Are Unloader Braces Effective?

So the knee pain you’ve been experiencing has really been cramping your style, but you’re not about to let that keep you down. You need support and pain relief, so you take to the internet in search of the perfect knee brace. Who knew there were so many knee braces out there? How can you possibly know which brace is the right one for you? And what is an unloader brace anyway?

Unloader Knee Braces - What Are They?

Unloader braces are a classification of knee braces that work by unloading weight from one or more parts of the knee. Unloader braces are used to achieve the goals of easing pain, preventing further damage, and providing additional support and stability.

They offer a conservative treatment option for many patients with mild-to-moderate osteoarthritis (OA), a condition that causes the breakdown of the cartilage coating the bones of the joint. This cartilage separates the bones and cushions the space between them. If your knee OA has progressed to the point that there is little-to-no cartilage left, your doctor may have told you that you’re “bone-on-bone” – Ouch!

Unloader Knee Braces - How Do They Work?

Body weight combined with gravity generates a great deal of shock for our knees to absorb when they’re bearing weight. This results in greater contact force between the cartilage coating the bones, eventually wearing the cartilage down and causing pain and inflammation. By redistributing the weight away from the painful part(s) of the joint, unloaders decrease the friction between the bones in the area and alleviate pain as a result

Types of Unloader Knee Braces

To better understand the types of unloader knee braces and determine the type that would benefit you the most, you’ll first need to understand the parts of the knee that arthritis can affect. 

Let’s take a quick look at the anatomy of our knees. Osteoarthritis can occur in three separate compartments of the knee joint: (1) the inner (medial) compartment, (2) the outer (lateral) compartment, and (3) the compartment beneath the kneecap (patellofemoral compartment).

icarus medical diagram image

Figure 1. Basic Anatomical Figure 

Three bones make up the knee joint: The femur (thigh bone), patella (knee cap), and the tibia (shin bone). Cartilage covers the surfaces of where these bones meet to provide separation and cushioning. Our quadriceps merge to form a tendon that covers the patella and connects to the tibia. When we flex our quads, this tendon is pulled upward, drawing the patella up into the femur.

Alright, now that we’ve brushed up on some anatomy, let’s get into the braces, their benefits, and how they work!

 

Uni-Compartmental Unloader Knee Braces

Traditional unloader braces typically unload weight from only one compartment of the knee. These are known as uni-compartmental unloaders. This type of brace redirects weight away from either the medial or lateral compartment of the knee, typically whichever has more damage and is more painful. Shifting weight away from the problem region reduces the friction between the bones and can help alleviate pain as a result. The take-home message is this – Traditional, AKA uni-compartmental, unloader braces “unload” weight from one of three regions of the knee joint.

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Figure 2. Uni-compartment Unloading with 3-Point Pressure Systems

The figure above shows pain localized to the medial compartment of the knee. The red arrow extending downward represents the downward force being absorbed in that region. When wearing a uni-compartment unloading brace, more specifically, a medial unloader, this downward force decreases in strength as indicated by the shorter red arrow. To unload the medial compartment, the brace is designed with a 3-point pressure system. The locations and directions of these forces are shown by black arrows. By applying pressure at these locations, the brace forces the medial compartment open, reducing the magnitude of the downward force in the medial compartment.

Uni-compartmental unloader braces are often helpful for patients with unilateral meniscus tears or unilateral arthritis.

Multi-Compartmental Unloader Knee Braces

What if arthritis is affecting more than just one compartment of your knee, or is localized behind your knee cap? In 87%-94% of patients with medial and/or lateral OA, the area between the kneecap and thigh bone (patellofemoral compartment) is also affected 1,2. Does your pain increase when you stand up from a squat or seated position, and go up and/or down steps? If the answer to any of these questions is yes, your patellofemoral compartment may also be affected. The Icarus Ascender knee brace brings the first effective bracing option to the market for people experiencing such pain.

The patented tensioning system is the hallmark of the Ascender’s functionality. By adjusting a dial at the top of the brace, you can dynamically change the amount of tension in the hinges. Imagine you’re pulling on a rubber band – The farther back you stretch the rubber band, the stronger and faster it will fling forward when you take release it. Now, imagine you’re in a deep squat – The more tension you add to the brace hinges, the stronger the assistive force springing you back to a standing position will be. The tension in the hinges assists our quads, reducing the force driving the patella into the femur. The assistance from the Ascender effectively reduces pain for patients who are already experiencing bone-on-bone contact and may minimize further damage to the cartilage in the joint.

Figure 3. Multi-compartment Unloading with Ascender Knee Brace

To unload all three compartments of the knee joint, Icarus designed the Ascender to assist you when straightening your leg, resist bending of your leg, and absorb shock otherwise absorbed by your knee. The resistance you experience when bending your leg as well as the assistance you experience when straightening (extending) your leg both reduce the force driving your patella into your femur by up to 40 lbs. The shock absorbed in your medial and lateral compartments also decreases.

To ensure every user gets as much relief as possible from their Ascender, we’re also able to model the same 3-point pressure system seen in unicompartmental unloaders into the Ascender brace. This provides additional unloading in the medial or lateral compartment, whichever is more painful. This is commonly done for patients with damage in both their patellofemoral compartment and either the medial or lateral compartment. Without the 3-point pressure system, the Ascender unloads weight from all three compartments of the joint.

What's The Best Unloader Knee Brace?

Unloader knee braces can unload weight from 1, 2, or all 3 compartments of the knee joint. Traditional unloader knee braces use a 3-point pressure system to unload unicompartmentally. The Ascender introduced a new class of knee brace by offering options to patients with both bi- and tri-compartmental damage.

Unloader knee braces are typically made from metal, plastic, or a combination of both. Depending on the brand and type of traditional unloader brace, many can be custom-made to fit the individual and some offer adjustability in the amount of force being redistributed.

We understand that no two people have the same clinical history or experience the same pain, so making the Ascender as tailored to each individual’s needs as possible has always been a top priority in our research and development efforts. Our patented tensioning system allows for dynamic assistance across the entire joint, and the benefits of the Ascender brace don’t stop there. Most custom braces are made by heating and adjusting the shape of prefabricated braces. Our scan-to-3D print technology allows us to design braces intended for the optimal fit and function for the individual patient from the start.

Do I Need an Unloader Knee Brace?

Many patients with a range of diagnoses benefit from wearing knee braces, as they often provide additional pain relief, support, and stability to the knee joint. 

Talk with your doctor about your knee symptoms and let them help you choose the right brace for your diagnosis/ diagnoses. Icarus Medical’s Ascender knee brace offers a cost-effective, highly-customizable option for patients with a range of conditions. The cost of the Ascender brace averages around $150 after insurance and is designed to provide maximum support and comfort for each individual leg. Our mission is to have you moving and exercising the way you used to as quickly, safely, and free of pain as possible. Don’t wait to get the support you need and deserve. Your joints affect your mobility for the rest of your life and that is an investment worth making!

  1. Duncan, R. C., Hay, E. M., Saklatvala, J. & Croft, P. R. Prevalence of radiographic osteoarthritis—it all depends on your point of view. Rheumatology 45, 757–760 (2006).
  2. Heekin, R. D. & Fokin, A. A. Incidence of Bicompartmental Osteoarthritis in Patients Undergoing Total and Unicompartmental Knee Arthroplasty: Is the Time Ripe for a Less Radical Treatment? J. Knee Surg. 27, 077–082 (2014).
  3. (https://orthoinfo.aaos.org/en/treatment/unicompartmental-knee-replacement/)
    1. Figure 1
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