Knee Injury Solutions
Using orthoses as functional therapy in patients with knee-joint injuries
Injuries in the knee joint area are a common diagnosis that may require the preoperative, postoperative and conservative use of a knee brace. The use of knee braces as a conservative treatment measure is recommended not only in the two S1 guidelines on anterior and posterior cruciate ligament ruptures: 1,2
In two representative patient surveys, it could be shown that knee orthoses are used as aids and are worn with pleasure and consistently. Knee orthoses can protect the result of the operation and support the patient in their early functional therapy. 3-5 In addition, the surveys showed a high level of patient satisfaction: 94 percent of users would recommend a knee orthosis to others.
The subjective protective function of a knee orthosis in critical everyday situations 4.5
In clinical studies of traumatic knee injuries, the focus is on clinically objectifiable endpoints (especially functional outcomes). However, the subjective, patient-relevant benefit of a knee orthosis in the early rehabilitation phase is rarely investigated. Therefore, from March to September 2018, medi® carried out a representative survey of 2,956 patients who were prescribed the M.4s® Comfort orthosis due to an injury in the knee joint.
In addition to information on the indication, etiology of the injury and therapy, the frequency of critical events during rehabilitation as well as the benefit and comfort of the orthosis were queried.
For the first time, a large survey of almost 3,000 patients showed that 63 percent of the patients actually experienced an event that could endanger the outcome of the operation due to a critical everyday situation.
94 percent of the participants confirmed that the orthosis gave them security and that it supported them during therapy. As part of the patient survey, it was also shown that the knee brace gave 87 percent of the participants the certainty that the knee was correctly extended and bent. 92 percent of the patients agreed / fully agreed that the orthosis protected them from critical or dangerous knee movements.
The following was stated as the critical situation:
- Bending the knee too much
- Excessive extension of the knee
- Twist knees
Five years after an initial survey on the use of medical aids (bandages, orthoses, medical compression stockings and insoles), the Allensbach Institute conducted a second survey on behalf of eurocom e. V. carried out. This confirmed the results of the first survey.
The current survey results show that the need and use of medical aids continues to rise. The use of supports and orthotics on the knee joint is particularly important here: 43 percent of the patients stated in the survey that they wear a knee support or orthotic.
The two S1 line lines “Anterior cruciate ligament rupture” and “Posterior cruciate ligament rupture” as well as the S2k guideline “Meniscus Diseases” advocate the use of conservative therapeutic measures, including the use of a knee orthosis for injuries to the knee joint.
Anterior cruciate ligament rupture: conservative therapy in older, less active patients
If, for example, there is an isolated rupture of the anterior cruciate ligament (ACL), the initiation of conservative therapy is possible – especially in older patients with reduced demand for activity.
Surgical care is the more common treatment method for younger, more active patients. The postoperative measures provide for active implementation with exercise therapy and a functional orthosis (e.g. M.4s® Comfort).
In the case of a combined injury (ACL rupture and inner ligament rupture), the anterior cruciate ligament is usually surgically treated, and the collateral ligament is usually treated with a functional orthosis due to its high degree of spontaneous healing. 1
Posterior cruciate ligament rupture: early diagnosis and initiation of adequate orthotic treatment
In the guideline on posterior cruciate ligament rupture (HKB), the orthosis is accorded a high priority as a conservative measure: Even in an active young patient, conservative treatment with a knee orthosis is legitimate or the option of choice. In this indication, early diagnosis and initiation of adequate orthosis treatment is considered to be particularly important.
When using the knee orthosis postoperatively after an HKB plastic surgery, the knee joint should first be placed in a splint with a calf pad (e.g. medi PTS ). Alternatively, the use of an orthosis with active
calf support (e.g. M.4s® PCL dynamic ), in which the movement therapy is also carried out, is recommended. 2
Meniscus diseases: options for conservative, surgical and postoperative treatment
The S2k guideline on meniscus disease also addresses the possibilities of conservative, surgical and postoperative treatment methods after meniscus lesions. Conservative therapy options are the main focus for patients with negative clinical meniscus signs but visible meniscus lesions on MRI. Likewise in symptomatic patients with degenerative joint changes. 6th
Knee orthoses can support the patient especially postoperatively ( e.g. after meniscus suturing) and during movements with axial load. This avoids the combination of “flexion” and
“full load” (knee fixed in extension position).