OA brace after medial meniscetomy

[Juha_74]

Hi there,

I have been studying about OA-braces and I believe that they will help to reduce pain and using them will slow down prolong development of knee arthrosis in many cases. I am trying to find what is most suitable brace for my situation. I have only about 20% medial meniscus left and I have mostly pain in my knee.

What do you think about OA- braces after medial meniscectomy? Idea is that OA-brace is moving the pressure from medial side to lateral in the same way than high tibial osteotymy but it doesnt't require surgery of long rehab.

Medial joint space narrowing after meniscetomy



Same knee when OA-brace is unloading the medial joint space



I called to Don Joy and they recommend Defiance or Adjuster to me. Defiace is lighter and smaller. Adjuster is more robust.

Ossur recommends very similar braces to me. They are called Unloader One and OAsys. Unloader is dynamic and OA sys is static.

What do you think about these OA-braces? What product should I choose? I don't have valgus or varus in my legs.

Thanks in advance.

[splat]

They're OK while they hold their position on your leg, but once they slip out of place, the pain returns.

[jerlane]

You're talking about an "unloader" brace. Custom ones can work fairly well in the right situation. Off the shelf unloaders are junk in my opinion, and custom ones cost roughly $2500, . I've never heard of anyone using one prophylactically after meniscectomy, but I guess you could consider it. They are typically used once arthritis has set in to help delay the need for knee replacement.

The problem I see in using it the way you describe is that the braces are fairly cumbersome. Most people don't want to deal with them on a daily basis and typically just wear them when they are more active. Skiing, hiking, hunting, things like that. It's just not practical to use everyday. Now that you have lost the protection of the meniscus, you are at higher risk of arthritis which is obviously what you are hoping to avoid. Unfortunately, just routine day-to-day activity will eventually take its toll.

FWIW, the caption on the first photo above is not accurate. The bone on bone appearance highlighted by the red mark is a result of the loss of articular cartilage, not the loss of the medial meniscus. As I said above, meniscectomy sets you up for this, but if you took and xray the day after your surgery it would not look like this unless you already had advanced arthritis.

[kingdom-tele]

I agree with most of what jerlane has said, however, I have had good success with the ossur unloader 1 OTS braces, they are a pain in ass to get the straping dialed in, but once that is tweaked the brace is incredibly light, utilizes only a single hinge so a little less cumbersome and the padding uses a decent, skin friendly, non slip material

but, with any brace, they are leg dependent.

townshend also has decent unloader (double hinge design)

[jfost]

Ossur bought a company called Generation II that made the best OA "Unloader" style brace on the market. They used to be based in Bothell, WA... now they are at Ossur North America HQ in Aliso Viejo, CA.

We have found in our practice that the (now Ossur) GII Unloader single-sided joint unloader design is the best for pain relief, and function while in-brace.

Pete Townshend doesn't make unloader braces, but Townsend Design does! They have a fantastic joint that mimics the natural knee tracking, but not the best unloader IMHO.

In short, if I needed an ACL or PCL "functional brace" - I'd go Townsend, if I needed an unloader, go with the GII (Ossur) Brace.

[kingdom-tele]

Pete Townshend doesn't make unloader braces, but Townsend Design does!

Nice one.

Believe it or not, I was always the first one out in the third grade spelling bee contests.

[jfost]

TeeHee.

I've been thinking of how cool the graphics could be on the Pete Townshend "Baba OA'Unloader" signature model!

[Juha_74]

Hi guys,

You're talking about an "unloader" brace. Custom ones can work fairly well in the right situation. Off the shelf unloaders are junk in my opinion, and custom ones cost roughly $2500, . I've never heard of anyone using one prophylactically after meniscectomy, but I guess you could consider it. They are typically used once arthritis has set in to help delay the need for knee replacement.

The problem I see in using it the way you describe is that the braces are fairly cumbersome. Most people don't want to deal with them on a daily basis and typically just wear them when they are more active. Skiing, hiking, hunting, things like that. It's just not practical to use everyday. Now that you have lost the protection of the meniscus, you are at higher risk of arthritis which is obviously what you are hoping to avoid. Unfortunately, just routine day-to-day activity will eventually take its toll.

FWIW, the caption on the first photo above is not accurate. The bone on bone appearance highlighted by the red mark is a result of the loss of articular cartilage, not the loss of the medial meniscus. As I said above, meniscectomy sets you up for this, but if you took and xray the day after your surgery it would not look like this unless you already had advanced arthritis.

Jerlane, I'm afraid that you're right about the fact that day to day activity will lead to arthritis in my knee. That makes me sad but I have to do what I can to delay arthiris as much as I can. What do you think about using unloader to delay arthiris? I'm I just dreaming? I don't care if braces are cumbersome. I can life with that but this knee pain is killing me inside. I haven't done skiing, windsurfing or rock climbing after my meniscectomy due to the pain. I miss outdoor hobbies very much. The picture with unloader is just example.

I was thinking to buy Ossur Unloader 1 OTS. Kingdom-tele, have you skied telemark with Ossur Unloader 1? Does it work when you're knees are bending? I have understood that it works only when you're leg is straighten.

