Effect of Closed Kinetic Chain Exercise With Customized Knee Brace on Pain and Functional Performance in Patients With Bilateral Medial Compartment Knee Osteoarthritis

Abstract

BACKGROUND:  Knee osteoarthritis (OA) is a degenerative condition often seen in the elderly, influenced by factors like joint alignment, mechanics, and muscle strength. It affects functional performance in daily activities due to pain and reduced mobility. Closed kinetic chain exercise (CKCE) can enhance joint stability, strength, and proprioception, while a customized knee brace helps offload the medial compartment by correcting malalignment. This study explores the combined effect of CKCE and a customized brace on pain and function in individuals with bilateral medial compartment knee OA. OBJECTIVE: This study aimed to evaluate the effectiveness of a structured CKCE program combined with a customized valgus unloader knee brace in reducing pain and improving range of motion (ROM), muscle strength, and overall functional performance in individuals with bilateral medial compartment knee OA, compared to conventional physiotherapy alone. METHODS:  A total of 204 participants were initially recruited and equally allocated into Group A and Group B (102 participants each) using the envelope method. However, eight participants were lost to follow-up, resulting in 196 participants (98 in each group) who completed the study. Over six weeks, the patients engaged in conventional exercises and CKCE with a customized knee brace. The Visual Analogue Scale (VAS), ROM, manual muscle testing (MMT), and Knee Injury and Osteoarthritis Outcome Score (KOOS) were utilized for evaluating the results. RESULTS: Both groups showed significant improvements post-intervention, but Group B demonstrated superior outcomes across all measures. Pain scores (VAS) at rest and during activity decreased more in Group B (p<0.0001). ROM and MMT significantly improved, particularly in knee flexion and extension (p<0.0001). KOOS domains, namely, pain, symptoms, activities of daily living (ADL), sports/recreation, and quality of life, also showed greater improvements in Group B (p<0.0001), reflecting enhanced functional performance. CONCLUSION: The combination of CKCE and a customized knee brace was more effective than conventional physiotherapy alone in reducing pain and improving functional outcomes in patients with bilateral medial compartment knee OA. This integrated intervention enhances joint mechanics, promotes muscular strength, and supports a better quality of life. CKCE with bracing should be considered a viable conservative treatment strategy in the management of medial knee OA.