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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.