Abstract
BackgroundPatellar stabilizing braces are used to alleviate pain and prevent subluxation/dislocation by having biomechanical effects in terms of improved patellar tracking. The purpose of this study is to analyze the effects of the dynamic patellar realignment brace, Patella Pro (Otto Bock GmbH, Duderstadt, Germany), on disease determinants in subjects with patellofemoral instability using upright weight-bearing magnetic resonance imaging (MRI).MethodsTwenty subjects (8 males and 12 females) with lateral patellofemoral instability were studied in an open-configuration magnetic resonance imaging scanner in an upright weight-bearing position at full extension (0° flexion) and 15° and 30° flexion with and without the realignment brace. Disease determinants were defined by common patellofemoral indices that included the Insall–Salvati Index, Caton–Deschamps Index, and the Patellotrochlear Index to determine patella height and patella tilt angle, bisect offset, and tuberositas tibiae–trochlear groove (TT–TG) distance to determine patellar rotation and translation with respect to the femur and the alignment of the extensor mechanism.ResultsAnalyses of variance revealed a significant effect of the brace with reduction of the three patellar height ratios, patella tilt angle, and bisect offset as well as TT–TG distance. Post hoc pairwise comparisons of the corresponding conditions with and without the realignment brace revealed significantly reduced patella height ratios, patella tilt angles, and bisect offsets at full extension and 15° and 30° flexion. No significant differences between the TT–TG distances at full extension but significant reductions at 15° and 30° flexion were observed when using the realignment brace compared to no brace.ConclusionsThis study suggests that the dynamic patellar realignment brace is capable of improving disease determinants in the upright weight-bearing condition in the range of 0° to 30° flexion in patients with patellofemoral instability.
Highlights
Patellar stabilizing braces are used to alleviate pain and prevent subluxation/dislocation by having biomechanical effects in terms of improved patellar tracking
Post hoc pairwise comparisons revealed reduced patellar height ratios at full extension and 15° and 30° flexion when using the realignment brace compared to the condition without the brace (Figs. 4a, 4b, and 4c)
Post hoc pairwise comparisons revealed that the brace significantly reduced the patella tilt angle by 3.2° ± 2.8° at full extension, 5.0° ± 3.6° at 15° flexion, and 4.0° ± 4.3° at 30° flexion (Fig. 4d)
Summary
Patellar stabilizing braces are used to alleviate pain and prevent subluxation/dislocation by having biomechanical effects in terms of improved patellar tracking. MRI has evolved as the most essential method offering numerous options such as the examination during weight-bearing conditions and at different flexion angles [6,7,8] This appears important since at extension and early flexion, patellar motion is largely influenced by quadriceps activation [6, 8,9,10] and most patients are prone to lateral subluxation and/or dislocations within. Physical therapy represents an important factor since muscular dysfunction might be positively influenced [12,13,14] Supportive devices such as patellar stabilizing braces and patellar taping are used to alleviate pain by restoring better joint kinematics and prevent subluxation/dislocation by having biomechanical effects in terms of improved patellar tracking [15,16,17,18] and improved proprioception [14, 19]. The biomechanical effects of the brace in vivo remain to be proven
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