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Research & Clinical Newsletter
January 2014
Bracing & Supports
Research & Clinical
In this newsletter (click on link):
A60 ANKLE BRACE is MORE EFFECTIVE THAN NEUROMUSCULAR TRAINING for REDUCING ANKLE SPRAIN RECURRENCE
SUCCESSFUL REHAB from HIP ARTHROSCOPY with X-ACT ROM BRACE
REVIEW RECOMMENDS ACL BRACING
REVIEW CONFIRMS EFFECTIVENESS of DONJOY OA BRACES is EVIDENCE BASED
SIMILAR DEGREE of PAIN RELIEF with VALGUS BRACE as with HIGH TIBIAL OSTEOTOMY
REVIEW CONFIRMS BRACING is RECOMMENDED CONSERVATIVE TREATMENT MODALITY for KNEE OA
LUMBAR CORSTETS may PREVENT THE DEVELOPMENT OF LBP IN GOLFERS
NEW RESEARCH PROJECT – CONSERVATIVE TREATMENT OF ACHILLES TENDON RUPTURE
Research & Clinical
A60 ANKLE BRACE is MORE EFFECTIVE THAN NEUROMUSCULAR TRAINING for REDUCING ANKLE SPRAIN RECURRENCE
47% less recurrent sprains
“Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial.” Janssen et al.
Br J Sports Med. 2014 Jan 7. [Epub ahead of print]
Purpose: To evaluate the effectiveness of combined bracing and neuromuscular training, or bracing alone, against the use of neuromuscular training on recurrences of ankle sprain after usual care.
Design: Randomised Controlled Trial
Subjects: 384 athletes who had sustained a lateral ankle sprain.
Methods: participants were randomly assigned to one of the three intervention groups:
training group: 8-wk home-based neuromuscular training programme,
brace group: Aircast A60 brace to be worn during all sports activities for 12 months,
combi group: training programme + brace for 8 weeks.
Outcomes:
Main outcome: self-reported recurrence of the ankle sprain.
Results:
47% reduction in risk of ankle sprain recurrence with A60 bracing versus neuromuscular training.
Conclusion: Bracing was superior to neuromuscular training in reducing the incidence (but not the severity) of self-reported recurrent ankle sprains after usual care.
iDJO link: http://intranet.djo.eu/en_US/variant-71426.html
SUCCESSFUL REHAB from HIP ARTHROSCOPY with X-ACT ROM BRACE
“Outcomes of endoscopic gluteus medius repair with minimum 2-year follow-up.” Domb et al. Am J Sports Med. 2013 May;41(5):988-97.
iDJO link: http://intranet.djo.eu/en_US/variant-69952.html
“Arthroscopic ligamentum teres reconstruction.” Lindner et al.
Arthrosc Tech. 2012 Dec 20;2(1):e21-5.
iDJO link: http://intranet.djo.eu/en_US/variant-69953.html
The X-Act ROM was part of a successful protocol in both studies for treating tears of ligaments / muscles around the hip joint endoscopically.
Research & Clinical
REVIEW RECOMMENDS ACL BRACING
controls anteroposterior laxity in ACL deficient patients
protects ACL after reconstruction
“Anterior cruciate ligament bracing: evidence in providing stability and preventing injury or graft re-rupture.”Bodendorfer et al.
Phys Sportsmed. 2013 Sep;41(3):92-102.
Purpose:
To review the available literature on the efficacy of knee brace use in the prevention and
treatment of patients with ACL injuries.
To identify populations that may benefit most from bracing.
Design: Review article
Results: bracing offers:
Prevention of anterior tibia translation mechanically by the brace but also through
improved muscle balance.
20-30% greater resistance to lateral blows to the knee.
Protection of failed ACL surgery but also of a successful reconstruction for highly active
athletes participating in high-impact sports.
Conclusion: Functional braces are recommended for ACL deficient patients and ACL reconstructed high-impact sports athletes.
iDJO link: http://intranet.djo.eu/en_US/variant-69975.html
EFFECTIVENESS of DONJOY OA BRACES is EVIDENCE BASED
42 OA braces identified on the US market
Only 15 have clinical evidence to support their effectiveness
“Osteoarthritic Knee Braces on the Market: A Literature Review.” Brooks.
J Prosthet Orthot. Jan 2014;26(1)2-30.
Purpose: to review the range of braces available on the US market and the clinical data supporting their efficacy in relieving symptoms and to provide an updated picture of each evidence based brace.
Design: Review article
Results & conclusions:
42 custom and off-the-shelf OA knee braces are currently available within the US, yet only 15 have evidence-based information to support their effectiveness.
DonJoy OA Adjuster, Nano and Defiance are on the short list of evidence based braces.
Research & Clinical
The clinical data of these braces support their effectiveness in reducing pain, improving function and also in delaying surgery, and clearly suggest that they do reduce excessive compressive and shearing loads that are responsible for pain in symptomatic OA.
This article offers an outstanding competitive summary of the OA Market. It maps out where we stand vs. the competition from a research standpoint.
iDJO link: http://intranet.djo.eu/en_US/variant-71425.html
SIMILAR DEGREE of PAIN RELIEF with VALGUS BRACE as with HIGH TIBIAL OSTEOTOMY
When a valgus brace provides pain relief, then high tibial osteotomy (HTO) will provide similar degree of pain relief.
