A knee brace can help some people with knee osteoarthritis, but it does not suit everyone.[1] A US guideline strongly recommends a brace for the main joint of the knee when osteoarthritis limits walking, stability or pain enough to need an assistive device.[1] In one small trial (31 completed), people with an unloader brace reported less pain than those without.[2]
- What is knee osteoarthritis?
- Can a knee brace help with knee arthritis pain?
- Can a knee brace help with kneecap pain?
- What has research found about knee braces?
- What else is used alongside a brace?
- Is a knee brace right for me?
- When does knee arthritis need more than a brace?
- When is urgent help needed?
- What should I do next?
What is knee osteoarthritis?
Osteoarthritis is the most common form of arthritis, affecting an estimated 302 million people worldwide.[1] The knees, hips and hands are the most commonly affected limb joints.[1]
Osteoarthritis involves the whole joint. The cartilage breaks down, the bone changes and the joint lining becomes inflamed, which leads to pain, stiffness, swelling and loss of normal joint function.[1]
A knee brace is also called a knee support or a knee guard.
Can a knee brace help with knee arthritis pain?
The 2019 guideline from the American College of Rheumatology and the Arthritis Foundation strongly recommends tibiofemoral knee braces for some people with knee osteoarthritis.[1] A tibiofemoral brace supports the joint between the thigh bone and the shin bone.
The guideline names who it is for. It is for people whose osteoarthritis in 1 or both knees has a large enough effect on walking, joint stability or pain to warrant an assistive device. It is also for people who can put up with the inconvenience and burden of wearing a brace.[1]
More on how the guideline words this
The guideline says a brace is for people with “a sufficiently large impact on ambulation, joint stability, or pain to warrant use of an assistive device”. Ambulation means walking.[1]
Can a knee brace help with kneecap pain?
Some knee osteoarthritis sits at the front of the knee, between the kneecap and the thigh bone. The guideline calls this patellofemoral knee osteoarthritis.[1]
For it, the guideline conditionally recommends a patellofemoral brace when the osteoarthritis has a large enough effect on walking, joint stability or pain to warrant an assistive device.[1] The guideline made the recommendation conditional because results varied across published trials and some people find these braces hard to tolerate.[1]
What has research found about knee braces?
An unloader brace is designed to take load off the more diseased side of the knee.[2]
In a 2016 trial of people with osteoarthritis on the inner side of the knee, 50 people were randomly assigned to an unloader brace or to no brace.[2] Thirty-one completed the study, 16 with a brace and 15 without.[2] The authors’ institution received research funding from the company that makes the brace.[2] The brace group reported significantly less pain, fewer arthritis symptoms and better ability to take part in daily activities.[2] There was no difference in function in sport and recreation or in knee-related quality of life.[2] There was no difference in ability to sleep or in use of anti-inflammatory medicines.[2]
A systematic review of 31 studies and 619 patients looked at valgus offloader braces for osteoarthritis on the inner side of the knee. Most of the studies reported improved pain. Results varied on whether function and stiffness improved.[3]
More on the limits of this research
- The brace used in the 2016 trial was a medial unloader brace, made for osteoarthritis on the inner side of the knee.[2]
- The authors’ institution received research funding from the company that makes the brace. The company contributed to the study’s conception and design, and was not involved in collecting, analysing or interpreting the data, in writing the paper or in submitting it for publication.[2]
- The trial aimed for 30 people in each group and did not reach that number, because enrolment was difficult under the strict study criteria.[2]
- Of the 50 people assigned, 19 dropped out. In the brace group 4 left because of brace discomfort. In the control group 5 left because of significant pain and a wish for more aggressive treatment.[2]
- Both groups could keep using their usual treatments, including anti-inflammatory medicines, home exercises and joint supplements. The authors said some of the improvement could be due to these other treatments, which were not rigidly controlled.[2]
- The systematic review said larger prospective randomized trials with consistent outcome measures would help to work out the effects of valgus offloader bracing.[3]
What else is used alongside a brace?
A brace is one option among several. The guideline strongly recommends:
- Exercise for knee, hip and hand osteoarthritis.[1]
- Weight loss for knee and hip osteoarthritis in people who are overweight or obese. The guideline says the benefit of weight loss for symptoms is enhanced by an exercise programme.[1]
- A walking stick (cane), when the osteoarthritis has a large enough effect on walking, stability or pain.[1]
- Tai chi for knee and hip osteoarthritis.[1]
The guideline conditionally recommends heat or cold applied to the joint.[1]
Medicines and injections are covered on separate pages: how to manage arthritis pain and knee injections.
Is a knee brace right for me?
That depends on which part of the knee is affected and how much it limits you. The guideline says that good bracing is likely to need clinicians who know the different types of brace and have expertise in fitting them.[1] It also says that care should be coordinated between primary care providers, specialists and providers of braces.[1]
The authors of the 2016 trial wrote that not all patients are candidates for braces.[2] They wrote that braces can be irritating and uncomfortable for people with obesity and for people with skin or vascular issues, and that some people find braces inconvenient.[2]
A doctor can assess which part of the knee is affected and whether a brace suits it.
When does knee arthritis need more than a brace?
Surgery for osteoarthritis is only needed in a small number of cases, where other treatments have not been effective or where daily life is seriously affected.[4] Even then, surgery cannot be guaranteed to get rid of your symptoms altogether.[4]
The total knee replacement and partial knee replacement pages explain those operations and how the decision is made.
When is urgent help needed?
The list below covers the signs that should not wait for a routine appointment.
What should I do next?
If knee pain is not settling, or you are unsure what is causing it, an assessment is a sensible next step. The assessment brings together the patient’s story, an examination and any tests that help, so that the patient and the surgeon can decide together. It looks at the structure involved, the patient as a whole person and the goal they want to return to. An appointment supports an informed decision. It is not a commitment to surgery.
- Read about the Knee Hub.
- Arrange a knee assessment when you are ready.
This page provides general information and cannot diagnose an individual condition. OrthoKinetics does not provide emergency or urgent care through this webpage or its WhatsApp contact.
References
- Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2020;72(2):149-162. doi:10.1002/acr.24131. PMID 31908149. PMC11488261.
- Ostrander RV, Leddon CE, Hackel JG, O’Grady CP, Roth CA. Efficacy of unloader bracing in reducing symptoms of knee osteoarthritis. Am J Orthop (Belle Mead NJ). 2016;45(5):306-311. PMID 27552455.
- Gohal C, Shanmugaraj A, Tate P, et al. Effectiveness of valgus offloading knee braces in the treatment of medial compartment knee osteoarthritis: a systematic review. Sports Health. 2018;10(6):500-514. doi:10.1177/1941738118763913. PMID 29543576.
- NHS. Osteoarthritis: treatment and support. https://www.nhs.uk/conditions/osteoarthritis/treatment/ (page last reviewed 20 March 2023).
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