OA-brace after medial meniscetomy

[JuhaH]

Hi there,

I have been 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 studying what is most suitable brace for my situation. I have 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 lateral side to medial 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.

[pegleg78]

I have had multiple unloader braces and I can tell you that I would only choose a Townsend. I had a Donjoy for the medial compartment and it was awful! It slipped down all the time and was very uncomfortable. I then tried the townsend and there was a world of difference. I was albe ot wear the townsend all day without a problem. A few years later I needed a lateral unloader and tried a Breg brace, once again I had a horriable time and ended up woth a townsend. That is what I wear now and i really like it it helps out with the pain and makes it so I can get through the day!

[dm]

I don't recommend the Donjoy brace, it slips, tends to chafe, and is generally not meant for extended wear (8+hrs /day use) as judged by this consumer.

I've been using a G2 Select unloader, and I've had success with it, it's strong enough to put up with heavy use, and I've had good tech support from the company, they've replaced straps/pads for me for free when they could've charged me.

I've not tried Townsend, but I know they use a carbon-fiber shell design like G2 does, so I figure either brace would work if you're looking for "endurance wear" bracing, versus "occasional use".

[bd1]

I agree about the donjoy, i'd been using one for the last 6 months and hated wearing the thing, it rubbed and slipped down and round.
I've just been fitted with a townsend custom premier brace, the fit's perfect, i've had it for a week now and have been wearing it for 10 to 12 hrs a day with no slippage or rubbing,
It's very comfortable to wear, I had 80% of laterelal meniscus removed and find it helps greatly with that aswell as my buggered synthetic lcl.
I!d reccomend townsend to anyone if you use a brace.

[JuhaH]

Hi,

Please specify what model you have used. Don Joy and other brand's have many models and they differ a lot from each other. For example many skiiers like Don Joy's Defian but I think it's too robust for everyday use in office.

[Kaputt_Knee]

Juha,

many skiers use DJ because of the marketing! I do not have to wear a brace for the same reasons as you but I also found the DJ, Bregg and Bledsloe braces bulky and uncomfortable. The DonJoy particularly so as it slipped, the inner sleeve rubbed and caused sweat blisters when worn for skiing or any sports.

I now have a Townsend Rebel and can wear it under my office clothing if the need arises. They have a modular fitting process so they can mix and match the various components so that you get an excellent fit without the need for any re-adjustment. My surgeon and physios were impressed with the joint on the Townsend and commented that it was the first they had seen that appeared to mimic the actual movement of a healthy knee. If you can get a custom fit it is good, but they are not available here in Germany yet as non of the suppliers has been trained to take the moulds required for custom fitting.

My Rebel CI (Combined Instabilities) cost my insurer 500 Euros, considerably less than the others. I only know the price as they rang me up to check if it was really a proper brace! 

Sue 

[bethus82]

Sue -- does the brace have any long-term effects or does it just relieve pain while you are wearing it?
Do you have pain while or after skiing?
I had a partial medial meniscectomy a year a go and still have pain, similar to before the surgery.
Thx.

[Kaputt_Knee]

I do not have any pain at all at the moment.

I have some stiffness and I have a weak LCL (Lateral collateral Ligament) as it was only replaced in August 2008.

I only wear the brace for skiing and paragliding, both activities where an involuntary pivot could cause me problems. My attitude is to adapt but move on. There is nothing I can do about the condition of my knees, except keep them as flexible and as fit as possible. My braces help me to do this.

I do not run, nor take part in any high impact activities any more - motion is what the knee is designed for and requires. I have modified my activities but I still keep moving. I see my cup as being half full not half empty - I can still do many of the activities I have done all my life and I have good excuses for not doing the ones that are beyond the capability of my knees. But usually that means going slower at the same things, rather than giving up and feeling sorry for my self.

I listen to my body and immediately see my specialist if anything causes me problems and we discuss ways of overcoming the difficulties. I see these problems as challenges to be overcome rather than insurmountable problems.

I'll never give up skiing, I may eventually give up paragliding, but I'll find somerthing else to replace it that also challenges me both mentally and physically. 

[JuhaH]

Hi,

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. What do you think about my plan to purchase two OA-braces? Is it difficult to adjust brace or do you need brace (orthotic) specialist to do it for you?

I haven't done skiing, windsurfing or rock climbing after my meniscectomy due to the pain. I feel that now I'm more or less crippled and I miss my outdoor hobbies very much. I don't care if braces are cumbersome or look funny. I can life with that but this knee pain is killing me inside. Do you have experience about light & low impact sports with CTi OA brace?

