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Robert-Lachaine X, Dessery Y, Belzile ÉL, Corbeil P. Knee braces and foot orthoses multimodal 3-month treatment of medial knee osteoarthritis in a randomised crossover trial. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38895856 DOI: 10.1002/ksa.12312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/27/2024] [Accepted: 06/02/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Immediate biomechanical and functional benefits of knee braces and lateral wedge foot orthoses (FO) are often reported on patients with medial knee osteoarthritis. However, the effectiveness of their combined use in a longer-term orthotic treatment remains unclear. The aim was to evaluate pain, function, comfort and knee adduction moment (KAM) during the stance phase of gait with three modalities of orthotic treatment. METHODS Twenty-two patients with knee osteoarthritis were analysed in a randomised crossover trial including a knee brace with valgus and external rotation functions (VER), FO and their combined use (VER + FO). Western Ontario and McMaster Universities scale (WOMAC) and Knee injury and Osteoarthritis Outcome Scores and KAM during gait were obtained before and after each orthotic treatment of 3 months. Repeated measures analyses of variance contrasted the factors orthosis (VER, FO, VER + FO), treatment (pre and post) and wear (without and with) on pain, function, comfort and KAM. RESULTS An interaction between orthosis and treatment on the WOMAC pain (effect size [ES] = 0.17) and a main effect on the pain visual analogue score (ES = 0.24) indicated that VER and VER + FO were more alleviating than FO. The three modalities of orthotic treatment significantly improved functional scores (ES > 0.2) and reduced discomfort (ES = 0.25). A significant multivariate interaction between orthosis and wear (ES = 0.73) showed that the KAM reduction while wearing the orthoses was more pronounced with the VER and VER + FO than the FO. CONCLUSION The VER-brace obtained more effectiveness than FO on pain and KAM after 3 months for medial knee osteoarthritis and the combined treatment did not substantially improve biomechanical and functional outcomes. LEVEL OF EVIDENCE Therapeutic study level I randomised crossover trial.
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Affiliation(s)
- Xavier Robert-Lachaine
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, Quebec, Canada
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, Quebec, Canada
| | - Yoann Dessery
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, Quebec, Canada
| | - Étienne L Belzile
- Division de Chirurgie Orthopédique, CHU de Québec Université Laval, Quebec City, Quebec, Canada
- Département de Chirurgie, Faculté de Médecine, Université Laval, Quebec City, Quebec, Canada
| | - Philippe Corbeil
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, Quebec, Canada
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2
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Trivedi U, Joshi AY. Advances in active knee brace technology: A review of gait analysis, actuation, and control applications. Heliyon 2024; 10:e26060. [PMID: 38384524 PMCID: PMC10878936 DOI: 10.1016/j.heliyon.2024.e26060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
This article discusses the significance of knee joint mechanics and the consequences of knee dysfunctions on an individual's quality of life. The utilization of active knee braces, which incorporate concepts of mechatronics systems, is investigated here as a potential treatment option. The complexity of the construction of the knee joint, which has six degrees of motion and is more prone to injury since it bears weight, is emphasized in this article. By wearing braces and using other support devices, one's knee can increase stability and mobility. In addition, the paper discusses various technologies that can be used to measure the knee adduction moment and supply spatial information on gait. Actuators for active knee braces must be compact, lightweight, and capable of producing a significant amount of torque; as a result, electric, hydraulic, and pneumatic actuators are the most common types. Creating control mechanisms, such as position control techniques and force/torque control approaches, is essential to knee exoskeleton research and development. These methods might make knee joint rehabilitation and assistive technology safer and more effective.
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Affiliation(s)
- Udayan Trivedi
- Mechatronics Engineering Department, Parul University, Vadodara, Gujarat, India
| | - Anand Y. Joshi
- Mechatronics Engineering Department, Parul University, Vadodara, Gujarat, India
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3
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Jahn J, Ehlen QT, Huang CY. Finding the Goldilocks Zone of Mechanical Loading: A Comprehensive Review of Mechanical Loading in the Prevention and Treatment of Knee Osteoarthritis. Bioengineering (Basel) 2024; 11:110. [PMID: 38391596 PMCID: PMC10886318 DOI: 10.3390/bioengineering11020110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
In this review, we discuss the interaction of mechanical factors influencing knee osteoarthritis (KOA) and post-traumatic osteoarthritis (PTOA) pathogenesis. Emphasizing the importance of mechanotransduction within inflammatory responses, we discuss its capacity for being utilized and harnessed within the context of prevention and rehabilitation of osteoarthritis (OA). Additionally, we introduce a discussion on the Goldilocks zone, which describes the necessity of maintaining a balance of adequate, but not excessive mechanical loading to maintain proper knee joint health. Expanding beyond these, we synthesize findings from current literature that explore the biomechanical loading of various rehabilitation exercises, in hopes of aiding future recommendations for physicians managing KOA and PTOA and athletic training staff strategically planning athlete loads to mitigate the risk of joint injury. The integration of these concepts provides a multifactorial analysis of the contributing factors of KOA and PTOA, in order to spur further research and illuminate the potential of utilizing the body's own physiological responses to mechanical stimuli in the management of OA.
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Affiliation(s)
- Jacob Jahn
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Quinn T Ehlen
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Chun-Yuh Huang
- Department of Biomedical Engineering, College of Engineering, University of Miami, Coral Gables, FL 33146, USA
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4
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Du W, Guo Y, Wang C, Cui W, Chen W, Li X. Biomechanical response of lower limb joints to lateral wedge insoles. Sci Rep 2024; 14:107. [PMID: 38167577 PMCID: PMC10762160 DOI: 10.1038/s41598-023-50693-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
Lateral wedge insole (LWI) is a frequently recommended treatment option for early and midterm stages of medial knee osteoarthritis. However, studies of its effects on the lower limb joints are incomplete and imperfect. The main purpose of this study was to quantitatively analyze the response of intervention of LWI on lower-limb joint kinematics, ground reaction forces (GRFs), and centre of pressure (COP). Gait analysis of 16 healthy subjects was conducted. Three-dimensional motion data and force plate measurements were collected in the control (barefoot) and experimental conditions (wearing a pair of assigned shoes with 0, 7, and 10 mm LWIs). Results showed that the peak knee flexion angle was increased by 3.43°, 3.09°, and 3.27° with 0, 7, and 10 mm LWIs, respectively (p < 0.01). The ankle peak dorsiflexion angle was significantly decreased by 3.79°, 2.19°, and 1.66° with 0, 7, and 10 mm LWIs, respectively (p = 0.02). The internal rotation angle was increased by 2.78°, 3.76°, and 4.58° with 0, 7, and 10 mm LWIs, respectively (p < 0.01). The forefoot with LWIs showed highly significantly smaller inversion, eversion, and adduction angles (all p < 0.01). The 1st peak of the vertical GRF (p = 0.016) also increased significantly by a maximum of 0.06 body weight (BW) with LWIs. These results indicated that biomechanical changes and limitations of lateral wedges insole should be analyzed in more detail, possibly leading to new guidelines for the design and application.
