Unloader Knee Braces After Tibial Plateau Fractures

Unloader knee braces are often used by those who have sustained a tibial plateau fracture and want to return to sports such as skiing.

A tibial plateau fracture is a break through the top of the shin bone at the knee joint.

It is an "intra-articular" fracture meaning that the break goes through the joint surface itself. This leads to a significantly higher risk of osteoarthritis. Because of this, active people are using an unloader knee brace to decrease the load on the affected compartment when they return to demanding sports like skiing.

Many surgeon explain to their tibial plateau fracture patients that they will need a knee replacement at some time in the future. The only thing that is unknown is when. Anyone looking to test their knee in more physically stressful sports should investigate non-operative ways of decreasing the forces through their knee.

Are Unloaders Hot To Wear?

Those living in warm climates often ask how hot they are going to be wearing an unloader knee brace in summer.

Modern unloaders are not enclosed braces and as such are much cooler to wear than a neoprene sleeve or other type of covered brace.

They are not as cool as wearing nothing but many are surprised.

In very hot areas it is often wise to buy an extra set of padding and straps so you can wash one set while the other is on the brace. Rotating them makes a huge difference and extends the life of the softgoods.

How Long Do Unloader Knee Braces Last?

Knee Osteoarthritis is a chronic condition and unloader knee braces need to be able to provide long term support. The big manufacturers all have a warranty on their flagship products:

The Donjoy OAdjuster comes with a one year warranty on the frame and hinges and six months on the softgoods.

The Ossur Unloader comes with a two year frame and hinge warranty and six months on the softgoods.

The Bledsoe Thruster has 3 years on the hinge, one on the frame, and 90 days on the softgoods.

All of these braces have been around for a number of years and have shown themselves to be up to the job long term.

Unloader Knee Braces and Watersports

Another common question: Can I wear an unloader during watersports?

This depends on the brand. Not all are designed to be worn in the wet but some such as the Donjoy OAdjuster are regularly worn by surfers.

Although they tolerate water well, getting sand in the hinges is not advised.

If you have a specific sport or functional task in mind, check the capabilities of your chosen unloader knee brace before you buy.

Different names

An Unloader knee brace can also be known as an offloading knee brace.

It is also included in the category term Arthritis Knee Brace but this would also include basic products that do not provide an unloading force.

The use of the word "unloader" is becoming much more common and it will probably take over completely from offloader soon.

Can You Use Unloader Knee Braces For Rheumatoid Arthritis?

Rheumatoid arthritis is a systemic disease and as a result is widespread and not focused on just one area of the body. Each joint that is affected also has widespread arthritis so unlike unicompartmental knee osteoarthritis, there is no "good" half of the knee to unload onto. 

For this reason, Unloader Knee Braces should not be used by those suffering from Rheumatoid Arthritis.

A basic knee support may be of help in these cases.

Can you use an Unloader Knee brace with widespread arthritis?

Modern unloader knee braces decrease the workload of the worn half of the knee by shifting the body weight to the other side.

If both sides of the knee are worn there is no "good" side and any unloading of one side is likely to aggravate the other.

In this case a basic knee support is a better idea (and cheaper) than an Unloader Knee Brace

Can Unloaders Be Worn Prior to High Tibial Osteotomy?

Both an Unloader Knee Brace and a High Tibial Osteotomy aim to unload the affected compartment of the knee. An osteotomy does this on a permanent basis through the realignment of the bones, an Unloader does this by applying an external force and can be adjusted to suit. An unloader cannot correct as much as an osteotomy but comes with significantly less risks.

Unloaders can be used prior to osteotomies and can help to delay the need for one. Some surgeons place all of their osteotomy patients in an unloader prior to surgery.

This makes sense as it is a way to "try before you buy" and approximates the effects of the surgery.

Can you Ski in an Unloader Knee Brace?

Another common question is about the types of sports that can be done in an Unloader Knee Brace.

The latest generation of unloading braces are very functional and are designed to allow a high level of activity.

Aerial skiers in the Olympic Games frequently wear ACL braces on both legs and these braces are very similar to unloaders such as the Donjoy OAdjuster.

If they can do triple backflips in two braces you can probably make it down the slope in one.

 

Can you wear two Unloader Knee Braces?

Many people unfortunately suffer from knee osteoarthritis in both legs. This prompts the question: "Can you wear an unloader knee brace on both legs at the same time?"
The answer is generally Yes.
Modern unloading knee braces are very low profile ensuring they don't get in the way of each other.
The Donjoy OAdjuster previously had the unloading hinges prominent on the frame but the current model has addressed this making it easy to wear two at once.

Most people try out an unloader on the worst knee and if they get a good result move on to the second.

Varus or Valgus?

When choosing an unloader knee brace there is one thing you have to be certain about....

Which side of your knee the osteoarthritis is on.

Is it the inside (most common) or outside half of your knee?

If it is the inside part of your knee your Doctor may say you have a Varus knee - what is commonly called bowlegged.

When the outside half is worn, the foot tends outwards and this is described as having a Valgus knee. You may call it being knock-kneed.

An Unloading Knee Brace will only work if you get the right one. The wrong one will not only fail to help,it is likely to increase symptoms.

Knee Arthritis Community

One of the best online forums for all things related to the knee is:

http://www.kneeguru.co.uk/KNEEtalk/

There are sections on acute sporting injuries all the way through to knee osteoarthritis.