I think that OA-brace offers a small degree of help for us after meniscectomy and it's only another piece of the puzzle. On the other hand I think that brace is good investment if it helps to reduce our pain and will delay knee arthiris as much as possible. What do you think about using unloader brace to delay knee arthritis? I'm I just dreaming?

[JuhaH]

If you're interested, read study about Unloader One and study about Unloader braces for medial compartment.

[dm]

The initial setup on an unloader brace needs to be determined by a physician in conjunction with an orthotist to determine the correct amount of unloading force required. Degrees of correction can vary from 2-10degrees, and what you need can be determined from xrays, exam, etc, and your doctor will tell the orthotist what your brace needs to be set up for, because too much unloading force can be as bad as not enough.

[bethus82]

What causes joint space narrowing?  Any idea why most people feel better after a meniscectomy and others don't?

Juha -- Are you using a brace now and if so is it helping?  (I figured out how to add my history and did so)
Thx

[dm]

Joint space narrowing is caused predominantly by either a:injury or b: "wear and tear".  You get joint space narrowing develop from injury when you get a meniscus tear and a significant portion of the meniscus has to be removed, so the joint narrows because there's simply no more meniscus there, or not as much there anymore. In 'wear and tear' the meniscus abrades with age, the bone surfaces change shape with arthritic changes, and the joint space changes and narrows.

In either case, the patient ends up with constant or intermittent pain with activity, and the unloader brace realigns the long bones, shifting stresses through the joint, moving weight through the joint to the healthier, undamaged/lesser damaged compartment, by shifting the stress off the damaged side.

think of it like lining up two pencils with the erasers together, if the pencils are in perfectly straight alignment, everything works good, but if there's an angle, where the erasers meet, there's pain because there's uneven forces being applied to one side of the joint, and the unloader applies sideways pressure, straightening out the bend, so that the "pencils" line up again, relieving the kink, so to speak, and helping the pain.

There's some studies out there that show that unloader braces, while they may seem unwieldy and awkward, are underutilized by physicians to relieve oa pain in conjunction with medications. Granted, there has to be a willingness on the part of the patient to use the brace, and to adapt to its necessity, but they can make a lot of difference in pain levels and the lack of lifestyle changes required due to knee issues.

You can go for long walks, hike, etc in these braces, they give a lot of freedom. I've even heard of people running in them. I wouldn't try it, I've got too much other damage.

[bethus82]

Thanks, DM.  A physiatrist said that my pain was caused by arthritis, which is in both knees, and
gave me 2 Ossur unloader braces.  While I do not agree with that diagnosis as the arthritis is "early"
and I had zero pain before my cycling accident, when I wear the brace on my surgery knee it feels better.
 I think the pain is from the meniscus no longer being normal or smooth, and ongoing inflammation.  My surgeon
said that he would recommend a brace only for skiing and similar activities (which I do not intend to do
anytime soon), but a friend told me that his surgeon gave him a brace 6 months post-meniscectomy, and it
helped him such that after a while he felt better and no longer needed it.
Perhaps I should get another surgeon's opinion - would hate to mess anything else up by wearing that brace.

[dm]

You may find that wearing the brace on the operated knee may be of use for activities when you're going to be on your feet for extended periods. Consult your doctor, find out about your xrays, and exactly what stage of arthritis, if any, they think you have. reality is that they can argue that most people in their 30s or later will have some degree of early arthritis, but those with injury are likely to have knees in much worse shape than those whose knees have never been previously injured. If the meniscus damage has been repaired and there is no ligament damage, then there's a reasonable expectation that you should be pretty much pain free within 6 months after surgery, if there was nothing else wrong, such as articular cartilage problems, etc. Talking to your surgeon about what he saw in your knee during the surgery, etc would give you more information to go on.

That the brace helps is not a bad thing, I would hazard you must have had a large part of your meniscus removed, do you know how much? Mine helps me with over 2/3 of mine removed.

If you think inflammation is a concern, you may consider asking your surgeon if a cortisone shot is warranted, if the shot helps for a time but the symptoms return, it can be an indicator that something is going on that hasn't been dealt with, and that they need to take another look at your knee with a new mri and perhaps consider re-scoping it.

Did you get pictures or a video of the procedure, to show the condition of what was found and what they did about it? My OS always does this.

[JuhaH]

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.

[bd1]

Hi juhah,
Glad to hear the brace is helping with your pain issues, like you I have only 20% of meniscus left(lateral) and find my brace lets me do things I couldn't do cause of pain after walking distances, i'd started hiking again, until I reinjured my knee in dec'.
Sorry to hear your having nerve pain, it's a crappy pain to deal with,
Hope all goes well.
Bd1