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Affiliation(s)
- Weijin Du
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Yuan Guo
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Chenyan Wang
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Weiling Cui
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Weiyi Chen
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China.
| | - Xiaona Li
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China.
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Khosravi M, Jalali M, Babaee T, Ali Sanjari M, Rahimi A. Evaluating the effective pressure applied by a valgus knee orthosis in individuals with medial knee osteoarthritis based on the dose-response relationship. Knee 2023; 40:174-182. [PMID: 36463763 DOI: 10.1016/j.knee.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/23/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND There is evidence that valgus knee orthosis improves clinical and biomechanical outcomes in individuals with medial knee osteoarthritis (MKOA). It is unclear whether variations in pressure application by orthosis straps can affect the biomechanical outcomes. This study aimed to determine the dose-response relationship between different orthosis straps tensions and changes in knee adduction moment (KAM) parameters in individuals with MKOA. METHOD Twenty-four individuals with symptomatic MKOA were enrolled in this quasi-experimental study. Five tension conditions in orthosis straps were tested in 20-mmHg increments, from 0 (no pressure) to 100 (maximal pressure) mmHg. Patients were asked to adjust the orthosis strap tension based on their perceived comfort. After each condition, a 3D gait analysis was performed, and KAM parameters were calculated. The participants also reported their satisfaction with knee orthosis adjustment for each pressure condition. RESULTS With successive increases in strap tension from 40 to 80 mmHg, the first peak, second peak, and angular impulse of KAM decreased nonlinearly (from 6 % to 25 %). Increasing the orthosis strap tension to 100 mmHg significantly decreased (P < 0.05) the participants' satisfaction level. The effective dosages (IC50) of pressure for the first peak, second peak, and angular impulse of KAM as responses were 58, 65, and 69 mmHg, respectively. CONCLUSION The KAM decline was not linear as the strap pressure increased. Patients were dissatisfied with orthosis adjustment when strap tension was above 80 mmHg. The optimum dosage of pressure on the knee joint's lateral side for adjusting an orthosis' strap tension is approximately 69 mmHg.
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Affiliation(s)
- Mobina Khosravi
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Jalali
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Taher Babaee
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sanjari
- Biomechanics Lab, Rehabilitation Research Center and Department of Basic Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Abbas Rahimi
- Department of Physiotherapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Robert-Lachaine X, Dessery Y, Belzile ÉL, Corbeil P. Knee braces and foot orthoses multimodal treatment of medial knee osteoarthritis. Gait Posture 2022; 96:251-256. [PMID: 35709608 DOI: 10.1016/j.gaitpost.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/19/2022] [Accepted: 06/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee braces and lateral wedge foot orthoses are two treatment options recommended for medial knee osteoarthritis, but the combination of both of them could further improve their effectiveness. RESEARCH QUESTION The aim was to evaluate whether the combination of lateral wedge foot orthoses with two types of knee brace enhances the biomechanical effects and pain relief during the stance phase of gait while maintaining comfort. METHODS Ten patients with medial knee osteoarthritis were fitted with a standard valgus brace, an unloader brace with valgus and external rotation functions, and 7° lateral wedge foot orthoses. The pain relief, comfort, kinematics and kinetics of the lower limb were measured during walking without orthotics, with the combined and with the isolated treatments. RESULTS The valgus and external rotation brace significantly reduced the knee adduction moment and allowed more knee flexion both in isolation and in combination to foot orthoses compared to the valgus brace or without treatment. Pain relief was not significant with the different orthotic treatment modalities. The valgus brace and combined treatment with either brace significantly increased the discomfort level, whereas the valgus and external rotation brace or foot orthoses in isolation did not induce significant discomfort. SIGNIFICANCE Amongst the tested orthotic treatment modalities, the valgus and external rotation brace obtained better biomechanical outcomes while maintaining comfort. The combined treatment with foot orthoses enhanced the effectiveness of the valgus brace, however foot orthoses may be unnecessary with the valgus and external rotation brace.
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Affiliation(s)
- Xavier Robert-Lachaine
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC, Canada; Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, QC, Canada
| | - Yoann Dessery
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
| | - Étienne L Belzile
- Division de Chirurgie Orthopédique, CHU de Québec Université Laval, Quebec City, QC, Canada; Département de Chirurgie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
| | - Philippe Corbeil
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC, Canada.
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7
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Fesharaki SA, Farahmand F, Saeedi H, Raeissadat SA, Abdollahy E, Ahmadi A, Maroufi N. The Effects of Knee Orthosis with Two Degrees of Freedom Joint Design on Gait and Sit-to-Stand Task in Patients with Medial Knee Osteoarthritis. Sultan Qaboos Univ Med J 2021; 20:e324-e331. [PMID: 33414937 PMCID: PMC7757919 DOI: 10.18295/squmj.2020.20.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/22/2020] [Accepted: 04/19/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives Knee bracing as a conservative treatment option for patients with medial knee osteoarthritis (KOA) is of great interest to health practitioners and patients alike. Optimal orthotic knee joint structure is essential to achieve biomechanical and clinical effectiveness. Therefore, this study aimed to identify the effects of a knee orthosis with a new two-degrees-of-freedom (DOF) joint design on selected gait parameters and in a sit-to-stand task in patients with mild-to-moderate medial KOA. Methods This study was conducted both at the Physical Medicine and Rehabilitation Clinic in Shahid Modarres Academic Hospital and the Biomechanical Laboratory of Rehabilitation Faculty of Iran University of medical Sciences in Tehran, Iran from September 2015 to October 2017. The gait performance of 16 patients was assessed without an orthosis, using a common one-DOF (DOF) knee orthosis and using the same knee orthosis with a two-DOF orthotic joint design. The interactive shearing force between limb and brace in the shell area during a sit-to-stand test was also identified. Repeated measures analysis of variance was used to analyse the data. Results Compared with walking with no orthosis, both orthosis conditions reduced the external knee adduction moment significantly (P ≤0.05). A significant increase between the one-DOF and two-DOF conditions in terms of walking speed (P = 0.041 and P = 0.009, respectively) and stride length (P = 0.028 and P = 0.038, respectively) was observed. In a sit-to-stand test, wearing the orthosis significantly decreased knee transverse plane range of motion (P ≤0.05). There was a 41.31 ± 8.34 Newtons reduction in knee flexion constraint force. Conclusion The two-DOF knee orthosis was more comfortable compared to the one-DOF knee orthosis during deep knee flexion. Otherwise, the one-DOF- and two-DOF-braces performed similarly.
