• 健児 村田

The Impact of Orthotic Therapy on Instability and Functional Improvement in Knee Joint Disease

The Impact of Orthotic Therapy on Instability and Functional Improvement in Knee Joint Disease - A Systematic Review


Kenji Murata*1, Takuma Sakakida2, Sora Kawabata3, Moeka Yokoyama4, Yuri Morishita5, Shunsuke Kita3, Kubota Keisuke1, Takuma Kano3, Takuma Kojima3, Terada Hidenobu3, Chiharu Takasu3, Naohiko Kanemura1


1 Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan

2 Department of Rehabilitation, Izumi Rehabilitation hospital, Chiba, Japan

3 Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan

4 Sportology Center, Graduate School of Medicine, Juntendo University, Tokyo, Japan

5 Department of Rehabilitation, Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan


Corresponding author: Kenji Murata, Ph.D.

Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University

Sannomiya 820, Koshigaya, Saitama 343-8540, Japan

Phone and Fax: +81-489-73-4123

Email: murata-kenji@spu.ac.jp


Keywords

ACL injury, Knee brace, Osteoarthritis, Joint instability, Systematic review


ABSTRACT

Purpose: Joint instability is a common joint dysfunction and a cause of musculoskeletal disorder and pain after anterior cruciate ligament injury and osteoarthritis. The aim of this literature review is to review the existing evidence regarding the impacts of knee brace in persons with joint instability, or laxity after knee disease concerning physical and functional outcomes.

Methods: A systematic search was performed at MEDLINE, Central Register of Controlled Trials (CENTRAL), PubMed, and PEDro and Web of Science databases until April 2, 2022, with their language limited to English. Studies to be included were randomized controlled trials (RCTs), controlled clinical trials, and controlled experimental studies that included comparison of interventions and no interventions testing effectiveness of orthotics in joint instability symptom patients

Results: Total 250 studies were retrieved and 12 articles met the inclusion criteria. Beneficial effects of knee braces appear to vary with disease. Self-reported instability may be improved with orthotics, while its effects are unclear in an objective assessment of joint instability. However, improved subjective instability lead to improved physical function.

Conclusion: Our aim is to provide information to both healthcare professionals with updated and high-quality recommendations for the management of instability joint condition. It is concluded that orthotic therapy may have a certain effect on subjective evaluation in joint instability.


Abbreviations

OA: Osteoarthritis

ACL: Anterior Cruciate ligament

PCL: Posterior Cruciate ligament


1.Introduction

Joint instability, excessive joint laxity, or hyper-mobility is a common finding of clinical importance in knee disease management. Anterior cruciate ligament (ACL) and osteoarthritis, among knee joint diseases, are commonly seen in young and elderly patients, and are representative orthopedic diseases that cause pain and functional impairment that limit activities of daily living and reduce quality of life. Main symptoms after ACL injury, are pain and intra-articular hematoma in an acute phase, and a number of cases that progress to knee joint functional decline including anterior tibial instability in a chronic phase and then to knee osteoarthritis (OA) due to degeneration of cartilage tissue[1–3] are finally seen. On the other hand, knee OA occurs in tibiofemoral and patellofemoral joints, and is regarded as a progressive, non-inflammatory or low grade-inflammation knee joint disease caused by increased mechanical stress that increases with age[4,5], muscle weakness[6], and joint instability[7,8]. Thus, joint instability is a common symptom in ACL injury and OA that affects physical functions and results in limitations in daily living[9].

Human have a number of joints and multiple bones connected to each other. Joint instability is a condition of excessive bone movement due to trauma, tears, or deformity, which elevates mechanical irritation to the surrounding tissues. In articular cartilage having joint instability, catabolism is increased in articular cartilage, resulting in complete loss of cartilage in the joint and progressive degeneration of cartilage tissue[10,11]. Treatment options for the joint instability are limited, such as reconstructive surgery after ACL or PCL injury and TKA for severe OA. However, in recent years, reports of conservative treatment after ACL injury have acknowledged the diversification of treatment as human and animal studies have shown signs of feasibility that are increasing [12–15]. Moreover, a certain level of effectiveness has been reported for conservative treatment, mainly physical therapy, for knee OA [16] and a systematic review of the study has also been reported[17]. In general, although muscle strengthening and joint range of motion exercises are the mainstays of conservative therapy, knee orthoses as an additional strategy have been reported to provide rest in an acute phase and dynamic stabilization in a chronic phase and beyond, as well as a sense of security and functional improvement for the patients themselves when wearing them not limited to knee disease [18–20]. In particular, it has been reported that soft orthotic and taping therapies improved functional outcomes and reduced instability in sprain patients.


