Summary: This paper set out to answer the question whether unloader bracing in knee osteoarthritis could really avoid or delay the need for surgery in over 500 patients, and whether this would be cost effective when used in the NHS in the UK.

Objectives:

To investigate the clinical efficiency and cost effectiveness of an unloader brace for managing unicompartmental knee osteoarthritis.

Design:

A retrospective cohort study of 540 consecutive patients managed with an unloader brace over 5 years at our unit.

Participants:

Out of the 540 patients, we have excluded 31 patients, as they did not fit our eligibility criteria.
We have included 509 consecutive participants (212 females and 297 males), aged 32 to 91 (mean of 59) years old, who were managed with an unloader brace for unicompartmental arthritis.

Intervention:

Each patient was prescribed an unloader brace, and followed up for a minimum of one year.
Main outcome measures
Failure of the brace was the end point of failure; this was defined by listing those patients for surgery for their knee OA.

Results

447 (87.82%) participants had medial compartment knee OA, and 62 (12.18%) had lateral compartment OA. 409 (80.4%) patients managed with an unloader brace did not require surgery for their knee OA; the mean follow-up was 3 years with a minimum follow-up of 1 year. 100 participants went on to have knee surgery; 96 had a total knee replacement (TKR), and 4 underwent a high tibial osteotomy. Those with lateral OA wore their brace for a mean of 8.3 months prior to surgery, whilst those with medial OA wore the brace for 7.1 months prior to surgery.
In this cohort, in our unit, we performed 141 fewer TKR’s at the trust than expected, in 2019, with an annual saving of £864,820.

Conclusions

As yet, to the best of our knowledge, this is the largest study supporting the use of an unloader brace for UKOA as both efficacious and cost effective; bracing has either delayed or negated the need for surgery for up to 5 years. As the global consensus deviates towards the non-operative treatment of orthopaedic problems, in the light of the emergence of the COVID19 pandemic, bracing could be a safe alternative for patients presenting with knee arthritis; Its use contributed to a reduction in the patients undergoing TKR surgery, thus resulting in significant cost saving.

