The Best Hinged Knee Brace for Your Needs

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There is a lot of variety when it comes to hinged knee braces, as you probably already know. To list just a few types, hinged knee braces include functional, prophylactic, unloading, rehabilitative – and the list goes on. Some target only a narrow category of treatment, while others are more multi-functional. Making it even more confusing, not all braces are supported by research. In many cases, the evidence is inconclusive. So out of all this information, what is the best hinged knee brace for your needs?

Because you deserve to know which braces could actually help you, this article is a research-based overview of the main categories of hinged knee braces. For your ease, we’ve organized the content into several sections. While we recommend reading it all in order, feel free to click on a topic if you have a specific question in mind:

1. Why wear a hinged knee brace?

2. Types of hinged knee braces

a. Prophylactic braces

b. Functional braces

c. Unloader/Offloader braces

3. Types of hinged knee braces for your condition

a. Injury prevention

b. Recovery from injury or surgery

c. Knee osteoarthritis

4. Features of a high quality hinged knee brace

Why wear a hinged knee brace?

As the name suggests, hinged knee braces include hinges. The hinges typically connect solid bars that run alongside the leg. The hinges and bars work together to stabilize the knee by limiting certain movements. A hinged brace can prevent hyperextension, control the speed and range of leg movements, and promote a certain alignment of the joint. 

Hinged braces are typically worn when the knee is unstable or vulnerable to more damage, such as in cases involving injury, surgery recovery, or knee osteoarthritis. In comparison, non-hinged knee braces include products such as sleeves and compression braces. Because they do not include hinges or bars, they offer less support but more freedom of movement. As a result, sleeves and compression braces are better suited for treating knee conditions that are mild or moderate in severity. If you want to learn more about when to choose a non-hinged knee brace, check out this guide for everything you need to know.

While your basic hinge provides stability and controlled movement, some are serious multi-taskers. As companies have continued to roll out newer brace technologies, innovation has reached even the hinges themselves. The hinge of the Levitation brace by Spring Loaded, for example, contains compact liquid springs. During a knee bend, the liquid springs store energy and reduce pressure on the joint. When the leg extends, the springs release the energy to assist the user. As a result of this groundbreaking technology, people with serious injury or impairment can experience the benefits of powerful knee extension assistance without the bulk or price tag of a robotic exoskeleton. 

Levitation’s patented hinge contains liquid springs that store and release energy, a technological feat that makes pain-free movement possible.

Types of hinged knee braces

The best hinged knee brace won’t be the same for everyone. If you’ve already been browsing options for hinged knee braces, you’ll likely have noticed them categorized in a few different ways. We’ll explain the categories as simply as possible to help you make an informed decision. 

At the most basic level, hinged braces can be categorized as either rigid or soft. A rigid hinged brace restricts movements more than a soft hinged brace, and as a result offers more support to the joint. You can usually tell whether a hinged brace is rigid or soft, depending on how evident the side bars are. 

You may also see hinged braces categorized according to their purpose. Until 2008, the American Association of Orthopaedic Surgeons defined knee braces as prophylactic, functional, rehabilitative, and patellofemoral 1

The types of hinged knee braces used here

As brace technology has changed over the years, more brace categories have been described. As you encounter a variety of hinged knee brace types, keep in mind that there is no standardized list. The categories mainly serve to help companies describe the different types of braces to their customers. In addition, some braces may not neatly fall under one particular category, while others may be designed to treat more than one condition. 

For the purpose of this article, we will use the categories of prophylactic, functional, and unloader/offloader. Rehabilitative braces tend to overlap with functional and unloader/offloader braces, depending on the type of injury or surgery recovery they target. Because of this, this article will discuss rehabilitative bracing as a subcategory of both functional and unloader/offloader bracing. 

Although patellofemoral bracing is another popular brace type, these are typically not hinged. As such, we will limit our discussion of patellofemoral braces to the one hinged knee brace that is able to target this area. 

Prophylactic Braces

Prophylactic braces are hinged knee braces worn for the purpose of preventing injury and are typically used by athletes. They were first used in the 1990s by the US National Football League and later spread to college-level football and other sports2

Across most sports today, prophylactic bracing is less popular than it used to be. However, they are still commonly used by linemen in US college-level football2

Prophylactic braces are intended to protect the knees when they encounter forces that push them inward (valgus stress) or rotational stress3. These braces supposedly protect the medial collateral ligament (MCL) from injury, as well as help the cruciate ligaments keep the joint stable3

Cruciate ligaments include the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). They are pairs of ligaments that form an X. The ACL and PCL are responsible for stabilizing the knee by preventing back and forth movements within the joint. 

prophylactic hinged knee brace to support cruciate ligaments or meniscus

To date, it is unclear whether prophylactic braces actually prevent injury. Studies in the early 1990s suggest that prophylactic braces reduce MCL injuries4-6. However, more recent studies call these results into question by pointing out flaws in the research6,7. For the most part, results on the effectiveness of prophylactic braces are inconclusive1,7,8. As a result, prophylactic braces cannot be recommended or discouraged with high confidence.

