MSK injury? Make splinting choices based on the evidence

Evidence: A single study evaluating a neutral knee sleeve vs control exhibited improved pain scores following several months of treatment. Mixed results were demonstrated with patient perceived quality of life improvement though.¹⁵ Currently, there is inconclusive evidence to support the use of valgus offloader braces per AAOS guidelines.¹⁶ This decision is based on 3 separate studies of moderate to high strength evidence. Improvements in the domains of pain, stiffness, self-reported functional capacity, and physical performance were unclear and no conclusions were able to be drawn.^17,18

Inconclusive support for valgus knee bracing—along with the high cost of equipment—should reserve this option for patients with advanced knee osteoarthritis.

Harms: To date, no harmful AEs have been demonstrated with the use of knee sleeves. Valgus knee bracing can be uncomfortable, leading to poor adherence, but there are no long-term negative consequences.

Bottom line: Use of knee sleeves is worthwhile in patients with mild-to-moderate OA to improve functional scores. Inconclusive support for valgus knee bracing, along with the high cost of equipment, should reserve this option for patients with advanced OA who do not respond to typical conservative management and who are unwilling or ill-advised to undergo knee arthroplasty.^16-18

Medial collateral ligament injury

An injury of the medial collateral ligament (MCL)—the medial stabilizer of the knee—can result from either a direct blow or a noncontact twisting injury. Grade 1 injuries have no actual ligament tear, grade 2 injuries have partial disruption, and grade 3 injuries denote a complete tear.

Goal of splinting: A hinged knee brace (FIGURE 6) allows for full extension but limited valgus and varus stresses.

^{IMAGE COURTESY OF: GEOFFREY A. MCLEOD, DO, CAQSM}

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