In recent years, joint instability is a factor that decreases activities of daily living and quality of life in both ACL tears and knee OA. However, effects of orthotic therapy on joint instability in the knee joint are unknown for patients with ACL tears and OA associated with joint instability. The aim of this literature review is to review the existing evidence regarding the impact of knee brace in persons with joint instability, or laxity after knee disease concerning physical and functional outcomes. Moreover, we provide information to both healthcare professionals together with updated and high-quality recommendations for the management of instability joint condition.



2.Methods

2.1. Search protocol registration

The detailed protocol for this study was published in PROSPERO, an international database for the prospective registration of systematic reviews in the field of health and social welfare (PROSPERO record registration number: CRD Applied). In addition, this paper was finalized in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA guidelines) [21]. Studies were systematically searched until April 2, 2022. The electronic databases The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and PEDro were used to conduct the search, and a secondary search was conducted by hand research to address publication bias. Each database search strategy is described in Appendix 1 and the search was conducted by two researchers (KM and TS).




2.2. Study selection (primary screening)

The aim is to investigate impacts of knee brace therapy on ACL injury, PCL injury and OA with joint instability. After duplicate articles were removed for the studies retrieved from different databases, this study was screened by reviewing the title, abstract and language. Patients with knee joint disease included in the search for this study were those diagnosed with osteoarthritis of the knee (tibiofemoral joint) on radiographs or clinical examination, those with anterior cruciate ligament (ACL) injuries of the knee joint including postoperative management, and those with posterior cruciate ligament injuries. Patients with knee joint instability due to sequelae of stroke, children with knee joint disease, patients who underwent total knee arthroplasty or high tibial osteotomy, and patients with rheumatoid arthritis were excluded from the subjects for this review. In addition, the study design of the articles included in the search included randomized controlled trials (RCTs) and controlled clinical trials, as well as controlled experimental studies that included the diseases in question. Articles whose language was not English or studies whose full texts were unavailable were removed as the primary review.


2.3. Inclusion criteria (secondary review)

Each selected primary study was searched for secondary evaluation by two evaluators (KM and ST) independently based on eligibility criteria. Inclusion criteria were assumed that the articles to be extracted had been comparatively validated for the impact of knee brace therapy under the following conditions. First, selected article required a clear description of joint instability in methods and results. Seconds, we selected papers that assume comparative validation of various orthotics regarding custom-made orthoses. (1) compared orthosis with no treatment cases, (2) compared orthosis with conventional standard treatment, (3) compared conservative treatment with orthosis with surgical treatment, and (4) compared different types of orthoses. The following information was extracted from each eligible paper: author’s name, year of publication, disease of interest, study design, population characteristics (number and gender of participants, age, joint instability), comparison and validation groups and their intervention methods, outcome measures, evaluation follow-up period, and effect of orthotic therapy. Any disagreements between them were evaluated by a third party (SK) and papers were extracted.


2.4. Qualitative Evaluation of Studies

For the qualitative evaluation of each article, different measures were used for different study designs; for RCT studies, the quality of evidence from the systematic review was assessed by the Cochrane risk of bias tool[22]. The above is designed to assess the quality of evidence for each outcome measure across studies and consisting of random assignment order, blinding of group classification, blinding of participants and researchers, blinding of outcomes, withdrawal from the study, selective reporting, and other biases. The overall quality of evidence was assessed as Low, and Some was judged to be High. In addition, non-RCTs were evaluated by using the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS)[23], which is a risk of bias assessment tool for non-randomized studies and is designed to assess participant selection, confounding variables, exposure consisting of measurement, outcome blinding, incomplete outcome data, and selective outcome reporting. All evaluations were blended by using RevMan 5.



3.Results

3.1. Search results

We evaluated 271 papers in the first round of evaluation. Duplicate articles were removed, and 37 articles were selected by the final primary evaluation (Figure1). Among them, 37 articles underwent a secondary evaluation, and after strict verification of inclusion and exclusion criteria, 12 articles were finally included in the systematic review[19,24–34] (Table 1). Of the 12 papers selected, the number of included diseases was 2 for osteoarthritis of the knee[24,25], 8 for anterior cruciate ligament injuries (4 of which were postoperative)[19,28–34], and 2 for posterior cruciate ligament injuries (2 of which were postoperative) [26,27]. In addition, three of the study designs were RCTs[27,31–33] and nine of them were non-RCT studies[19,24–26,28–30,34].