Functional Braces 

Functional braces are designed to protect and support knees after injury or reconstructive surgery9. They were originally made to support the knees of athletes who were recovering from ACL injuries10

There have been a number of advances within functional bracing. Firstly, there is a greater variety of them than ever before. Newer types include braces that treat the PCL or have added rehabilitative benefits. New mechanical components have also been added to their design. Dynamic tensioning systems, for example, correct joint positions by applying a load to the knee. 

With the proliferation of functional bracing, it seems research can hardly keep up. To date, research on functional bracing has produced mixed results on its effectiveness1,11

While functional braces may support your knee during rotational movements, like when you pivot12, they do not seem to prevent abnormal movements of your shin bone (which is important in many sports)10,13. Additionally, functional braces do not appear to improve physical performance if you have had an ACL reconstruction14-16

Unloader/Offloader Braces

Unloaders and offloaders are knee braces that treat knee osteoarthritis (OA). Most braces for knee OA work by redistributing force from the unhealthy knee compartment to the healthy compartment.

Compared to prophylactic and functional braces, you might notice that knee OA braces usually only have one bar running along one side of the leg. This is because the single bar helps redistribute pressure across the knee. When there is a bar on only one side of the leg, the brace is described as unilateral. In comparison, a hinged brace with two bars on the sides is called a bilateral brace.

With the help of its unilateral hinge, the brace applies pressure to one side compartment. This compartment is usually the only knee compartment affected by OA, or at least the compartment most affected by the disease. As a result, the brace shifts the user’s body weight and other joint forces to the healthier and stronger tibiofemoral compartment. 

Offloaders

Companies typically market their hinged knee braces for OA as unloaders. You may also see these braces described as uni-compartment unloaders or valgus/varus braces.

Uni-compartment unloading refers to the reduction of knee joint forces within a single knee compartment. Although the knee has three compartments – two side compartments and a kneecap – a uni-compartment unloader can only act on the side compartments. This is because this type of brace works by applying a load to one side of the knee. As a result, joint pressures are shifted from one side of the knee to the other.

Valgus and varus are terms that describe the direction of the force acting on the knee. Valgus means going inward while varus means going outward. So if you encounter a uni-compartment valgus unloader, you would know that it targets OA in the inner (medial tibiofemoral) knee compartment.

But based on how unicompartmental unloaders and valgus/varus braces actually work, they would more accurately be described as offloaders. This is because the braces offload – or shift – forces within the knee, rather than entirely eliminating forces over the entire joint. 

While the difference between offloader and unloader may seem minor, knowing the difference can help you while brace shopping. This is because traditional braces for knee OA (offloaders) are different from true unloader knee braces. Depending on your individual OA pattern, you may find an offloader or an unloader to be the best hinged knee brace for you.

Unloaders

True unloader braces work by removing forces across the entire knee. There is currently only one on the market – the Levitation brace by Spring Loaded. Previously, exoskeletons were the only type of technology that could remove forces across the entire joint.

levitation is one of the best hinged knee braces available to treat osteoarthritis
Thanks to its embedded spring loaded hinge, the Levitation brace by Spring Loaded is considered an unloader knee brace

To learn whether an offloader or an unloader brace is best suited for your condition, jump to this article’s Knee Osteoarthritis section.

To learn more about the different knee OA patterns, take a look at our Guide to Knee Osteoarthritis

The best hinged knee brace for your needs

Injury Prevention

If you play a sport where your knee is frequently pushed inwards or rotated, a prophylactic brace may help support your ligaments3. However, it is important to note that the current state of research does not conclusively support the use of prophylactic braces. 

At worst, prophylactic bracing may cause more injuries1. At best, these braces may support your joints during certain movements. For example, prophylactic bracing has been shown to support the knee perform movements associated with ACL injuries17

If you are still set on finding a prophylactic brace, some brands have performed well in certain tests. The Drytex Economy hinged knee brace by Donjoy, for example, has performed well in squatting and proprioception tests18. Proprioception refers to your ability to gauge your body’s position and movement. The “H” Buttress by DonJoy has performed well in balance tests18. Finally, longer prophylactic braces are recommended over shorter ones, since they are able to better protect the MCL3

Recovery from Injury or Surgery

ACL and PCL Injuries

In the case of ligament injuries, functional braces were initially created to target the treatment of ACL injuries or ACL reconstruction. The Rebound ACL Knee Brace by Ossur, marketed as the next generation of ACL bracing, includes a dynamic tensioning system (DTS) that applies a load to the thigh and tibia. As a result of its DTS, forces acting on the ACL are reduced when the leg goes from a bent to straight position. The Rebound is primarily intended to be worn after ACL reconstruction.

