Valgus bracing for knee osteoarthritis: a meta-analysis of randomized trials

To evaluate the effects of valgus knee bracing on pain and function, and compliance and complications, in patients with medial knee osteoarthritis (OA).

A meta-analysis of randomized controlled trials that compared changes in patient-reported pain and/or function in patients with medial knee OA was performed. Seven databases were searched from their inception to January 2014. Two reviewers independently determined study eligibility, rated risk of bias, and extracted data. Pooled estimates and 95% confidence intervals (95% CIs) for standardized mean differences (SMDs) for the improvement in pain (and function) were calculated. Event rates (proportions) were calculated for studies that reported complications.

Six studies were included in the meta-analysis. Overall, there was a statistically significant difference favoring the valgus brace group for improvement in pain (SMD 0.33 [95% CI 0.13, 0.52], P = 0.001) and function (SMD 0.22 [95% CI 0.02, 0.41], P = 0.03). When compared to a control group that did not use an orthosis, the effect size was moderate for pain (SMD 0.56 [95% CI 0.03, 1.09], P = 0.04) and function (SMD 0.48 [95% CI 0.02, 0.95], P = 0.04). When compared to a control group that used a control orthosis, only a small, statistically significant effect for pain remained (SMD 0.33 [95% CI 0.08, 0.58], P = 0.01). Instructions for brace use varied considerably and compliance ranged from 45% to 100%. Up to 25% of patients reported minor complications with brace use.

Meta-analysis of randomized trials suggests valgus bracing for medial knee OA results in small-to-moderate improvements in pain. Effect sizes vary based on study design and warrant future research.