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Affiliation(s)
- Siamak Aghajani Fesharaki
- Department of Orthotics & Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.,Under-Secretary General for Health, Treatment and Rehabilitation of Iranian Red Crescent Society, Tehran, Iran
| | - Farzam Farahmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Hassan Saeedi
- Department of Orthotics & Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Raeissadat
- Physical Medicine & Rehabilitation Department, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Abdollahy
- Department of Biomechanics, Djavad Mowafaghian Research Centre of Intelligent Neuro-Rehabilitation Technologies, Tehran, Iran
| | - Amir Ahmadi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Maroufi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Robert-Lachaine X, Dessery Y, Belzile ÉL, Turmel S, Corbeil P. Three-month efficacy of three knee braces in the treatment of medial knee osteoarthritis in a randomized crossover trial. J Orthop Res 2020; 38:2262-2271. [PMID: 32077519 DOI: 10.1002/jor.24634] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 01/24/2020] [Accepted: 02/11/2020] [Indexed: 02/04/2023]
Abstract
Immediate biomechanical and functional effects of knee braces are often reported, however, the duration and type of knee brace treatment for knee osteoarthritis (KOA) remain unclear. The objective was to evaluate usage, comfort, pain, and knee adduction moment (KAM) of three knee braces each worn 3 months by patients. Twenty-four patients with KOA were assigned in a randomized crossover trial a valgus three-point bending system brace (V3P-brace), an unloader brace with valgus and external rotation functions (VER-brace) and a stabilizing brace used after ligament injuries (ACL-brace). Functional questionnaires and gait assessment were carried out before and after each brace wear period of 3 months. A Friedman test was applied between brace wear diary recordings. Repeated measures analyses of variance contrasted the factors brace type (ACL, V3P, and VER), time (pre and post) and wear (without and with) on comfort, pain, function, and KAM. Brace usage was similar, but the V3P-brace was slightly less worn. Discomfort was significantly lowered with the VER-brace. All knee braces relieved pain and symptoms from 10% to 40%. KAM angular impulse was reduced with the three braces, but the VER-brace obtained the lowest relative reduction of 9%. The interaction between time and wear indicated that part of the KAM reduction with brace wear was maintained post treatment. All three knee braces have great benefits for pain and function among the medial KOA population. The VER-brace offers additional advantages on daily use, comfort and KAM, which could improve compliance to brace treatment.
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Affiliation(s)
- Xavier Robert-Lachaine
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada.,Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC, Canada
| | - Yoann Dessery
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
| | - Étienne L Belzile
- Division de Chirurgie Orthopédique, CHU, Quebec City, QC, Canada.,Département de Chirurgie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
| | - Sylvie Turmel
- Division de Chirurgie Orthopédique, CHU, Quebec City, QC, Canada
| | - Philippe Corbeil
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC, Canada
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9
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Miles C, Greene A. The effect of treatment with a non-invasive foot worn biomechanical device on subjective and objective measures in patients with knee osteoarthritis- a retrospective analysis on a UK population. BMC Musculoskelet Disord 2020; 21:386. [PMID: 32546226 PMCID: PMC7298846 DOI: 10.1186/s12891-020-03382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background Osteoarthritis is a major cause of pain and disability worldwide, therefore ways of treating this condition are paramount to a successful health system. The purpose of the study was to investigate the changes in spatial-temporal gait parameters and clinical measurements following treatment with a non-invasive foot-worn biomechanical device on patients with knee osteoarthritis within the UK. Methods A retrospective analysis was carried out on 455 patients with knee osteoarthritis. All patients were evaluated using a computerized gait test and two self-assessment questionnaires (WOMAC and SF-36) at baseline and after 3 and 6 months of treatment. The biomechanical device is a shoe-like device with convex pods under the sole that have the capability of changing foot centre of pressure and training neuromuscular control. The device was individually calibrated for each patient to minimise symptoms whilst walking and train neuromuscular control. Patients used the device for short periods during activities of daily living. Repeated measures statistical analyses were performed to compare differences over time. Results After 6 months of treatment significant improvements were seen in all gait parameters (p < 0.01). Specifically, gait velocity, step length and single limb support of the more symptomatic knee improved by 13, 7.8 and 3%, respectively. These were supported by significant improvements in pain, function and quality of life (48.6, 45.7 and 22% respectively; p < 0.001). A sub-group analysis revealed no baseline differences between those who were recommended joint replacement and those who were not. Both groups improved significantly over time (p < 0.05 for all). Conclusions Our results suggest that the personalised biomechanical treatment can improve gait patterns, pain, function and quality of life. It may provide an additional solution to managing UK patients suffering from knee osteoarthritis but needs to be tested in a controlled setting first.
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Affiliation(s)
- Christopher Miles
- Sport and Exercise Science Research Centre, Department of Life Sciences, University of Roehampton, 19 Conifer drive, Brentwood, London, CM14 5TZ, UK.
| | - Andrew Greene
- Sport and Exercise Science Research Centre, Department of Life Sciences, University of Roehampton, 19 Conifer drive, Brentwood, London, CM14 5TZ, UK
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10
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Khan SJ, Khan SS, Usman J, Mokhtar AH, Abu Osman NA. Orthoses versus gait retraining: Immediate response in improving physical performance measures in healthy and medial knee osteoarthritic adults. Proc Inst Mech Eng H 2020; 234:749-757. [PMID: 32459132 DOI: 10.1177/0954411920924525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The conservative techniques of treating knee osteoarthritis (kOA) include wearing orthoses such as knee braces and laterally wedged insoles and applying gait modification techniques such as toe-in gait and toe-out gait. This study aimed at assessing the immediate effects of these techniques in improving physical function of healthy and kOA participants. Five Osteoarthritis Research Society International (OARSI) recommended performance-based tests were randomly applied to measure physical function: (1) 30-second chair stand test (30CST), (2) 40-m (4 × 10) fast-paced walk test (40FPW), (3) stair climb test (SCT), (4) timed up and go test (TUGT) and (5) 6-minute walk test (6MWT) during a single-visit on 20 healthy and 20 kOA patients (age: 59.5 ± 7.33 and 61.5 ± 8.63 years, BMI: 69.95 ± 9.86 and 70.45 ± 8.80 kg/m2). The interventions included natural gait, toe-out gait, toe-in gait, laterally wedged insoles and knee brace. Analysis was performed through repeated-measures ANOVA and independent sample t-test. 30CST and TUGT showed no significant differences for the five test conditions (p > 0.05). Toe-out showed profound effects via pairwise comparison in impairing the physical function while knee brace improved it during 40FPW, SCT and 6MWT. In general, all the tested conservative techniques except laterally wedged insoles had immediate effects on physical performance measures in both healthy and medial knee osteoarthritis participants. The valgus knee brace improved the parameters the most, while toe-out gait impaired them the most. Future studies can develop strategies for improving gait retraining methods on the basis of issues identified by this study.