AUTOLOGOUS MICRO-FRAGMENTED ADIPOSE TISSUE (MFAT) TO TREAT SYMPTOMATIC KNEE OSTEOARTHRITIS: Early outcomes of a consecutive case series Abstract Presentation 6 minutes Wouter Van Genechten, MD, BELGIUM Kristien Vuylsteke, Mrs, BELGIUM Pedro Rojas Martínez, MD, MEXICO Linus Swinnen, MD, BELGIUM Kristof Sas, MD, BELGIUM Peter Verdonk, MD, PhD, BELGIUM
A Modified Lemaire Lateral Extra-Articular Tenodesis in High-Risk Adolescents Undergoing Anterior Cruciate Ligament Reconstruction: Two-Year Clinical Outcomes ePoster Presentation Sofia Hidalgo Perea, BS, UNITED STATES Christopher Brusalis, MD, UNITED STATES Frank A. Cordasco, MD, MS, UNITED STATES Daniel W. Green, MD, MS, UNITED STATES
Sport Specialization Classification And Injury Risk In Female Athletes ePoster Presentation Ehiamen T Okoruwa, MD, MS, UNITED STATES Alexandra Abbott, MD, UNITED STATES Symone M Brown, MPH, UNITED STATES Mary K. Mulcahey, MD, UNITED STATES
Long Term Results Of Collagen Meniscus Implant (Cmi) An Analysis Of 156 Cases At mean 11 Years Of Follow-Up Abstract Presentation 5 minutes Gian Andrea Lucidi, MD, ITALY Alberto Grassi, PhD, ITALY Stefano Di Paolo, Eng, PhD, ITALY Piero Agostinone, MD, QATAR Giacomo Dal Fabbro, ITALY Luca Macchiarola, MD, ITALY Nicola Pizza, MD, ITALY Stefano Zaffagnini, MD, Prof., ITALY
Descriptive Epidemiology Study Of The Justifying Patellar Instability Treatment By Early Results (Jupiter) Cohort Abstract Presentation 6 minutes Meghan E. Bishop, MD, UNITED STATES Jacqueline M. Brady, MD, UNITED STATES Simone Gruber, MS, UNITED STATES Matthew William Veerkamp, BA, UNITED STATES Joseph T. Nguyen, MPH, UNITED STATES Ben E. Heyworth, MD, UNITED STATES Marc Tompkins, MD, UNITED STATES Daniel W. Green, MD, MS, UNITED STATES Eric J. Wall, MD, UNITED STATES The JUPITER Group, UNITED STATES Beth Ellen Shubin Stein, MD, UNITED STATES Shital N. Parikh, MD, UNITED STATES
Meniscal Extrusion Was Associated To Early Oa On Mri After Surgery For Disco Id Lateral Meniscus ePoster Presentation Kazuya Nishino, MD, JAPAN Yusuke Hashimoto, MD, PhD, JAPAN Takuya Kinoshita, MD, PhD, JAPAN Hiroaki Nakamura, MD, PhD, JAPAN
The Importance of Limb Alignment on Patient Reported Outcome Following High Tibial Osteotomy ePoster Presentation Gwenllian F. Tawy, PhD, MRes, BSc(Hons), UNITED KINGDOM Hamza Shahbaz, MB ChB Student, UNITED KINGDOM Leela C. Biant, MS, MFSTEd, FRCSEd(Tr&Orth), UNITED KINGDOM
MPFL Length Change Patterns In Asymptomatic Knees Of Patients With Contralateral Patellar Instability ePoster Presentation Miho J. Tanaka, MD, PhD, UNITED STATES Karina Mirochnik, BS, UNITED STATES F. Joseph Simeone, MD, UNITED STATES Eric M. Berkson, MD, UNITED STATES Kartik M Varadarajan, PhD, UNITED STATES
Bacterial Contamination Of Irrigation Fluid And Suture Material During ACL Reconstruction And Meniscus Surgery Abstract Presentation 5 minutes Benjamin Bartek, MD, GERMANY Tobias Winkler, Prof., MD, GERMANY Anja Garbe, MD, GERMANY Carsten Perka, MD, PhD, GERMANY Tobias M. Jung, MD, GERMANY
