The 'Unloader Moment'

Some time ago at a medical educational meeting about high tibial osteotomy, I was chatting to a representative from the company Ossür.

The focus of the educational meeting was the value of surgical re-alignment of the leg to unload one side of the knee where it was showing stress mostly from the lack of the meniscal shock absorber on that side and tending to bow or to go knock-kneed.

Ossür were manning a stand highlighting their ‘Unloader’One’ brace. This is a lightweight functional brace that adjusts the forces through the knee as the patient takes weight on that side, changing the physical ‘adductor moment’ so that pressure is relieved on any damaged joint cartilage surface present on the one side. It can be used before osteotomy surgery to give the patient with a painful knee from one-sided joint cartilage damage an idea of the kind of pain relief they might expect from an osteotomy. What the company representative was telling me was that the brace in its own right may offer pain relief sufficient to avoid or delay the need for surgery.

My interest was especially piqued when my Ossür colleague talked about what they called ‘the unloader moment’ - that moment when a person struggling with pain from such problems puts on their brace for the first time and their face lights up with amazement. I challenged them to invite me to demonstrate this to me by inviting a number of patients to try the brace, and also to allow the input from a number of people who were already wearing it. I suggested that I could ask a colleague who has a medical photographic and videographic business to record the interviews (Dodec Medical).

They were as good as their word. It took some time but I was subsequently invited by them to a day’s filming in Droitwich in the UK, where they had invited nine people to be interviewed and filmed in my presence. All nine arrived for the day’s event. One was himself a physiotherapist who had worn an unloader for some years. Three other people had worn the brace for some time, and four had never seen the brace before but had been deemed suitable for this test by a responsible clinician. One of the four declined to be filmed when he understood that he needed to sign a permission form for the footage to be put onto the internet, but he did participate and was fitted with the brace, so only the three others were filmed.

All the interviews and the new-patient fittings were conducted by Lisa Williams BSc of Cardiff UK. Lisa has her own physiotherapy clinic in Cardiff, UK. She was for two years prior to 2010 a specialist clinician with the Ossür company, and she has extensive experience with bracing of the knee and other joints.

Each person was video-recorded, and those people new to the brace filmed walking on the flat and on stairs. After they were fitted with the brace by Lisa Williams the exercises were repeated. Here are the recordings. There has been some post-production but the videos are faithful to what I heard and saw -

The Interviews

1. Caroline

Actively working in countryside management. Caroline was new to the Unloader One brace. She had never seen it before.

2. Andrew

Physiotherapist. Experienced user of the Unloader One brace, and very familiar with it.

3. Mike

Warehouse supervisor. New to the Unloader One brace, but had spoken to a friend who wore a brace and advised him to take up this offer.

4. Steve (1)

Company Director. Experienced user of the Unloader One brace.

5. Zanthe

Cabin crew member and a competitive horserider. New to the Unloader One brace, and had never seen it before.

6. Steve (2)

Frontline motorcycle police officer. Experienced wearer of the Unloader One brace.

7. Julie

Teacher and runner. New to the Unloader One brace.

8. Tina

Teacher and dancer. Very experienced with the Unloader One.

The Outcomes

I was very impressed with the outcomes of the Unloader One on the new patients, but you are able here to judge for yourself.