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Affiliation(s)
- Saad Jawaid Khan
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia.,Department of Biomedical Engineering, Faculty of Engineering Science and Technology, Ziauddin University, Karachi, Pakistan
| | - Soobia Saad Khan
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Juliana Usman
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia.,Centre for Applied Biomechanics, University of Malaya, Kuala Lumpur, Malaysia
| | - Abdul Halim Mokhtar
- Sports Medicine Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Noor Azuan Abu Osman
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia.,Centre for Applied Biomechanics, University of Malaya, Kuala Lumpur, Malaysia.,University of Malaysia Terengganu, Terengganu, Malaysia
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11
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Ferreira V, Simões R, Gonçalves RS, Machado L, Roriz P. The optimal degree of lateral wedge insoles for reducing knee joint load: a systematic review and meta-analysis. Arch Physiother 2019; 9:18. [PMID: 31890292 PMCID: PMC6921534 DOI: 10.1186/s40945-019-0068-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 11/08/2019] [Indexed: 12/17/2022] Open
Abstract
Background Lateral wedge insoles are traditionally used to reduce the adduction moment that crosses the knee during walking in people with medial knee osteoarthritis. However, the best degree to reduce knee joint load is not yet well established. Methods Electronic databases were searched from their inception until May 2017. Included studies reported on the immediate biomechanical effects of different degrees of lateral wedge insoles during walking in people with knee osteoarthritis. The main measures of interest relating to the biomechanics were the first and second peak of external knee adduction moment and knee adduction angular impulse. For the comparison of the biomechanical effects of different degrees of insoles, the studies were divided in three subgroups: insoles with a degree higher than 0° and equal to or lower than 5°; insoles higher than 5° and equal to or lower than 9°; and insoles higher than 9°. Eligible studies were pooled using random-effects meta-analysis. Results Fifteen studies with a total of 415 participants met all eligibility criteria and were included in the final review and meta-analysis. The overall effect suggests that lateral wedge insoles resulted in a statistically significant reduction in the first peak (standardized mean difference [SMD] -0.25; 95% confidence interval [CI] -0.36, - 0.13; P < 0.001), second peak (SMD -0.26 [95% CI -0.48, - 0.04]; P = 0.02) and knee adduction angular impulse (SMD -0.17 [95% CI -0.31, - 0.03]; P = 0.02). The test of subgroups found no statistically significant differences. Conclusion Systematic review and meta-analysis suggests that lateral wedge insoles cause an overall slight reduction in the biomechanical parameters. Higher degrees do not show higher reductions than lower degrees. Prior analysis of biomechanical parameters may be a valid option for selecting the optimal angle of wedge that best fits in knee osteoarthritis patients with the lowest possible degree.
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Affiliation(s)
- Vitor Ferreira
- 1School of Health Sciences, ESSUA - School of Health, Edificio 30, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Rita Simões
- Santa Casa da Misericórdia da Mealhada, Aveiro, Portugal
| | - Rui Soles Gonçalves
- 3Polytechnic Institute of Coimbra, Coimbra Health School, Coimbra, Portugal University of Coimbra, Centre for Health Studies and Research, Coimbra, Portugal
| | - Leandro Machado
- CIF2D, LABIOMEP, Faculdade de Desporto da Universidade do Porto, Coimbra, Portugal
| | - Paulo Roriz
- CIDESD-ISMAI, INESC-TEC, LABIOMEP, Coimbra, Portugal
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Petersen W, Ellermann A, Henning J, Nehrer S, Rembitzki IV, Fritz J, Becher C, Albasini A, Zinser W, Laute V, Ruhnau K, Stinus H, Liebau C. Non-operative treatment of unicompartmental osteoarthritis of the knee: a prospective randomized trial with two different braces-ankle-foot orthosis versus knee unloader brace. Arch Orthop Trauma Surg 2019; 139:155-166. [PMID: 30255369 DOI: 10.1007/s00402-018-3040-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The use of an unloader brace is a non-surgical treatment option for patients with medial osteoarthritis (OA). However, many patients do not adhere to brace treatment, because of skin irritation due to the pads at the level of the joint space and bad fit. A new concept to unload the medial compartment of the knee is a foot ankle brace with a lever arm pressing the thigh in valgus. The aim of this prospective randomized trial was to examine the outcomes of patients with medial OA after treatment with a conventional knee unloader brace (Unloader One®) and the new foot ankle orthosis (Agilium FreeStep®). METHODS For this multicenter trial, 160 patients (> 35 years) with medial OA were randomly allocated to treatment with a conventional knee unloader brace (Unloader One®) or treatment with the new knee OA ankle brace (Agilium FreeStep®). The primary outcome measure was pain (numerical analog scale) at baseline (T0), 8 weeks (T1), and 6 months (T2). Secondary outcome measures were knee function (Knee Injury and Osteoarthritis Outcome Score, KOOS), side effects, additional interventions, and compliance. RESULTS In both groups, walking pain improved between T0 and T1 and also between T0 and T2 without a significant group difference. For pain at sports, both groups showed a significant improvement between T0 and T2 without a significant group difference. The KOOS subscales symptoms, pain, activity, sport, and quality of life increased significantly in both treatment groups without any significant group differences at T 0, T1, and T2. There was also no significant group difference in additional interventions and weekly or daily brace use. In the Agilium FreeStep® group (23.5%), significantly less patients reported bruises in contrast to the Unloader One® group (66.7%). DISCUSSION The results of this clinical trial show that the foot ankle brace is as effective as a conventional knee unloader brace for the treatment of medial knee OA with regard to clinical outcome. The rate of side effects such as bruises was significantly lower in the Agilium FreeStep® group. TRIAL REGISTRATION DRKS00009215, 13.8.2015.