In recent years, PCL functional braces have been released. Like the ACL, the PCL stabilizes the knee. While the ACL prevents the tibia from moving too far forwards, the PCL prevents the tibia from moving excessively backwards. 

PCL functional braces are marketed as dynamic force PCL braces. They work by applying a counteracting force against the backwards movement of the tibia. These braces are encouraged as a supplementary treatment to PCL injury management. 

The first dynamic force PCL brace to be launched was the Ossur Rebound PCL Knee Brace. Like the company’s ACL counterpart, the brace includes a DTS that applies a counter force on the tibia. As a result, the PCL is supported during leg bending and straightening19,20. Another PCL brace with research support includes the Albrecht Jack PCL brace21

Meniscus Injuries

For mild acute tears of the meniscus or degenerative meniscus tears, a knee brace can be a useful contribution to your overall treatment strategy22,23

Some research shows that offloaders (also known as unicompartmental unloaders or valgus/varus braces) can minimize meniscal strain, so long as your ACL is healthy24. Popular brands of offloaders include the Donjoy Defiance and the Ossur Unloader One. 

You can read more about treating meniscus injuries here

ACL Reconstruction

In patients with a weakened or reconstructed ACL, there is evidence that a brace with a dynamic tensioning system (DTS) can reduce the amount of strain put on the meniscus25. A brace with a DTS may also protect the ACL after reconstruction, preventing future injury25

If you are returning to sports after ACL reconstruction, wearing a functional brace likely won’t interfere with your physical performance26. However, functional braces may give you a false sense of security, and could result in injury if you push yourself too hard1,10

Rehabilitation from Injury or Surgery

You may also encounter functional rehabilitative braces, which are a type of functional brace that offers rehabilitative benefits to the knee after repeated use9. Some rehabilitative benefits include improvements in knee function, lessened knee pain, and increased muscular strength9

The Guardian’s Rehabilitator line includes braces designed for PCL injury and OA management. Both the company’s PCL Rehabilitator and OA Rehabilitator include pneumatic air bladders that apply either a dynamic force against the tibia or the knee joint, respectively. In clinical studies, the OA Rehabilitator has resulted in increased quadriceps strength after repeated use27,28. Similar effects can be expected to occur with the PCL Rehabilitator since it shares its quadriceps strengthening mechanism with the OA Rehabilitator. 

Knee Osteoarthritis

Depending on your specific knee OA pattern, the best hinged brace for you may be an offloader or an unloader knee brace. To learn more about the different knee OA patterns, take a look at our Guide to Knee Osteoarthritis.

diagram of patterns of knee osteoarthritis to be treated with hinged knee brace
Your pattern of knee osteoarthritis is determined by the number and types of knee compartments affected by the disease.

Osteoarthritis in One Side of the Knee

If you have osteoarthritis in only one of your knee’s side compartments, your arthritis pattern would be described as unicompartmental tibiofemoral. For this condition, offloader bracing may be an effective short-term solution29,30. However, this type of bracing may be best suited for managing only small to moderate amounts of knee pain31.

There is some long-term promise to wearing an offloader knee brace. One study showed that patients who wore an offloader for two years were less likely to need knee surgery 8 years later32. At the same time, many patients with knee OA choose to use an offloader brace while they wait for their eventual knee surgery32. In that case, offloader bracing may be a cost-effective way to manage your symptoms before you undergo surgery, if you end up needing it.

Popular hinged braces for unicompartmental TF include the Ossur Unloader One, the Donjoy Defiance, and the Breg Solus Plus. Additionally, the Guardian OA Rehabilitator is an innovative brace that includes a pneumatic air bladder to redistribute forces across the knee. The Rehabilitator also offers the benefits of increased quadriceps and hamstring strength after repeated use27,28.

Downsides to Offloader Bracing

Unfortunately, offloaders are only effective at treating a small number of knee OA cases. Since these braces redistribute pressure from one side of the knee to the other, they can only treat OA that presents in one of these compartments. This disease pattern represents only 4-20% of all knee OA cases33-35

Additionally, the long-term benefits of using an offloader brace are not very clear30,31,36. This is partly because long-term studies (those done over multiple years) are difficult to conduct. Most patients do not wear their braces consistently for multiple years, making it hard for researchers to make conclusions about long-term bracing effects36.

Osteoarthritis in Multiple Compartments or in the Kneecap

If your knee OA pattern does not fit the description of unicompartmental tibiofemoral, then you likely have the disease in multiple compartments and/or in your kneecap. These remaining cases are seen in approximately 80% of knee OA patients33-35.

