionally recommend patellofemoral brace 1, 2

Step 3: If patient cannot tolerate brace burden → consider cane/walker (strong recommendation) or kinesiotaping (conditional recommendation). 1, 4

Step 4: Always combine with mandatory quadriceps strengthening, weight loss if BMI >25, and patient education. 2, 4

Step 5: Consider referral to physical or occupational therapy for proper fitting, training, and education about alternatives. 4