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Affiliation(s)
- Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Grunewald, Caspar Theyß Strasse 27-31, 14193, Berlin, Germany.
| | - Andree Ellermann
- Arcus Sportklinik, Rastatter Straße 17, 75179, Pforzheim, Germany
| | - Jörg Henning
- Krankenhaus Lahnhöhe, Zentr. für konserv. Orthopädie, Am Kurpark 1, 56112, Lahnstein, Germany
| | - Stefan Nehrer
- Donau Universität Krems, Dr. Karl Dorrek Straße 30, 3500, Krems, Austria
| | | | - Jürgen Fritz
- Orthopädisch Chirurgisches Centrum Tübingen, Wilhelmstr. 134, 72074, Tübingen, Germany
| | - Christoph Becher
- Orthopädische Klinik der MH Hannover, Anna-von-Borries-Straße 1-7, 30625, Hannover-Kleefeld, Germany
| | - Alfio Albasini
- FISIOTERAPIA Albasini and Müller, Viale Giuseppe Motta 15, 6500, Bellinzona, Switzerland
| | - Wolfgang Zinser
- St. Vinzenz Hospital-Dinslaken, Dr. Otto-Seidel Str. 31, 46535, Dinslaken, Germany
| | - Volker Laute
- Gelenk und Wirbelsäulenzentrum, Kieler Str. 1, 12163, Berlin, Germany
| | - Klaus Ruhnau
- Gemeinschaftspraxis Rosenthal and Schubert, Viktoriastr. 66-70, 44787, Bochum, Germany
| | - Hartmut Stinus
- Orthopaedicum Northeim, Sturmbäume 3, 37154, Northeim, Germany
| | - Christian Liebau
- Asklepios Harzklinik Fritz-König-Stift, Ilsenburger Straße 95, 38667, Bad Harzburg, Germany
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13
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Parween R, Shriram D, Mohan RE, Lee YHD, Subburaj K. Methods for evaluating effects of unloader knee braces on joint health: a review. Biomed Eng Lett 2019; 9:153-168. [PMID: 31168421 DOI: 10.1007/s13534-019-00094-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/13/2018] [Accepted: 01/08/2019] [Indexed: 02/01/2023] Open
Abstract
The paper aims to provide a state-of-the-art review of methods for evaluating the effectiveness and effect of unloader knee braces on the knee joint and discuss their limitations and future directions. Unloader braces are prescribed as a non-pharmacological conservative treatment option for patients with medial knee osteoarthritis to provide relief in terms of pain reduction, returning to regular physical activities, and enhancing the quality of life. Methods used to evaluate and monitor the effectiveness of these devices on patients' health are categorized into three broad categories (perception-, biochemical-, and morphology-based), depending upon the process and tools used. The main focus of these methods is on the short-term clinical outcome (pain or unloading efficiency). There is a significant technical, research, and clinical literature gap in understanding the short- and long-term consequences of these braces on the tissues in the knee joint, including the cartilage and ligaments. Future research directions may complement existing methods with advanced quantitative imaging (morphological, biochemical, and molecular) and numerical simulation are discussed as they offer potential in assessing long-term and post-bracing effects on the knee joint.
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Affiliation(s)
- Rizuwana Parween
- 1Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372 Singapore
| | - Duraisamy Shriram
- 1Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372 Singapore
| | - Rajesh Elara Mohan
- 1Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372 Singapore
| | - Yee Han Dave Lee
- 2Changi General Hospital, 2 Simei Street 3, Singapore, 529889 Singapore
| | - Karupppasamy Subburaj
- 1Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372 Singapore
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14
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Temporary postoperative treatment with compartment-unloading knee braces or wedge insoles does not improve clinical outcome after partial meniscectomy. Knee Surg Sports Traumatol Arthrosc 2019; 27:814-821. [PMID: 30159739 PMCID: PMC6510808 DOI: 10.1007/s00167-018-5106-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/13/2018] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate whether temporary postoperative compartment-unloading therapy after arthroscopic partial meniscectomy (APM)-with either knee braces or wedge insoles-leads to superior clinical outcome as compared to controls. This difference in clinical outcome was tested in the form of two knee scores, physical activity and general health outcome over the first postoperative year. METHODS Sixty-three patients who underwent arthroscopic partial meniscectomy (APM) were randomized to one of the following three groups: 12 weeks postoperative knee compartment-unloading therapy with either a knee brace (brace group) or wedge insoles (insole group) or no specific postoperative therapy (control group). Patient-reported outcome was assessed with the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC Score), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the MARX score (physical activity) and the SF-12 (general health). RESULTS Sixty-three patients were available for analysis. Except for the SF-12 mental score, all other scores showed significant improvement over time. With regard to the hypotheses proposed, no significant group * time interactions were observed for any of the outcome parameters. This means that the group (i.e. the type of postoperative treatment) was not related to the degree of improvement of any of the scores. CONCLUSIONS It was concluded that 12 weeks of compartment-unloading therapy-with either a knee brace or wedge insoles-is ineffective with regard to clinical outcome after APM. This applies to the knee score outcome, physical activity and general health outcome over the first year following APM. LEVEL OF EVIDENCE Randomized controlled trial, Level I.
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15
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Shaulian H, Solomonow-Avnon D, Herman A, Rozen N, Haim A, Wolf A. The effect of center of pressure alteration on the ground reaction force during gait: A statistical model. Gait Posture 2018; 66:107-113. [PMID: 30172216 DOI: 10.1016/j.gaitpost.2018.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/28/2018] [Accepted: 08/16/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Foot problems and lower-limb diseases (e.g., foot ulcers, osteoarthritis, etc.), are presented with a ground reaction force (GRF) that may deviate substantially from the normal. Thus, GRF manipulation is a key parameter when treating symptoms of these diseases. In the current study, we examined the impact of footwear-generated center of pressure (COP) manipulations on the GRF components, and the ability to predict this impact using statistical models. METHODS A foot-worn biomechanical device which allows manual manipulation of the COP location was utilized. Twelve healthy young men underwent gait analysis with the device set to convey seven COP conditions: (1) a neutral condition, (2) lateral and (3) medial offset along the medio-lateral foot axis, (4) anterior and (5) posterior offset along the antero-posterior foot axis, and (6) a dorsi-flexion and (7) plantar-flexion condition. Changes in the magnitude and the early stance-phase impulse of the GRF components across COP conditions were observed. Linear models were used to describe relationships between COP conditions and GRF magnitude and impulse. RESULTS With respect to ANOVA, the vertical and antero-posterior components of the GRF were significantly influenced by the COP configuration throughout the different stages of the stance-phase, whereas the medio-lateral components were not. The models of vertical, antero-posterior and medio-lateral GRF components were statistically significant. SIGNIFICANCE The study results are valuable for the development of a method and means for efficient treatment of foot and lower-limb pathologies. The ability to predict and control the GRF components along three orthogonal axes, for a given COP location, provides a strong tool for efficient treatment of foot and lower-limb diseases and may also have relevant implications in sports shoe design. This study is a preliminary investigation for our ultimate goal to develop an effective treatment method by developing an autonomous GRF manipulations device based on closed-loop feedback.