3.2. Assessment of joint instability

Table 2 shows the disease-specific characteristics of the methods used to assess joint instability in the selected papers. In knee OA, joint instability was assessed by subjective self-report in the clinical findings and by Dynamic Instability in the experimental comparative studies[24,25]. On the other hand, the assessment of joint stability in ACL and PCL injuries has not been done by the examiner's subjective evaluation, such as the Lachman test and the anterior drawer test, and the quantitative evaluation, such as the amount of anterior and posterior drawer with devices such as the KT1000[19,30,31,33,34] and KneeLax [26], were conducted. Only Swirtun et al. used a subjective assessment of instability to evaluate joint instability after ACL injury[32].


3.3. Effects of Orthotic on Instability Associated with OA

Two studies that focus on pain and function in orthotic therapy for OA were extracted[24,25] . Regardless of type, orthotic wear soothed pain while walking and showed a positive short-term effect on activity limitation. On the other hand, the soft brace was the most effective orthotic for joint instability, and PR values indicating dynamic instability were improved with the soft brace compared to the case without soft brace. However, no effects are recognized in objective joint instability.





3.4. The effect of orthotic on instability associated with knee ligament rupture

Four studies conservative treatment after ACL injuries were extracted [28,29,32,34]. Evaluation that employed patients’ subjective results showed a positive impact for instability, while studies employing quantitative evaluation such as anterior draw volume revealed no significant effects. Therefore, differences in effects on joint instability were observed due to differences in evaluation methods. On the other hand, different types of orthoses showed different responses focusing on functions. Strutzenberger et al. indicated that dynamic instability is significantly decreased sleeve orthoses more than shell orthoses, and suggested that high orthotic area adhesion is positive for proprioception[29]. A similar result was reported by Palm et al. that soft knee braces improve postural stability in ACL tear patients by approximately 22% while they did not describe the mechanism by which bracing the knee itself improves the overall effect[28]. In addition, Swirtun, et al. found that patients with no operative acute ACL injury experienced a positive influence for instability and rehabilitation using orthotics though it was not significantly supported by objective evaluations[32]. Also, Risberg, et al. reported that orthotic was not difference for range of motion, muscle strength, pain, and knee function[19]. These results suggest that soft-tissue bracing may have a subjective effect on patients while there was no difference in objective assessment.





3.5. Effect of orthotic therapy after ACL and PCL reconstruction on knee instability

  Four studies were accepted for brace after reconstructive surgery following ACL injury[19,30,31,33]. However, there was no statistical difference in joint instability: soft brace vs. hard brace[30], functional brace orthosis vs. neoprene knee sleeve[31], and with brace vs. without brace[19,33]. The studies showed different results regarding functional improvement, and no effective evidence was obtained. Table 3 shows detail functional influence. For PCL injury, two articles were employed for orthotic therapy after reconstructive surgery [26,27]. Li et al observed effects of a tibial support brace on posterior deviation in the supine position after reconstructive surgery, with braces with tibial support that significantly increased Lysholm and IKDC scores compared to regular braces in PCL reconstruction. The other study revealed contribution of long leg cast immobilization to posterior stability after reconstructive surgery, showing significantly better results at 2 years postoperatively in Telos posterior stress radiograph and IKDC scores. On the other hand, both results showed no change in ROM.


3.6 Risk of bias

Risk of bias assessment of included RCT yielded Figure 2. For selection bias, Low risk of bias is 1 study, and unclear risk of bias is 3 studies. A majority of the RCTs did not provide adequate information to determine whether outcome assessors were blinded or whether researchers selectively reported the outcomes. On the other hand, detection bias and reporting bias is all high risk of bias. The predominant unclear and high risks of bias was anticipated as more of the included studies were retrospective RCT study.




4.Discussion

This systematic review examined the effects of orthotic therapy on joint instability related to ligament injuries and osteoarthritis, two of the most frequent knee joint diseases. These effects can be simplified by categorizing them into instability and function: for OA, patients were subjectively improved in terms of instability, though there are no studies that objectively assess instability. On the other hand, the effects of orthotics on OA patients have been shown to improve activity levels, though they were only due to a reduction in the patient's own anxiety caused by the orthotic. On the other hand, as for the effect of orthotics on instability after ligament injury, no objective numerical evidence of long-term effects of orthotics on stability or physical function was obtained. However, as with OA, there were scattered articles showing improved patients' subjective sense of anxiety. Although this point needs to be discussed, the type of orthosis may not have a significant impact after ligament injury and should only be used for postoperative protection.