Analysis of bone union after biplanar medial closing wedge distal femoral osteotomy ePoster Presentation Takehiko Matsushita, MD, PhD, JAPAN Shinya Oka, MD, PhD, JAPAN Akiyoshi Mori, JAPAN Shu Watanabe, MD, JAPAN Kiminari Kataoka, MD, JAPAN Koji Nukuto, MD, PhD, UNITED STATES Daisuke Araki, MD, PhD, JAPAN Yuichiro Nishizawa, MD, PhD, JAPAN Kanto Nagai, MD, PhD, JAPAN Noriyuki Kanzaki, MD, PhD, JAPAN Yuichi Hoshino, MD, PhD, JAPAN Ryosuke Kuroda, MD, PhD, JAPAN
Thermal Imaging Following Total Knee Arthroplasty - A Cross Sectional Diagnostic Study Abstract Presentation 5 minutes Lilach Gavish, PhD, MPH, ISRAEL Leonid Kandel, MD, ISRAEL Gurion Rivkin, MD, ISRAEL Itay Perets, MD, ISRAEL Mattan Yoav, Prof., ISRAEL Meir Liebergall, ISRAEL S.David Gertz, Prof., ISRAEL M Mark Hoffer, PhD, ISRAEL
Outcome Assessment Following Routine Application Of Customized Implants For Primary Tka In The General Population: A Systematic Review Of The Literature ePoster Presentation Eran Beit Ner, MD, ISRAEL Saad Dosani, MBChB Med, UNITED KINGDOM Leela C. Biant, MS, MFSTEd, FRCSEd(Tr&Orth), UNITED KINGDOM Gwenllian F. Tawy, PhD, MRes, BSc(Hons), UNITED KINGDOM
Onlay Patellofemoral Arthroplasty In Patients With Isolated Patellofemoral Arthritis: A Systematic Review ePoster Presentation Jordan C Villa, MD, UNITED STATES Albit Paoli, MD, UNITED STATES Howard Nelson-Williams, MD, MPH, UNITED STATES Rhamee Badr, MD, UNITED STATES Katharine Harper, MD, UNITED STATES
Comparison of Pain Score and Analgesic Usage Between Bone-Patellar Tendon-Bone, Hamstring and Quadriceps Tendon Autographs for Anterior Cruciate Ligament Reconstruction ePoster Presentation Jasmine Lyng, MD, CANADA Sheila McRae, PhD, MSc, CANADA Jarret M. Woodmass, MD, FRCSC, CANADA Gregory Adam Stranges, MD, CANADA Devin Lemmex, MD FRCSC, CANADA Robert Longstaffe, MD FRCSC, CANADA Peter B. MacDonald, MD, FRCS, Dip Sport Med, CANADA
Patient´S Sex And Height Predict Graft Size But Graft Size Does Not Influence Risk Of Graft Failure. A Study Of 4519 Patients With Primary Anterior Cruciate Ligament Reconstruction. ePoster Presentation Vasileios Sarakatsianos, MD, SWEDEN Riccardo Cristiani, MD, PhD, SWEDEN Marita L Harringe, PhD, RPT, SWEDEN Gunnar Edman, MD, PhD, Prof., SWEDEN Anders Stalman, MD, PhD, Professor, SWEDEN
Restoring Knee Phenotype And Joint Line Obliquity Reduces Postoperative Pain After Primary TKA Abstract Presentation 6 minutes Elliot Sappey-Marinier, MD, FRANCE Cécile Batailler, MD, PhD, FRANCE John Swan, MBBS, FRANCE Elvire Servien, MD, PhD, Prof., FRANCE Sebastien Lustig, MD, PhD, FRANCE
Prevalence Of Cartilage Lesions In Patients Undergoing Meniscal Surgery, A Cross-Sectional Study ePoster Presentation Eduardo Gardella, MD, CHILE Marcelo Acevedo, MD, CHILE Rodrigo Hernández-Tagle, MD, CHILE Juan Jose Valderrama, MD, CHILE Agustín León, MD, CHILE Xabier Carredano, MD, CHILE Gunther Redenz, PT, CHILE
Minimum 10-Year Clinical Outcome Of Lateral Collagen Meniscus Implants (Cmi) For The Replacement Of Partial Lateral Meniscus Defects. ePoster Presentation Alberto Grassi, PhD, ITALY Gian Andrea Lucidi, MD, ITALY Giuseppe Filardo, MD, PhD, MBA, Prof., SWITZERLAND Paolo Bulgheroni, MD, ITALY Erica Bulgheroni, MD, ITALY Luca Macchiarola, MD, ITALY Piero Agostinone, MD, QATAR Giacomo Dal Fabbro, ITALY Stefano Zaffagnini, MD, Prof., ITALY