Unfortunately, offloader bracing likely won’t provide adequate pain relief or sufficient improvements to your function if you are like the majority of knee OA patients.

Typical treatments for OA isolated to your kneecap include taping and knee sleeves. Taping works by adjusting the position of the patella to reduce the load applied on the patellofemoral compartment36. Knee sleeves work similarly by aligning the kneecap in a certain way and providing stability to the front of the knee36.

More recently, tri-compartment unloaders have come onto the market. They are currently the only hinged knee brace that can target OA in the kneecap or in multiple compartments. Tri-compartment unloaders can also treat unicompartmental tibiofemoral, although you do have a number of other bracing options if that is your disease pattern. But if your disease pattern is outside the realm of unicompartmental tibiofemoral, tri-compartment unloaders are an unparalleled bracing solution.

unloader or offloader brace may be best hinged knee brace for your osteoarthritis pattern
An offloader brace is typically best suited to treat osteoarthritis in one side of the knee, while an unloader can treat all patterns of knee osteoarthritis.

Tri-compartment Unloaders

The first, and currently only, tri-compartment unloader on the market is the Levitation brace by Spring Loaded. The brace contains liquid springs inside its hinges, which allow it to unload pressure across the entire knee, including the patellofemoral compartment37. Its innovative design has been shown to significantly reduce a number of joint forces38.

As a result of its powerful unloading capabilities, Levitation users experience substantial pain relief. 95% of Levitation users report pain relief as a result of wearing the brace, while 67% report using one less treatment method for their arthritis39. The brace has also been shown to significantly increase knee function, physical activity levels, and quality of life39.

Additional Benefits of the Levitation Knee Brace

Another huge benefit of Levitation is that it can support your exercise and weight management goals. For many knee OA patients, exercise and weight loss are highly recommended first-line treatments40-42. In reality, these treatments can be difficult to sustain, due to knee pain, lack of function and mobility, and lowered metabolism and energy levels due to dieting. But by reducing knee pain, improving function, and supporting increased physical activity levels39, Levitation can make it a lot easier to stick to an exercise or weight loss regimen.

Other standout features of Levitation include its lightweight and compact design and leg extension assist. Its assist is so powerful that at a 90-degree knee bend, Levitation can reduce knee joint forces by an amount equivalent to losing 45 lb of bodyweight37. As a result, Levitation can result in outcomes similar to weight loss. And while you may not do a lot of deep knee bends throughout the day, Levitation has been shown to support everyday actions like crouching, getting up from a chair, and walking up and down stairs43.

levitation is hinged knee brace that supports conservative treatment
Levitation’s powerful unloading capabilities make it a great tool to support other conservative knee OA treatments like exercise and weight management.

Features of a High Quality Hinged Brace

Once you do find the category of hinged knee brace that best suits your needs, you may still need to do some shopping around for the best brand. To help you in that effort, there are a few features that can distinguish a high quality brace.

Comfort & Breathability

Because you’ll be wearing your brace for a stretch of time, you want to make sure the brace fits comfortably. If you live in a warm climate, or plan to use the brace during athletic activities, you also want to make sure it’s breathable. Moisture for long periods of time promotes bacterial growth, which can lead to unpleasant odours. 

Look for moisture wicking materials like neoprene, spandex, and nylon. Meshing or open areas to allow air flow will also ensure the brace is comfortably breathable. 

Compressive Strength

Braces create stability by compressing the joint. Compression is also important for redistributing forces, as in the case with offloaders. A high quality brace should be able to fit firmly around the joint without slipping. Slippage can cause skin irritation and make the brace feel bulkier than it should. 

For good compression, look for straps made with strong velcro that can be adjusted. Other features like knobs that adjust compression or the angle of force redistribution are also signs of a high quality brace.

Lightweight & Streamlined Design

Wearing a brace can take some time to get used to, but you still want to make sure it’s lightweight and streamlined against your body. If the brace feels too heavy or bulky when you walk in it, first make sure it is fitted properly. A brace that is too loosely fit can sometimes contribute to unnecessary discomfort. 

Some braces have very long straps that can stick out and tug on things or cause chafing. In these cases, manufacturers usually intend the straps to be trimmed down once you have found your ideal range of strap length. 

Adjustability & Customization

Some braces will only come in universal sizes. In these cases, it’s important to check for adjustable features like straps or dials. Replaceable cushioning or soft goods will also ensure the brace fits snugly.

Braces can also be custom-fitted to your body. These types of braces are typically more expensive than universal designs. The type of customization may also differ. Some can be molded to the shape of your leg, while others can be customized with different shell colors or add-on features like pneumatic pads with compressed air. 

References

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