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Affiliation(s)
- Hadar Shaulian
- Biorobotics and Biomechanics Lab (BRML), Faculty of Mechanical Engineering, Technion-Israel Institute of Technology, 32000, Haifa, Israel.
| | - Deborah Solomonow-Avnon
- Biorobotics and Biomechanics Lab (BRML), Faculty of Mechanical Engineering, Technion-Israel Institute of Technology, 32000, Haifa, Israel
| | - Amir Herman
- Department of Orthopedic Surgery A, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Nimrod Rozen
- Department of Orthopedic Surgery, Ha'Emek Medical Center, Center, Afula, Israel
| | - Amir Haim
- Biorobotics and Biomechanics Lab (BRML), Faculty of Mechanical Engineering, Technion-Israel Institute of Technology, 32000, Haifa, Israel; Department of Orthopedic Surgery B, Sourasky Medical Center, Tel Aviv, Israel
| | - Alon Wolf
- Biorobotics and Biomechanics Lab (BRML), Faculty of Mechanical Engineering, Technion-Israel Institute of Technology, 32000, Haifa, Israel
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16
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Fryzowicz A, Dworak LB, Koczewski P. Prophylaxis of medial compartment gonarthrosis in varus knee - current state of knowledge. Arch Med Sci 2018; 14:454-459. [PMID: 29593820 PMCID: PMC5868653 DOI: 10.5114/aoms.2016.57961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/08/2015] [Indexed: 12/27/2022] Open
Abstract
The progression of gonarthrosis results in reduction of physical activity. One of the factors that increase the risk of osteoarthrosis may be joint overload related to the malalignment of the mechanical axis of the lower extremity. The medial compartment (MC) of the knee is particularly susceptible to overload due to the external knee adduction moment (EKAM). Varus knee malalignment contributes to increased EKAM and thus results in increased MC loading. The purpose of this study is to present methods described in current literature aimed at reducing the disproportion in the distribution of loads on articular surfaces of medial and lateral knee compartments in people with varus knee malalignment. Methods have been divided into non-surgical (gait training, physiotherapy, and orthopedic supplies such as valgus braces, lateral wedge insoles, walking poles) and surgical ones (corrective osteotomy).
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Affiliation(s)
- Anna Fryzowicz
- Chair of Biomechanics, University School of Physical Education, Poznan, Poland
| | | | - Paweł Koczewski
- Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
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17
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Clouthier AL, Hassan EA, Brandon SCE, Campbell A, Rainbow MJ, Deluzio KJ. Identification of good candidates for valgus bracing as a treatment for medial knee osteoarthritis. J Orthop Res 2018; 36:351-356. [PMID: 28755495 DOI: 10.1002/jor.23663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 07/24/2017] [Indexed: 02/04/2023]
Abstract
UNLABELLED Valgus unloader braces are a conservative treatment option for medial compartment knee osteoarthritis that aim to unload the damaged medial compartment through application of an external abduction moment. Patient response to bracing is highly variable, however. While some experience improvements in pain, function, and joint loading, others receive little to no benefit. The objective of this work was to analyze clinical measures and biomechanical characteristics of unbraced walking to identify variables that are associated with the mechanical effectiveness of valgus unloader bracing. Seventeen patients with medial knee osteoarthritis walked overground with and without a valgus unloader brace. A musculoskeletal model was used to estimate the contact forces in the medial compartment of the tibiofemoral joint and brace effectiveness was defined as the decrease in peak medial contact force between unbraced and braced conditions. Stepwise linear regression was used to identify clinical and biomechanical measures that predicted brace effectiveness. The final regression model explained 77% of the variance in brace effectiveness using two variables. Bracing was more effective for those with greater peak external hip adduction moments and for those with higher Kellgren-Lawrence grades, indicating more severe radiographic osteoarthritis. The hip adduction moment was the best predictor of brace effectiveness and was well correlated with several other measures indicating that it may be functioning as a "biomarker" for good bracing candidates. CLINICAL SIGNIFICANCE The ability to predict good candidates for valgus bracing may improve issues of patient compliance and could enable the ability to train patients to respond better to bracing. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:351-356, 2018.
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Affiliation(s)
- Allison L Clouthier
- Departmentof Mechanical and Materials Engineering, Queen's University, Kingston, 130 Stuart St McLaughlin Hall, Ontario, K7L 3N6, Canada
| | - Elizabeth A Hassan
- Department of Mechanical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Scott C E Brandon
- School of Engineering, University of Guelph, Guelph, Ontario, Canada
| | - Aaron Campbell
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Michael J Rainbow
- Departmentof Mechanical and Materials Engineering, Queen's University, Kingston, 130 Stuart St McLaughlin Hall, Ontario, K7L 3N6, Canada
| | - Kevin J Deluzio
- Departmentof Mechanical and Materials Engineering, Queen's University, Kingston, 130 Stuart St McLaughlin Hall, Ontario, K7L 3N6, Canada
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18
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Jafarnezhadgero AA, Oliveira AS, Mousavi SH, Madadi-Shad M. Combining valgus knee brace and lateral foot wedges reduces external forces and moments in osteoarthritis patients. Gait Posture 2018; 59:104-110. [PMID: 29028621 DOI: 10.1016/j.gaitpost.2017.09.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 09/23/2017] [Accepted: 09/28/2017] [Indexed: 02/02/2023]
Abstract
Osteoarthritis progression can be related to the external knee adduction and flexion moments during walking. Lateral foot wedges and knee braces have been used as treatment for osteoarthritis, but little is known about their influence on knee joint moments generated in the sagittal and frontal planes. Therefore, the aim of the present study was determine the effects of the isolated and combined use of valgus knee brace and lateral wedge foot orthotic on peak forces and moments during gait in knee osteoarthritis patients. Twenty four males (age: 62.1±2.0years) with varus alignment, symptomatic medial compartment knee osteoarthritis participated in this study. Subjects walked over ground at preferred speed in four conditions: (1) no assistive device (control); (2) using lateral wedges, (3) using knee braces, and (4) using both lateral wedges and knee braces. Ground reaction forces (GRF) and moments, as well as lower limb kinematics were recorded. Peak GRF, vertical loading rate, free moment, external knee adduction and flexion moments were compared across conditions. The concurrent use of lateral wedge and knee brace reduced the first peak GRF in the vertical (6%, p=0.002), anterior-posterior (30%, p=0.028) and medial-lateral directions (44%, p=0.029). Moreover, the use of these devices reduced the peak external knee adduction moment (25%, p=0.019), but not the external flexion moment and free moment (p>0.05). The combined use of lateral wedges and knee braces can reduce medial-lateral knee joint loading, but despite reduced peak forces in the sagittal plane, these device do not reduce joint moments.