Anterior Cruciate Ligament Deficiency Does Not Reduce the Clinical Effectiveness of Fixed-Bearing Partial Knee Arthroplasty ePoster Presentation Ashim Mannan, FRCS (Tr & Orth), UNITED KINGDOM Damian Bull, FRCS (Tr & Orth), UNITED KINGDOM Juned Ansari, FRCS (Tr & Orth), UNITED KINGDOM Caroline Bennett, RN, UNITED KINGDOM Tahir Idrees, PGDip Public Health, UNITED KINGDOM Katy Mason, MSc, PgDip, UNITED KINGDOM Emily London, MB ChB MRes, UNITED KINGDOM David Duffy, MBBS, MRCS, FRCS, UNITED KINGDOM Nick London, MA, MD, FRCS (Tr & Orth), UNITED KINGDOM
Increased Lower Extremity Injury Risk Associated with Player Load and Distance in Collegiate Women’s Soccer ePoster Presentation Michelle Xiao, BS, UNITED STATES Jessica N Nguyen, BS, UNITED STATES Calvin E Hwang, MD, UNITED STATES Geoffrey D. Abrams, MD, UNITED STATES
ACL Surgery: Can Patients Read, Understand, and Act on Online Resources? A Cross-Sectional Study of Online Patient Education Materials ePoster Presentation Alan Shamrock, MD, UNITED STATES Burke Gao, MD, UNITED STATES Trevor Gulbrandsen, MD, UNITED STATES Olivia O'Reilly, MD, UNITED STATES Kyle R. Duchman, MD, UNITED STATES Robert W. Westermann, MD, UNITED STATES Brian Wolf, MD, UNITED STATES
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A Randomized Controlled Trial Comparing Patellar Stabilizing, Motion Restricting Knee Brace vs. Sham Brace in Non-Operative Treatment for First-Time Traumatic Patellar Dislocation Abstract Presentation 7 minutes Essi Salonen, MD, FINLAND Petri J. Sillanpää, MD, PhD, FINLAND Aleksi Reito, MD, PhD, FINLAND Heikki Mikael Mäenpää, MD, PhD, FINLAND Ville M. Mattila, MD, PhD, FINLAND
Adolescent Pitcher Fatigue: Ulnar Collateral Ligament Stress, Ultrasonographic Assessment of Flexor-Pronator Mass Energy Depletion, and Correlation to Pitch Count ePoster Presentation Manuel F. Schubert, MD, MS, UNITED STATES Tariq Awan, DO, UNITED STATES Aaron David Sciascia, PhD, ATC, PES, SMTC, UNITED STATES Emily G. Figueroa, MS, UNITED STATES Jennifer M. DeMink, PT, DPT, OCS, UNITED STATES David M. Selak, PT, DPT, OCS, UNITED STATES Corey M. Snyder, PT, DPT, OCS, SCS, MTC, CSCS, UNITED STATES Joel Gagnier, ND, MSc, PhD, UNITED STATES Michael T. Freehill, MD, UNITED STATES
Intravenous administration of two dose tranexamic acid ( TXA) and local anesthesia (LA) at graft site , improves outcome in single bundle Anatomical Anterior Cruciate Ligament reconstruction in uniformed military personnel. ePoster Presentation Mujeeb Ashraf, FRCS, MCh,FEBTS, SAUDI ARABIA Abaad saad Al-Thagafi, MBBS, SAUDI ARABIA Hatim Mohammed Alshareef, MD, SAUDI ARABIA Hatem Al-Harbi, FRCSC, SAUDI ARABIA
The Application Of Ultrasound Guided Knee Arthroscopy For Calcified Patellar Tendinopathy In Elite Weightlifters Abstract Presentation 6 minutes George D. Tsikouris, MD, GREECE Nikolaos D. Gravvanis, MD, GREECE Georgia S. Dedousi, MD, GREECE Ioannis K. Antonopoulos, GREECE Fanis P. Papadakis, BSc, MSc(cand.), GREECE Demetrios P. Tsikouris, PT, GREECE Vassilis N. Psychoyios, MD, GREECE Theodoros G. Troupis, Prof, GREECE
