Comparative evaluation of advanced knee orthosis designs in managing knee osteoarthritis: A systematic review of biomechanical and clinical outcomes.

Abstract

Knee osteoarthritis (KOA) is a progressive degenerative joint disease without curative treatment. Novel knee orthoses incorporating pneumatic unloading, vibratory stimulation, and magnetic/electromagnetic fields have emerged as conservative options. This review evaluated and compared their biomechanical and clinical effects in adults with KOA. PubMed, Web of Science, Scopus, ProQuest, and Google Scholar were searched (January 1973-December 2025). Original studies assessing pneumatic, vibratory, or magnetic/electromagnetic knee orthoses in KOA were included. Two reviewers independently screened studies, extracted data, and assessed quality using the Downs and Black checklist. A narrative synthesis was conducted due to heterogeneity. Eleven studies (∼300 participants) were included. Pneumatic orthoses (eight studies) reduced knee adduction moment (KAM) by 7.6-39%, improved gait, decreased pain (up to 36%, P = 0.006), and enhanced strength and function (Lower Extremity Functional Scale P = 0.001; Knee Society Score P = 0.0067). Some findings suggested delayed progression (total knee arthroplasty 18% vs. 36%; injections 46% vs. 83%, P = 0.026). One vibratory orthosis study showed a greater reduction in KAM (P = 0.016) and sustained unloading after removal. Magnetic/electromagnetic field (ELF) orthoses (two studies) mainly improved pain (P = 0.011) and Knee Injury and Osteoarthritis Outcome Scores (KOOS), with limited biomechanical effects. Study quality ranged from poor to good (13-23/27), with small samples and short follow up being common. Pneumatic orthoses show the strongest evidence for biomechanical and clinical benefits in KOA. Vibratory designs may provide neuromuscular advantages, while magnetic/ELF devices mainly offer symptomatic relief. Larger, high-quality trials are needed.