Joint instability is caused by ligament injury, osteoarthritis, and hormone balance, and is a symptom in the form of the patient's self-joint insecurity during movement or activity. Alan et al. have proposed that joint instability should be divided into anatomic and functional instability, meaning that joint instability should be treated differently depending on whether it is caused by anatomic instability or functional instability. Instability in ligamentous injuries and instability in knee OA in this review should also be considered as different clinical findings of the same instability. Specifically, these differences are reflected in the evaluation methods. Although self-reports of joint instability during activity are used to assess joint instability in knee OA, these quantified values have not been presented by such objective evaluation[35,36]. These results are similar to those reported by Kawabata et al on the effects of exercise therapy in knee OA disease[17]. On the other hand, the evaluation of joint instability after ACL and PCL injuries is primarily based on quantification such the instability distance with a device, in addition to the therapist's subjective evaluation such as manual testing. In particular, Collins et al.[37] and Hewitt et al.[38] reported that one of the effects of orthoses in knee instability is the mediation of proprioceptive sensation. On the other hand, ACL and PCL injuries are anatomic injuries of torn ligaments, and recovery in proprioception may be judged as a difficult problem. These points might indicate that anatomical instability differs with the course of significant ligamentous injuries and chronic conditions such as OA.


The effect of orthotic therapy also differed between OA and ACL PCL injury. The effect of knee OA was positive for activities such as walking, as the reduction of dynamic instability and pain in the knee by wearing a soft-type knee orthosis improved confidence in the knee[24,25]. Kawabata et al. reported the effectiveness of exercise therapy, though they reported that it did not improve structural instability[17]. Others reported the possibility of improving instability depending on the severity and timing of OA[39] though there are sufficient evidence for these at this time. Moreover, it is also not clear whether orthotic wear controls intra-articular mobility. Draper et al. conducted a real-time MRI study of patellar kinematics and stated that normal sleeves did not control the motion of the brush skeleton[40]. They concluded that even in the patellofemoral joint, the intra-articular kinematic changes are minute and it is difficult to visualize them as effects. Therefore, it may be more likely that the effect of improving instability in knee osteoarthritis contributed to the improvement of intrinsic sensory-derived instability rather than structural instability. On the other hand, regarding the influence of ACL rupture showed a certain effect for subjective evaluation and laxity during movement including postural stability though objective results showed no such effects. However, a study using the custom-made orthosis also showed functional improvement which was debatable[34]. In general, orthotic therapy after ACL injury has certain benefits and is one of the standard methods for protection of wounds and limitation of motor function. In particular, postoperative rehabilitation after ACL or PCL injury, as it is well known that the effect of orthotic therapy after ACL or PCL surgery reduces the risk of re-tear, and therefore it is recommended. However, in this study, no evidence was available on whether different types of orthotics provide additional improvement in conservative therapy or postoperative rehabilitation after ACL or PCL injury


However, there are other reasons for knee joint instability. For example, we should consider the possibility that it may also be caused by differences in kinematic data such as hip, trunk, body center of gravity and foot pressure center. In this systematic review, caution in interpretation is needed regarding the fact that the improvement of instability is localized to the knee. In conclusion, however, we as therapists need to recognize a clear difference between the effects of orthotics on joint instability associated with ligament injuries and the effects of orthotics on joint instability in knee osteoarthritis.



5.Conclusion

The effects of orthotic therapy for knee instability might vary depending on diseases and evaluation means (Table 5). In knee OA, a reduction in patient subjective instability may result in functional improvement in activity level. Moreover, in orthotic therapy for a non-surgery case of ACL ruptures, patient subjective instability, may be reduced, and activity might be improved. However, it did not lead to objective improvements in function as seen in ROM and functional score. On the other hand, the effect of postoperative orthotic therapy led to a decrease in joint instability though was not influenced by the type of orthosis. Some studies showed that personalized orthotic therapy such as custom-made orthoses might have some functional effects.





Funding

This study was supported by JSPS KAKENHI (20K19417) Grant-in-Aid for Young Scientists.



Declaration of Competing Interest

Authors have no conflicts of interest to disclose.



Supplementary material

The following are the Supplementary data to this article:



References

[1] Blalock D, Miller A, Tilley M, Wang J. Joint instability and osteoarthritis. Clin Med Insights Arthritis Musculoskelet Disord 2015;8:15–23.