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Affiliation(s)
- Amir Ali Jafarnezhadgero
- Department of Physical Education and Sport Sciences, Faculty of Educational Science and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.
| | - Anderson S Oliveira
- Department of Materials and Production, Aalborg University, Fibigerstræde 16, building 4, DK-9220 Aalborg E, Denmark
| | - Seyed Hamed Mousavi
- Department of Sports Medicine, University Medical Center Groningen, The Netherlands
| | - Morteza Madadi-Shad
- Department of Physical Education and Sport Sciences, Faculty of Educational Science and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
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Brand A, Klöpfer-Krämer I, Morgenstern M, Kröger I, Michel B, Thannheimer A, Müßig JA, Augat P. Effects of knee orthosis adjustment on biomechanical performance and clinical outcome in patients with medial knee osteoarthritis. Prosthet Orthot Int 2017; 41:587-594. [PMID: 29214918 DOI: 10.1177/0309364617691623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Valgus bracing in medial knee osteoarthritis aims to improve gait function by reducing the loading of the medial compartment. Orthosis composition and optimal adjustment is essential to achieve biomechanical and clinical effectiveness. OBJECTIVES To investigate biomechanical functionality during gait, pain relief and compliance in patients with knee osteoarthritis using a lightweight adjustable knee unloader orthosis. STUDY DESIGN Prospective observational clinical trial. METHODS Instrumented gait analysis in 22 patients with unilateral medial knee osteoarthritis was performed after a 2-week orthosis acclimatisation period. Kinematics and kinetics during gait as well as force transmission from the orthosis to the knee were analysed. Measurements were performed without, at individualised and at reduced orthosis setting. The assessment was supplemented by patient-related pain sensation and compliance questionnaires. RESULTS Orthosis wear significantly reduced the knee adduction moment by up to 20% depending on orthosis adjustment, whereas pain sensation was significantly reduced by 16%. A significant positive correlation was found between force transmissions and knee adduction moment as well as for frontal knee angle. Compliance was good with a main daily use of 2-6 h. CONCLUSION The orthosis provides significant biomechanical improvements, pain relief and good patient compliance. Patients had a biomechanical benefit for the individualised and reduced orthosis adjustments. Clinical relevance In patients with medial knee osteoarthritis, a lightweight medial unloader orthosis effectively reduced external knee adduction moment and pain sensation during daily activities. Thus, use of lightweight orthoses effectively supports conservative treatment in medial knee osteoarthritis.
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Affiliation(s)
- Andreas Brand
- 1 Institute of Biomechanics, Trauma Center Murnau, Germany
- 2 Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Isabella Klöpfer-Krämer
- 1 Institute of Biomechanics, Trauma Center Murnau, Germany
- 2 Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Mario Morgenstern
- 3 Trauma Center Murnau, Germany
- 4 University Hospital Basel, Switzerland
| | - Inga Kröger
- 1 Institute of Biomechanics, Trauma Center Murnau, Germany
- 2 Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Björn Michel
- 5 Endogap Hospital and Clinics Garmisch-Partenkirchen, Germany
| | | | - Janina Anna Müßig
- 1 Institute of Biomechanics, Trauma Center Murnau, Germany
- 2 Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Peter Augat
- 1 Institute of Biomechanics, Trauma Center Murnau, Germany
- 2 Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
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20
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Ishii Y, Deie M, Fujita N, Kurumadani H, Ishikawa M, Nakamae A, Hayashi S, Hata J, Adachi N, Sunagawa T. Effects of lateral wedge insole application on medial compartment knee osteoarthritis severity evaluated by ultrasound. Knee 2017; 24:1408-1413. [PMID: 28970118 DOI: 10.1016/j.knee.2017.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 08/18/2017] [Accepted: 09/01/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND It is known that a lateral wedge insole (LWI) decreases medial loading stress in the knee. Medial meniscus pathology, such as a degenerative tear or a root tear, leading to malfunction and medial meniscus extrusion (MME), is a critical condition that leads to severe osteoarthritis (OA). However, the effect of LWI on MME is still unknown. The objective of this study was to investigate the effect of LWI use on MME in knee OA using ultrasonography. METHODS Thirty-one knees from 18 patients with knee OA diagnosed radiographically were allocated to the OA group (mean age, 73.6years; sex M:F, 2:16). Twenty-two knees from 11 volunteers without knee OA were also enrolled as an age-matched control group. MME was evaluated using ultrasonography with the patients in three positions: supine, standing without LWI, and standing with LWI. RESULTS In both groups, the mean values of the MME increased significantly when patients were in the standing position compared to the supine position. In the OA group, MME significantly decreased with LWI use. There was no significant difference in MME between use and non-use of an LWI in the control group. CONCLUSIONS The LWI could significantly decrease MME in patients with knee OA.
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Affiliation(s)
- Yosuke Ishii
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Masataka Deie
- Department of Orthopedic Surgery, Aichi Medical University, Aichi, Japan
| | - Naoto Fujita
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Kurumadani
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masakazu Ishikawa
- Department of Orthopedic Surgery, Integrated Health Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Atsuo Nakamae
- Department of Orthopedic Surgery, Integrated Health Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Seiju Hayashi
- Department of Orthopedic Surgery, Integrated Health Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jiro Hata
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Nobuo Adachi
- Department of Orthopedic Surgery, Integrated Health Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toru Sunagawa
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
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21
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Dessery Y, Belzile É, Turmel S, Corbeil P. Effects of foot orthoses with medial arch support and lateral wedge on knee adduction moment in patients with medial knee osteoarthritis. Prosthet Orthot Int 2017; 41:356-363. [PMID: 27555447 DOI: 10.1177/0309364616661254] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is contradictory evidence regarding whether the addition of medial arch supports to laterally wedged insoles reduces knee adduction moment, improves comfort, and reduces knee pain during the late stance phase of gait. OBJECTIVES To verify if such effects occur in participants with medial knee osteoarthritis. STUDY DESIGN Randomized single-blinded study. METHODS Gait analysis was performed on 18 patients affected by medial knee osteoarthritis. Pain and comfort scores, frontal plane kinematics and kinetics of ankle, knee, and hip were compared in four conditions: without foot orthosis, with foot orthoses, with medial arch support, and with foot orthoses with medial arch support and lateral wedge insoles with 6° and 10° inclination. RESULTS Lower-extremity gait kinetics were characterized by a significant decrease, greater than 6%, in second peak knee adduction moment in laterally wedged insole conditions compared to the other conditions ( p < 0.001; effect size = 0.6). No significant difference in knee adduction moment was observed between laterally wedged insole conditions. In contrast, a significant increase of 7% in knee adduction moment during the loading response was observed in the customized foot orthoses without lateral inclination condition ( p < 0.001; effect size = 0.3). No difference was found in comfort or pain ratings between conditions. CONCLUSION Our study suggests that customized foot orthoses with a medial arch support may only be suitable for the management of medial knee osteoarthritis when a lateral wedge is included. Clinical relevance Our data suggest that customized foot orthoses with medial arch support and a lateral wedge reduce knee loading in patients with medial knee osteoarthritis (KOA). We also found evidence that medial arch support may increase knee loading, which could potentially be detrimental in KOA patients.
