This put clinicians off referring their patients for bracing.
Around 7 or 8 years ago this changed as effective products entered the market and good results followed.
I have previously posted on a number of different products that had good results but as time has moved on what has changed?
Once clinical efficacy was achieved, a lot of the focus shifted to the experience of the user. Comfort, ease of application and weight were all targeted to increase compliance and widen the target market.
From the "original" unloaders, Ossur's Unloader One was one of the lightest as it was a single hinged device. This cut down on bulk and weight but its main limitations were that it only unloaded the joint in extension (making it unsuitable for those who had symptoms with a flexed knee such as climbing or descending stairs) and it offered no additional stability for those with ligamentous problems like ACL deficiency.
The Donjoy OA Adjuster addressed both of the above problems as it unloads throughout range and supports the ligaments of the knee (it is based on an ACL brace design) but it was significantly heavier than the Unloader One.
As Ossur and Donjoy (DJO Global) tend to be the innovators in knee brace development, I thought it was about time to see what had changed.
Ossur have not had a noted addition to their unloader range for the last few years but are probably due for an announcement.
Donjoy have added an update to the OA Adjuster range with the OA Adjuster 3. This is essentially the same unloading mechanism as the previous version but it is significantly lighter and has a slightly shorter calf cuff length. There are also improvements in the padding and liners while the durability and ligamentous support remain.
The biggest innovation from Donjoy is the OA Nano.
The design is based on the OA Adjuster, but magnesium is used in the frame to drastically reduce the weight.
A lighter frame makes application easier (as features such as the anti-migration strap are no longer required) and the malleable thigh and calf ensure a customizable fit. Its main limitation is its effectiveness on sizes above XL. Larger people are advised to stick with the strength of the OA Adjuster 3.
As need develops, so does technology. The braces listed above are improvements of existing designs. I expect a new mechanism will be released in the next 18 months that will challenge the traditional designs.
Product advancement is always welcomed and we are sure to face interesting times ahead.