[2] Wang L-J, Zeng N, Yan Z-P, Li J-T, Ni G-X. Post-traumatic osteoarthritis following ACL injury. Arthritis Res Ther 2020;22:57.

[3] Alonso B, Bravo B, Mediavilla L, Gortazar AR, Forriol F, Vaquero J, et al. Osteoarthritis-related biomarkers profile in chronic anterior cruciate ligament injured knee. Knee 2020;27:51–60.

[4] Li Y, Wei X, Zhou J, Wei L. The age-related changes in cartilage and osteoarthritis. Biomed Res Int 2013;2013:916530.

[5] Greene MA, Loeser RF. Aging-related inflammation in osteoarthritis. Osteoarthritis Cartilage 2015;23:1966–71.

[6] O’Reilly S, Jones A, Doherty M. Muscle weakness in osteoarthritis. Curr Opin Rheumatol 1997;9:259–62.

[7] Schmitt LC, Fitzgerald GK, Reisman AS, Rudolph KS. Instability, Laxity, and Physical Function in Patients With Medial Knee Osteoarthritis. Phys Ther 2008;88:1506–16.

[8] Sharma L, Lou C, Felson DT, Dunlop DD, Kirwan-Mellis G, Hayes KW, et al. Laxity in healthy and osteoarthritic knees. Arthritis Rheum 1999;42:861–70.

[9] Ardèvol J, Bolíbar I, Belda V, Argilaga S. Treatment of complete rupture of the lateral ligaments of the ankle: a randomized clinical trial comparing cast immobilization with functional treatment. Knee Surg Sports Traumatol Arthrosc 2002;10:371–7.

[10] Murata K, Kanemura N, Kokubun T, Fujino T, Morishita Y, Onitsuka K, et al. Controlling joint instability delays the degeneration of articular cartilage in a rat model. Osteoarthritis Cartilage 2017;25:297–308.

[11] Onitsuka K, Murata K, Kokubun T, Fujiwara S, Nakajima A, Morishita Y, et al. Effects of Controlling Abnormal Joint Movement on Expression of MMP13 and TIMP-1 in Osteoarthritis. Cartilage 2020;11:98–107.

[12] Kano T, Kokubun T, Murata K, Oka Y, Ozone K, Arakawa K, et al. Influence of the site of injury on the spontaneous healing response in a rat model of total rupture of the anterior cruciate ligament. Connect Tissue Res 2022;63:138–50.

[13] Kokubun T, Kanemura N, Murata K, Moriyama H, Morita S, Jinno T, et al. Effect of Changing the Joint Kinematics of Knees With a Ruptured Anterior Cruciate Ligament on the Molecular Biological Responses and Spontaneous Healing in a Rat Model. Am J Sports Med 2016;44:2900–10.

[14] Gföller P, Abermann E, Runer A, Hoser C, Pflüglmayer M, Wierer G, et al. Non-operative treatment of ACL injury is associated with opposing subjective and objective outcomes over 20 years of follow-up. Knee Surg Sports Traumatol Arthrosc 2019;27:2665–71.

[15] Kessler MA, Behrend H, Henz S, Stutz G, Rukavina A, Kuster MS. Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment. Knee Surg Sports Traumatol Arthrosc 2008;16:442–8.

[16] Skou ST, Roos EM. Physical therapy for patients with knee and hip osteoarthritis: supervised, active treatment is current best practice. Clin Exp Rheumatol 2019;37 Suppl 120:112–7.

[17] Kawabata S, Murata K, Nakao K, Sonoo M, Morishita Y, Oka Y, et al. Effects of exercise therapy on joint instability in patients with osteoarthritis of the knee: A systematic review. Osteoarthritis and Cartilage Open 2020;2:100114.

[18] McCaughan D, Booth A, Jackson C, Lalor S, Ramdharry G, O’Connor RJ, et al. Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives. BMJ Open 2019;9:e029313.

[19] Risberg MA, Holm I, Steen H, Eriksson J, Ekeland A. The effect of knee bracing after anterior cruciate ligament reconstruction. A prospective, randomized study with two years’ follow-up. Am J Sports Med 1999;27:76–83.

[20] Portnoy S, Frechtel A, Raveh E, Schwartz I. Prevention of Genu Recurvatum in Poststroke Patients Using a Hinged Soft Knee Orthosis. PM R 2015;7:1042–51.

[21] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372. https://doi.org/10.1136/bmj.n71.

