Bracing of the Reconstructed and Osteoarthritic Knee during High Dynamic Load Tasks

HARVI F. HART, KAY M. CROSSLEY, NATALIE J. COLLINS, DAVID C. ACKLAND

Lateral compartment osteoarthritis accompanied by abnormal knee biomechanics are frequently reported in individuals with knee osteoarthritis after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to evaluate changes in knee biomechanics produced by an adjusted and unadjusted varus knee brace during high dynamic loading activities in individuals with lateral knee osteoarthritis after ACLR and valgus malalignment. Nineteen participants who had undergone ACLR 5 to 20 years previously and had symptomatic and radiographic lateral knee osteoarthritis with valgus malalignment were assessed. Quantitative motion analysis experiments were conducted during hopping, stair ascent and descent under three test conditions: (i) no brace, (ii) unadjusted brace with sagittal plane support and neutral frontal plane alignment, and (iii) adjusted brace with sagittal plane support and varus realignment (valgus to neutral). Sagittal, frontal and transverse plane knee kinematics, external joint moment and angular impulse data were calculated. Relative to an unbraced knee, braced conditions significantly increased knee flexion and adduction angles during hopping (p=0.003, p=0.005; respectively), stair ascent (p=0.003, p<0.001, respectively) and descent (p=0.009, p<0.001, respectively). In addition, the brace conditions increased knee flexion (p<0.001) and adduction (p=0.001) angular impulses and knee stiffness (p<0.001) during hopping, as well as increased knee adduction moments during stair ascent (p= 0.008) and flexion moments during stair descent (p=0.006). There were no significant differences between the adjusted and unadjusted brace conditions (p>0.05). A knee brace, with or without varus alignment, can modulate knee kinematics and external joint moments during hopping, stairs ascent and descent in individuals with predominant lateral knee osteoarthritis after ACLR. Longer-term use of a brace may have implications in slowing osteoarthritis progression.