Comparison of Bone-Patella Tendon-Bone and Quadriceps Tendon Autograft for ACL Reconstruction at Twelve-Month Follow-Up ePoster Presentation Seth L. Sherman, MD, UNITED STATES Daniel William Hogan, MS, UNITED STATES Major Benjamin Burch, MD, UNITED STATES Joseph M. Rund, BS, UNITED STATES Richard Ma, MD, UNITED STATES Aaron Gray, MD, UNITED STATES John W. Welsh, BA, UNITED STATES Taylor E. Ray, UNITED STATES Derek W Geeslin, BS, UNITED STATES
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Evaluation Of Cartilage Repair After Open-Wedge High Tibial Osteotomy Using T2 Mapping Methods ePoster Presentation Ken Iida, MD, JAPAN Yusuke Hashimoto, MD, PhD, JAPAN Yohei Nishida, MD, JAPAN Shinya Yamasaki, MD, PhD, JAPAN Hiroaki Nakamura, MD, PhD, JAPAN
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Lateral Hinge Fracture Risk Reduction In Medial Opening Wedge High Tibial Osteotomy: Where Should The Apex Be? A Laboratory Study Abstract Presentation 5 minutes Humza Tariq Osmani, BSc (Hons), MBBS (Dist), FRCS (Tr & Orth), UNITED KINGDOM Jaison Patel, BSc, MBBS, FRCS, UNITED KINGDOM Stas Tomaszczyk, BA, MEng, UNITED KINGDOM Michael Sutcliffe, MA, PhD, UNITED KINGDOM Joel Melton, BM, MRCS (Ed), MSc (Orth Eng), FRCS, UNITED KINGDOM
Posterior Sagittal Position Of The Tibial Tubercle In Patients With Operative Patellofemoral Chondral Lesions As Measured By The Sagittal Tibial Tubercle-Trochlear Groove Distance ePoster Presentation Daniel James Kaplan, MD, UNITED STATES Edward Stephen Mojica, BS, UNITED STATES Paola Ortega, BA, UNITED STATES Jairo Triana, BS, UNITED STATES Laith M. Jazrawi, MD, UNITED STATES Eric Jason Strauss, MD Michael J Alaia, MD, UNITED STATES Guillem Gonzalez-Lomas, MD, UNITED STATES
Arthroscopic-Assisted Robotic Bi-Unicompartmental Knee Arthroplasty: A Pilot Cadaveric Study. ePoster Presentation Andrea Fernandez, MD, FRANCE Elliot Sappey-Marinier, MD, FRANCE Frédéric Lavoie, MD, MSc, FRCSC, CANADA Cécile Batailler, MD, PhD, FRANCE Elvire Servien, MD, PhD, Prof., FRANCE Sebastien Lustig, MD, PhD, FRANCE
Meniscal Repair at the Time of Primary ACLR Does Not Negatively Influence Short Term Knee Stability, Graft Rupture Rates, or Patient Reported Outcome Measures: the STABILITY Experience Abstract Presentation 6 minutes Andrew Firth, PhD, CANADA Hana Marmura, MPT, PhD, UNITED STATES Lachlan Batty, FRACS, AUSTRALIA Dianne M. Bryant, PhD, CANADA Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR Stability Study Group, CANADA
Comparison of the Use of 3-D Scaffolding vs Microfractures in the Repair of Total Chondral Defects in the Knee ePoster Presentation Jorge Nicolas Valladares, MD, MEXICO Mónica Araceli Cabrero Montes , MD, MEXICO Maria G. Zavala-Cerna, MD, PhD, MEXICO
Medium-Term Results of One-Stage vs Two-Stage Bilateral MPFL Reconstruction for Bilateral Patellofemoral Joint Instability: A Retrospective Cohort Study. Abstract Presentation 5 minutes Anindya Debnath, MS, DNB, INDIA Shaival Dalal, M.S.MRCS(Edinburgh), UNITED KINGDOM Randy Guro, BSc, UNITED KINGDOM Rahul Kotwal, FRCS(Ortho), UNITED KINGDOM Amit Pramod Chandratreya, FRCS(Tr&Orth), MS(Orth), MCh(Orth), UNITED KINGDOM