There is a good mix of health professionals, the first time injured and the old battle-axes who have been through many operations.

There is a lot of talk about operations but you will also find the odd discussion on non-surgical treatments like Hyaluronic acid injections, exercise and unloader knee braces.

It is a good place to catch up on developments and new procedure that may not yet be available in your country (e.g.the LARS ligament for ACL reconstructions). I go there frequently to catch up on the latest osteoarthritis news and I recommend registering or just browsing the forum topics to see if there is anything that interests you.

 

Unload - Don't Overload

Unloader Knee Braces apply a force to the leg that decreases the load on the affected area of the knee joint.

The inside half of the knee (the medial side) is more commonly affected. Unloader braces push or pull the lower part of the leg outwards, decreasing the load on the inside. Most brace companies also make a brace that can offload the outside half of the knee for those with lateral joint osteoarthritis.

If you got confused and ordered the wrong brace, not only wouldn't you be offloading the arthritic area, you would be compressing the worn part of the joint. This is likely to greatly increase your pain and other symptoms.

The moral to the story: If there is any doubt as to where you arthritis is located, speak to your doctor first.

This knowledge is absolutely required before you buy an unloading knee brace.

High Tibial Osteotomy Complications - Opening Wedge Vs Closing Wedge

A  recent sturdy looked at the incidence of complications in the two types of high tibial osteotomy.

They found that outcomes were similar for both procedures and there was no statistically significant difference in the rate of complications.

They did note that one of the biggest predictors of complication was patient obesity.

 

Those considering a High Tibial Osteotomy should first investigate the use of an Unloader Knee Brace. This non-operative management also aims to reduce the load through the worn half of the knee but is essentially risk free. An unloader brace may buy you a few extra years and delay the need for major surgical interventions such as osteotomies and joint replacements.

 

For more on the osteotomy article click here.

 

Seaweed Extract to treat Knee Osteoarthritis

Seaweed extract has been found to have anti-inflammatory properties.

An Australian study has looked at the effect of some of these extracts on knee osteoarthritis

They found very promising results but the results need to be taken with a grain of salt because:

It was a very small study (only 12 subjects)

The study was not blinded and did not have a control

It was funded by the manufacturer.

 

The results therefore are nothing more than an indication that more research is required. As the authors note, it is time for a double blinded, randomized control study. If the results are as promising in the next round everyone will stand up and notice.

 

See the study here.

Acupuncture no better than placebo for Knee Osteoarthritis

A study comparing acupuncture with a placebo control (sham acupuncture) has found no benefit for those suffering from knee osteoarthritis.

http://www.medicalnewstoday.com/articles/198017.php

It is unlikely to harm but unlikely to help it seems.

For non-surgical treatments you can stick to the trusted options:

• Weight Loss
• Quadriceps strengthening exercises
• Unloader knee Braces

OA Assist Unloader Knee Brace

When talking about single hinge unloader knee braces I often mention the Unloader One and Thruster. Both of these are designed for moderate to severe cases.

The OA Assist by Donjoy is an excellent single upright unloader for mild to moderate knee arthritis.

 

Here is a brief video on the OA Assist:

 

Of all the unloader knee braces on the market this has to be one of the easiest to fit. Strap it on and off you go.

Unloader One Animation

Here is an animation by Ossur demonstrating the indications for use of their Unloader One knee brace.

I do note that the knee shown has osteoarthritis in both the medial and lateral compartment. This is a mistake on their part as the whole reason you use an unloader knee brace is to shift the body weight away from the bad side and onto the good side.

If you don't have a "good" side to shift onto, you should not use the brace.

Unloader Knee Braces are for unicompartmental osteoarthritis which is arthritis in one half of the knee only.

Buy Time With an Unloader Knee Brace

One of the best reasons to uses non-surgical treatments is to buy yourself some time. Avoiding having a knee for 10 years and you benefit from the advances in technology that occur in that period of time.

 

With an aging population, there are billions of dollars to be made in the field of arthritis treatment so the amount of money invested has been rising rapidly. This is good news for anyone suffering from osteoarthritis. Stem cell research (see here for an example) is one such area where there have been promising early results.

There is no point waiting until you can't walk at all before having surgery but there is a lot to be gained by delaying it with the use of aids such as an unloader knee brace

Arthritis Foundation Supports Unloader Knee Braces

Just reading about the Arthritis Foundation quoting the American Academy of Orthopedic Surgeons saying that unloader knee braces

"may provide significant reduction in pain when properly fitted in selected patients with osteoarthritis of the knee."

The Physician and Sports Medicine Journal added this "ongoing research provides solid evidence that the [design] of these braces can normalize joint mechanics"

It seems that as a non-operative treatment, unloader knee braces are becoming increasingly popular as the evidence supporting them grows

The Unloader Knee Brace to treat osteoarthritis

What's all this about unloader knee braces?

 

Well if you have an arthritic knee, the old way of managing it was pain killers, and pain killers, and more pain killers until things got so bad you had a knee replacement.

 

These days the aim is to treat this disease every step along the way. That means using tactics like exercise, weight loss and the unloader knee brace.

 

Here is a simple animation I found on knee arthritis 

Sums it up pretty well.

Sound familiar to anyone?