Table 3.

Secondary outcomes of biomechanical studies which showed that valgus unloader braces decrease the knee adduction moment

References	Secondary outcome measures
Arazpour et al. [1]	Speed of walking significantly increased (p < 0.001) Reduction in knee range of motion (p = 0.002) Increase in step length (p < 0.001)
Dessery et al. [5]	Knee pain was alleviated with all three braces (p < 0.01)
Fantini Pagani et al. [11]	Significant decreases in knee lever arm, and joint alignment in the frontal plane were observed with the ankle–foot orthosis in all three different adjustments. No significant differences could be found in any parameter while using the laterally wedged insoles
Fu et al. [13]	Compared with pretreatment, the lateral-wedged insole, lateral-wedged insole with arch support, and valgus knee brace groups demonstrated significant reductions in WOMAC pain score (19.1 %, p = 0.04; 18.2 %, p = 0.04; and 20.4 %, p = 0.02, respectively). The valgus knee brace with lateral-wedged insole with arch support group demonstrated an additive effect with a statistically significant reduction in WOMAC total score (−26.7 %, p = 0.01). Compliance with treatment for the isolated insole groups were all over 90 %, but compliance for the valgus knee brace-associated groups was only around 50 %
Johnson et al. [18]	All but one of the compliant patients reported a decrease of at least two pain points after 3 months of use. There was one additional intervention in the brace cohort versus a statistical increase of 10 in the nonbrace cohort. All patients who were compliant with the brace showed an increase in thigh girth measurements, compared with none in the nonbrace cohort. Braced patients experienced retained improvements in at least one gait parameter including improved walking speed, total range of motion, and improved knee-angle at heel strike
Jones et al. [19]	Lateral wedged insole significantly increased walking speed, reduced the early stance EKAM 12 %, and the knee adduction angular impulse by 8.6 and 16.1 % respectively. The lateral wedged insole significantly reduced the early stance EKAM compared to the valgus knee brace (p = 0.001). The valgus knee brace significantly reduced the knee varus angle compared to the baseline and lateral wedged insole. Improvements in pain and function subscales were comparable for the valgus knee brace and lateral wedged insole. There were no significant differences between the two treatments in any of the clinical outcomes; however the lateral wedged insoles demonstrated greater levels of acceptance by patients
Laroche et al. [24]	VAS-pain and WOMAC significantly decreased at W5. Walking speed was not significantly modified by knee bracing at W0, but increased significantly at W5
Lindenfeld et al. [26]	No apparent gait adaptations were observed. Scores from an analog pain scale decreased 48 % with brace wear, and function with activities of daily living increased 79 %
Orishimo et al. [30]	With increasing tension in the brace, peak frontal plane knee angle shifted significantly from 1.6° ± 4.2° varus without the brace to 4.1° ± 3.6° valgus with maximum brace tension
Ota et al. [31]	The peak knee flexion angles during swing phase with KBF were also significantly larger than those with the KB (p = 0.004, the difference between these conditions of knee flexion angle: 1.5°)
Pollo et al. [32]	The medial compartment load at the knee decreased by an average of 11 % (114 N) Pain and activity level improved in all subjects with valgus bracing
Ramsey et al. [34]	Knee function and stability scored best with the brace in the neutral setting compared with the brace in the valgus setting. The cocontraction of the vastus lateralis-lateral hamstrings was significantly reduced from baseline in both the neutral (p = 0.014) and valgus conditions (p = 0.023), and the cocontraction of the vastus medialis-medial hamstrings was significantly reduced with the valgus setting (p = 0.068), as a result of bracing. Patients with greater varus alignment had greater decreases in vastus lateralis-lateral hamstring muscle cocontraction
Schmalz et al. [36]	Use of the tested brace also decreased the magnitude of gait asymmetry between the braced and contralateral legs during walking (horizontal ground reaction force, external knee flexion moment), presumably because the subjects’ need to walk abnormally to shield the knee from pain was reduced