Comparison Of Muscle Strength And Neuromuscular Control Up To 1 Year After Anterior Cruciate Ligament Reconstruction Between Patients With Dominant Leg And Non-Dominant Leg Injuries ePoster Presentation Ki-Mo Jang, MD, PhD, Prof., KOREA, REPUBLIC OF Dae Keun Suh, MD, PhD, KOREA, REPUBLIC OF Hye Chang Rhim, MD, KOREA, REPUBLIC OF Jin Hyuck Lee, PT, PhD, KOREA, REPUBLIC OF
Anterior Cruciate Ligament (ACL) Repair Using Cortical Or Anchor Fixation With Suture Tape Augmentation Vs ACL Reconstruction: A Comparative Biomechanical Analysis ePoster Presentation Lukas Nawid Muench, MD, GERMANY Daniel P. Berthold, Association.-Prof., GERMANY Simon Archambault, BS, UNITED STATES Maria Slater, BS, UNITED STATES Julian Mehl, MD, GERMANY ELIFHO OBOPILWE, ME, BSc, UNITED STATES Mark P. Cote, PT, DPT, MSCTR, UNITED STATES Robert A. Arciero, MD, UNITED STATES Jorge Chahla, MD, PhD, UNITED STATES James Lee Pace, MD, UNITED STATES
Degenerative Meniscal Tears: A Comparison Of Postoperative Outcomes Following Meniscectomy With And Without Bone Marrow Aspirate Concentrate ePoster Presentation Iciar M Davila Castrodad, MD, UNITED STATES Jennifer Kurowicki, MD, UNITED STATES Nikki Doerr, BS, UNITED STATES Alex M Giordano, BS, UNITED STATES Matthew J. Kraeutler, MD, UNITED STATES Cyrus Emami, UNITED STATES Anthony Festa, MD, UNITED STATES Casey Pierce, MD, UNITED STATES Vincent K. McInerney, MD, UNITED STATES Anthony Scillia, UNITED STATES
Outcomes after proximal hamstring surgery: an analysis of acute vs chronic repair after conjoint tendon injury ePoster Presentation Steven Cecchi, BSc (Hons), MBBS, AUSTRALIA Randeep Singh Aujla, MBChB ChM FRCS (Tr&Orth) MFSEM, UNITED KINGDOM Shahbaz S Malik, BSc, MB BCh, MSc (Orth Engin), LLM, FRCS (Tr&Orth), UNITED KINGDOM Brendan Ricciardo, MBBS FRACS, AUSTRALIA Peter Alberto D'Alessandro, MBBS Hons. (UWA) FRACS FAOrthA, AUSTRALIA
Isolated MCL Reconstruction Might Not Be Sufficient In Cases With A High-Grade Anteromedial Rotatory Knee Instability Abstract Presentation 5 minutes Elmar Herbst, MD, PhD, GERMANY Christian Peez, MD, GERMANY Lena Haferkemper, Ms., GERMANY Jens Wermers, MD, GERMANY Johannes Glasbrenner, MD, GERMANY Thorben Briese, MD, GERMANY Michael J. Raschke, MD, Prof., GERMANY Christoph Kittl, MD, MD(res), GERMANY
No Difference In Complication, Reoperation And Readmission Rates After Fast-Track Or Out-Patient Total Knee Arthroplasty ePoster Presentation Jean-Yves Jenny, Prof., FRANCE Vincent Gisonni, MD, FRANCE
Development Of Antibiotic Resistance In Periprosthetic Joint Infection After Total Knee Arthroplasty Abstract Presentation 5 minutes Antonio Klasan, MD, PhD, EMBA, FRCS, AUSTRIA Arne Schermuksnies, MD, GERMANY Susanne Fuchs-Winkelmann, MD, Assoc. Prof, GERMANY Thomas J. Heyse, MD, PhD, GERMANY

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Brace before you replace? Our clinical experience of 540 consecutive knees.

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Brace before you replace? Our clinical experience of 540 consecutive knees.

Brace before you replace? Our clinical experience of 540 consecutive knees.

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Conclusions