A valgus brace can be used as predictive tool for selecting HTO candidates.
“Valgus bracing in symptomatic varus malalignment for testing the expectable "unloading effect" following valgus high tibial osteotomy.” Minzlaff et al.
Knee Surg Sports Traumatol Arthrosc. 2014 Jan 17. [Epub ahead of print]
Purpose: to evaluate whether the expectable postoperative pain relief following valgus high tibial osteotomy (HTO) is reliably predictable with the temporary use of an unloading knee brace preoperatively.
Design: Prospective clinical trial.
Subjects: 57 patients with symptomatic varus malalignment.
Methods:
6-8 wks valgus brace treatment
Positive Brace test = pain relief medially without initiated symptoms laterally.
In "positive" Brace-Test cases -> a valgus HTO was suggested as a promising surgical option.
Follow-up evaluation 1 yr postop.
Outcome: Pain VAS (10 points scale)
Results:
48 patients had positive brace test (mean VAS decrease 6.7 to 2.5 points)
29 underwent HTO
Same level of pain relief post- HTO as with 6-8 wk bracing
Conclusion:
Significant pain relief with 6-8 weeks use of a valgus brace is correlated to comparable pain relief after HTO surgery and can therefore be used as a test tool for predicting the effect on pain relief from HTO.
Unloading of the medial compartment leads to significant pain reduction in the affected compartment and can be achieved either non-invasively by using a malalignment adjusting brace or invasively by valgus HTO with no significant difference between these two treatment alternatives.
iDJO link: http://intranet.djo.eu/en_US/variant-71443.html
Research & Clinical
BRACING is RECOMMENDED CONSERVATIVE TREATMENT MODALITY for KNEE OA
Helpful to promote a physically active lifestyle and offload the affected joint.
“Nonoperative treatment of unicompartmental arthritis: from bracing to injection.” Bert et al.
Clin Sports Med. 2014 Jan;33(1):1-10.
Purpose: To review the use of conservative treatment of OA of the knee.
Design: Review article
Conclusion:
Conservative modalities of treatment of OA of the knee should be considered before consideration of more aggressive surgical approaches.
It is not uncommon to delay surgical intervention by several years by using a home program of weight loss, exercise, pharmacologic treatment, bracing, and injection therapy.
iDJO link: http://intranet.djo.eu/en_US/variant-71442.html
LUMBAR CORSTETS may PREVENT THE DEVELOPMENT OF LBP IN GOLFERS
Reduced lumbar rotations
Reduced lumbar hyperextension
“Lumbar corsets can decrease lumbar motion in golf swing.” Hashimoto et al.
J Sports Sci Med. 2013 Mar 1;12(1):80-7.
Purpose: To evaluate the effects of wearing lumbar corsets on the 3-dimensional motion of the trunk in amateur golfers.
Design: biomechanical study.
Subjects: 11 amateur golf players with no history of low back pain.
Methods: full golf swings were monitored with motion camera in three conditions:
without a corset
with a soft corset
with a hard corset
Outcomes:
Max ROM and angular velocity of lumbar rotation, flexion-extension, and lateral tilt
Rotation of the hip joint
Results & Conclusions:
Wearing lumbar corsets during a golf swing can effectively decrease lumbar extension and rotation angles and angular velocity.
The hard corset was most effective
Wearing lumbar corsets increased the rotational motion of the hip joint (compensatory) while reducing the rotation of the lumbar spine.
iDJO link: http://intranet.djo.eu/en_US/variant-71441.html
Research & Clinical
NEW RESEARCH PROJECT – CONSERVATIVE TREATMENT OF ACHILLES TENDON RUPTURE
Where: Denmark, Hidovre hospital in Copenhagen
Who: Dr. Kristoffer Barfod, PhD
2013: K. Barfod finished his PhD research on “Acute Achilles Tendon Rupture – Assessment of non-operative treatment”
Purpose of the thesis was to evaluate non-operative treatment of acute Achilles Tendon Rupture.
Background:
o Over the past decade a change in treatment of acute AT rupture away from operative towards non-operative treatment has taken place.
o However, the optimal non-operative treatment protocol remains to be clarified, particularly the role of early weight bearing during rehabilitation.
o There is a need for a clinically applicable and accurate measurement to detect patients in risk of developing AT elongation
Conclusions of his PhD thesis:
There is considerable variation in treatment algorithms across Scandinavia.
Operative treatment with early weight bearing is preferred treatment method.
In non-operative treatment, immediate weight bearing was found to be safe and recommendable (RCT – 60 patients - DJ Nextep Contour walker).
The novel ultrasound measurement by K. Barfod showed excellent reliability and acceptable validity.
2014: Continuation of AT research with support of DJO
Purpose: move more patients from operative to non-operative functional treatment by
Acquiring further insight into the optimal non-operative treatment protocol and the role early dynamic mobilisation in this protocol.
Validating reliable ultrasound measurement techniques allowing for distinguishing patients in need for an operation from those that don’t need an operation, based on the AT length in the acute phase.
Design:
Randomised controlled trial involving 130 patients.
All patients will use the AIRSELECT STANDARD for 6 weeks.