Jfost, I'm trying to find Ossur GII that you are talking about. I can't find it from Ossur website http://www.ossur.com. Do you know here I could find GII brace?
Many say that Townsend braces fit really nicely. I live in Scandinavia and I haven't found yet Townsend reseller here in Finland.

I was talking previously about pain in my knee. New MRI-pictures show that I have incipient knee arthritis and that is propably causing the pain.

MRI-pictures taken 2 weeks ago





Thanks guys. Nice tips.

[kingdom-tele]

Juha - realize from my perspective most of the people I have fit for unicompartmental OA relief are fairly inactive in comparison to people looking to get back to skiing, etc. Very different torque/compression of the joints.

The PT side of my practice would argue the best management for your knee would be to maximize the strength and stability of the joint, if the brace offers a small degree of help, great, but its only another piece of the puzzle like they say here, hard tellin not knowin.

good luck

[Juha_74]

Juha - realize from my perspective most of the people I have fit for unicompartmental OA relief are fairly inactive in comparison to people looking to get back to skiing, etc. Very different torque/compression of the joints.

Yep, I agree with you and my primary goal is to reduce knee pain in my daily routines. I understand that without medial meniscus I can't do any more high impact sports. If unloader brace is going to help me achieving that I will be more than happy.

We don't have Townsend brace reseller here in Finland so I think I have to choose Ossur braces. For day to day use I would choose Unloader One OTS and CTi OA brace for more active life.

Do you have experience which one is better, CTi OA or Defiance?

The PT side of my practice would argue the best management for your knee would be to maximize the strength and stability of the joint, if the brace offers a small degree of help, great, but its only another piece of the puzzle like they say here, hard tellin not knowin.

good luck

Yes, I try to gain muscle in the in future. Ossur representative talked to me that patients without meniscus usually increase leg muscle after they begin to use unloader brace due to the pain relief. If you're interested, read this study about Unloader One and this study about unloader braces for medial compartment.

X-ray pictures taken last week. Luckily I don't have varus or valgus in my lower limb.



Thanks guys

[fallguy]

i have used the ossur unloader for about 3 years now. most of lateral meniscus is gone along with the articular catilage. no pain during normal activities jogging, running, mt. biking, only when skiing. the brace helps with skiing, extending my day by 1-3 hours before pain really out weighs the fun. i'm looking at knee replacement at some point, but until then, the brace helps alot.

[Juha_74]

What happened to you're knee? I hope that you and I have many great year's in outdoor activities before knee replacement

Ossur and Don Joy representatives told me that dynamic unloader single (for instance Ossur Unloader One) is for normal daily activities and static and stiffer OA brace such as CTi OA, Don Joy Defiance OA are for active life and sports. They argument for the static unloader brace was that dynamic unloader is not working when we bend our leg while skiing, mountain biking, etc.

Dynamic single hinged Unloader One



Static double hinged CTi OA

[Juha_74]

They're OK while they hold their position on your leg, but once they slip out of place, the pain returns.

Splat, what OA-brace have you used? I'm considering between CTi OA and Defiance OA but it's hard to choose because they are both custom made and we can't test the brace before ordering the brace. Several end users have told me that Don Joy Defiance is slipping often out of place. Double hinged OA-brace is expensive investment so I'm trying to find the best brace in market.

[fallguy]

Juha, my injuries were from years of skateboarding in my teens and years of skiing after that. the orthopedist i saw is an ortho for the US Ski team and was well aware of my desire to continue to ski at a high level. after surgery i still had pain so we tried the ossur unloader select. it fits my situation better because of the loss of cartilage. also for me, a glucosomine supplement with Hyaluronic acid has helped.

[Purveyor of Slack]

WTF DOES YOUR ORTHO AND/OR PT SAY......Oh wait its fucking gimp fucking central


You sir are a dumb ASSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS

[Juha_74]

Dude, I live in tiny Finland and osteoarthritis-brace market area is really small here. Of course I have talked to my ortho and PT about OA-braces but they didn't have enough experience especially skiing with them. Comments above are important to me.

[thin cover]

I have a don joy custom "medial offloading" brace. It was a process to get it. It definitely helps me, not with the pain so much but definitely with lateral support. But my injury is more involved. The guy who gave me an hour seminar when he delivered it said that these are made for activities like skiing and I could definitely see how this would help tremendously when making turns for someone that is experiencing instability in the knee from injury. It was prescribed specifically for taking the load off my medial condial so that is can repair properly.

[Juha_74]

Hi there,

I have been using Unloader One for about 2 months and it really helps to reduce pain in medial side. I wear the medial unloader for about 16 hours every day, with no problem.

[Mack1]

Hi Juha,
Have you tried Durolane? It is hyaluronic acid that acts as a buffer for joints. I've had 5-6 injections since ~2005 and despite the cost, I would highly recommend it. Let me know if you need more info.

[Juha_74]

Hi Mack,

Yep. I have had my first Hyalgan hyaluronic acid injection last week. My doctor is giving two more injections coming in forthcoming weeks. I'm a bit suspicious towards hyaluronic acid injections, but one have to try everything to delay the arthritis

[drmark]

Almost all my patients who were given unloader braces wore them only a few times and were angry that I perscribed them.