[22] Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343. https://doi.org/10.1136/bmj.d5928.

[23] Igelström E, Campbell M, Craig P, Katikireddi SV. Cochrane’s risk of bias tool for non-randomized studies (ROBINS-I) is frequently misapplied: A methodological systematic review. J Clin Epidemiol 2021;140:22–32.

[24] Cudejko T, van der Esch M, van den Noort JC, Rijnhart JJM, van der Leeden M, Roorda LD, et al. Decreased Pain and Improved Dynamic Knee Instability Mediate the Beneficial Effect of Wearing a Soft Knee Brace on Activity Limitations in Patients With Knee Osteoarthritis. Arthritis Care Res 2019;71:1036–43.

[25] Cudejko T, van der Esch M, van der Leeden M, van den Noort JC, Roorda LD, Lems W, et al. The immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence in patients with knee osteoarthritis. Arthritis Res Ther 2017;19:260.

[26] Li B, Shen P, Wang J-S, Wang G-B, He M, Bai L-H. Therapeutic effects of tibial support braces on posterior stability after posterior cruciate ligament reconstruction with autogenous hamstring tendon graft. Eur J Phys Rehabil Med 2015;51:163–70.

[27] Yoon KH, Park SW, Lee SH, Kim MH, Park SY, Oh H. Does cast immobilization contribute to posterior stability after posterior cruciate ligament reconstruction? Arthroscopy 2013;29:500–6.

[28] Palm H-G, Brattinger F, Stegmueller B, Achatz G, Riesner H-J, Friemert B. Effects of knee bracing on postural control after anterior cruciate ligament rupture. Knee 2012;19:664–71.

[29] Strutzenberger G, Braig M, Sell S, Boes K, Schwameder H. Effect of brace design on patients with ACL-ruptures. Int J Sports Med 2012;33:934–9.

[30] Mayr HO, Hochrein A, Hein W, Hube R, Bernstein A. Rehabilitation results following anterior cruciate ligament reconstruction using a hard brace compared to a fluid-filled soft brace. Knee 2010;17:119–26.

[31] Birmingham TB, Bryant DM, Giffin JR, Litchfield RB, Kramer JF, Donner A, et al. A Randomized Controlled Trial Comparing the Effectiveness of Functional Knee Brace and Neoprene Sleeve Use after Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2008;36:648–55.

[32] Swirtun LR, Jansson A, Renström P. The effects of a functional knee brace during early treatment of patients with a nonoperated acute anterior cruciate ligament tear: a prospective randomized study. Clin J Sport Med 2005;15:299–304.

[33] McDevitt ER, Taylor DC, Miller MD, Gerber JP, Ziemke G, Hinkin D, et al. Functional bracing after anterior cruciate ligament reconstruction: a prospective, randomized, multicenter study. Am J Sports Med 2004;32:1887–92.

[34] Wojtys EM, Huston LJ. “Custom-fit” versus “off-the-shelf” ACL functional braces. Am J Knee Surg 2001;14:157–62.

[35] Fitzgerald GK, Piva SR, Irrgang JJ. Reports of joint instability in knee osteoarthritis: its prevalence and relationship to physical function. Arthritis Rheum 2004;51:941–6.

[36] Irrgang JJ, Snyder-Mackler L, Wainner RS, Fu FH, Harner CD. Development of a patient-reported measure of function of the knee. J Bone Joint Surg Am 1998;80:1132–45.

[37] Collins AT, Blackburn JT, Olcott CW, Miles J, Jordan J, Dirschl DR, et al. Stochastic resonance electrical stimulation to improve proprioception in knee osteoarthritis. Knee 2011;18:317–22.

[38] Hewitt BA, Refshauge KM, Kilbreath SL. Kinesthesia at the knee: the effect of osteoarthritis and bandage application. Arthritis Rheum 2002;47:479–83.

[39] Fitzgerald GK, Piva SR, Gil AB, Wisniewski SR, Oddis CV, Irrgang JJ. Agility and perturbation training techniques in exercise therapy for reducing pain and improving function in people with knee osteoarthritis: a randomized clinical trial. Phys Ther 2011;91:452–69.

[40] Draper CE, Besier TF, Santos JM, Jennings F, Fredericson M, Gold GE, et al. Using real-time MRI to quantify altered joint kinematics in subjects with patellofemoral pain and to evaluate the effects of a patellar brace or sleeve on joint motion. J Orthop Res 2009;27:571–7.






閲覧数:3回0件のコメント