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Affiliation(s)
| | - Étienne Belzile
- 2 Centre de recherche FRQS du Centre hospitalier universitaire de Québec, Quebec, QC, Canada
| | - Sylvie Turmel
- 2 Centre de recherche FRQS du Centre hospitalier universitaire de Québec, Quebec, QC, Canada
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Shaw KE, Charlton JM, Perry CKL, de Vries CM, Redekopp MJ, White JA, Hunt MA. The effects of shoe-worn insoles on gait biomechanics in people with knee osteoarthritis: a systematic review and meta-analysis. Br J Sports Med 2017; 52:238-253. [PMID: 28684391 DOI: 10.1136/bjsports-2016-097108] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The effect of shoe-worn insoles on biomechanical variables in people with medial knee osteoarthritis has been studied extensively. The majority of research has focused specifically on the effect of lateral wedge insoles at the knee. The aim of this systematic review and meta-analysis was to summarise the known effects of different shoe-worn insoles on all biomechanical variables during level walking in this patient population to date. METHODS Four electronic databases were searched to identify studies containing biomechanical data using shoe-worn insole devices in the knee osteoarthritis population. Methodological quality was assessed and a random effects meta-analysis was performed on biomechanical variables reported in three or more studies for each insole. RESULTS Twenty-seven studies of moderate-to-high methodological quality were included in this review. The primary findings were consistent reductions in the knee adduction moment with lateral wedge insoles, although increases in ankle eversion with these insoles were also found. CONCLUSION Lateral wedge insoles produce small reductions in knee adduction angles and external moments, and moderate increases in ankle eversion. The addition of an arch support to a lateral wedge minimises ankle eversion change, and also minimises adduction moment reductions. The paucity of available data on other insole types and other biomechanical outcomes presents an opportunity for future research.
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Affiliation(s)
- Kathryn E Shaw
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jesse M Charlton
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Christina K L Perry
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Courtney M de Vries
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Matthew J Redekopp
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jordan A White
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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Xing F, Lu B, Kuang MJ, Wang Y, Zhao YL, Zhao J, Sun L, Wang Y, Ma JX, Ma XL. A systematic review and meta-analysis into the effect of lateral wedge arch support insoles for reducing knee joint load in patients with medial knee osteoarthritis. Medicine (Baltimore) 2017; 96:e7168. [PMID: 28614253 PMCID: PMC5478338 DOI: 10.1097/md.0000000000007168] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the immediate effects of lateral wedge arch support insoles (LWAS) on reducing the knee joint load in patients with medial knee osteoarthritis (OA) compared with an appropriate control. METHODS Databases including Medline, EMBASE, Web of Science, Wiley Online Library, Cochrane library, and Google Scholar were searched with no limits on study date or language, from the earliest available date to October 31, 2016. The included studies had to have the aim of reducing knee load and have an appropriate control. The main measured values were the first and second peak external knee adduction moments (EKAM) and the knee adduction angular impulse (KAAI). The random-effects model was used for analyzing the eligible studies. RESULTS Nine studies met the inclusion criteria with a total of 356 participants of whom 337 received LWAS treatment. The risk of methodological bias scores (quality index) ranged from 21 to 27 of 32. Treatment with LWAS resulted in statistically significant reductions in the first peak EKAM (P = .005), the second peak EKAM (P = .01), and the KAAI (P = .03). However, among trials in which the control treatment was control shoes, the LWAS showed no associations on the first peak EKAM (P = .10) or the KAAI (P = .06); among trials in which the control treatment was neutral insoles, the LWAS showed no associations on the second peak EKAM (P = .21) or the KAAI (P = .23). At the same time, the LWAS showed no statistically significant reduction on the first peak EKAM (P = .39) when compared with flat insoles. CONCLUSION Although meta-analysis outcomes of all studies indicated statistically significant associations between LWAS and reductions of the first peak EKAM, second peak EKAM and KAAI in people with medial knee OA while walking, different results existed in subgroups using various control conditions for comparison. These findings do not support the use of LWAS insoles for reducing knee load. An optimal LWAS treatment should provide the appropriate height of arch support and amount of lateral wedging. Further research should investigate the best combination of these 2 parameters to achieve efficacy without altered comfort.
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Affiliation(s)
- Fei Xing
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
- Tianjin Medical University
| | - Bin Lu
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
| | - Ming-jie Kuang
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
- Tianjin Medical University
| | - Ying Wang
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
| | - Yun-long Zhao
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
- Tianjin Medical University
| | - Jie Zhao
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
- Tianjin Medical University
| | - Lei Sun
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
| | - Yan Wang
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
| | - Jian-xiong Ma
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
| | - Xin-long Ma
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
- Department of Orthopedics, Tianjin Hospital, Tianjin, People's Republic of China
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How do rocker-soled shoes influence the knee adduction moment in people with knee osteoarthritis? An analysis of biomechanical mechanisms. J Biomech 2017; 57:62-68. [DOI: 10.1016/j.jbiomech.2017.03.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 02/02/2017] [Accepted: 03/31/2017] [Indexed: 11/20/2022]
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Einfluss von Gangbildmodifikationen und Orthesen auf die Kniegelenkbelastung bei Kniearthrose. MANUELLE MEDIZIN 2017. [DOI: 10.1007/s00337-016-0220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Tezcan ME, Goker B, Lidtke R, Block JA. Long-term effects of lateral wedge orthotics on hip and ankle joint space widths. Gait Posture 2017; 51:36-40. [PMID: 27693959 PMCID: PMC5140676 DOI: 10.1016/j.gaitpost.2016.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 09/10/2016] [Accepted: 09/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lateral wedge insoles have been used for the treatment of medial knee osteoarthritis (OA) and have been shown to reduce loading of the medial compartment of the knee. However, as the entire lower extremity acts as a single kinetic chain, altering the biomechanics of the knee may also have significant effects at the ankles or hips. We aimed to evaluate the effects of lateral wedge orthotics on ankle and hip joints, compared to neutral orthotics, by assessing the changes in joint space width (JSW) during 36 months of continuous use. METHODS We prospectively enrolled 109 subjects with symptomatic osteoarthritis of the medial knee according to the American College of Rheumatology criteria. The trial was double blind and patients were randomized to either wedged or neutral orthotic shoe inserts. Hip and ankle JSWs were quantified using plain radiographies at baseline and at 36-months follow-up. FINDINGS 45 patients completed the 36 month study. 31 of those who completed the study were using the lateral wedge versus 14 were using neutral orthotics. 2 patients in the wedge group had missing radiographs and were not included in the JSW analyses. There were no significant differences between the wedge and the neutral orthotics groups in the magnitude of JSW change at either the hip or the ankles at 36 month. INTERPRETATION We found no significant adverse effects of the lateral wedges on ankles or hips. (ClinicalTrials.gov NCT00076453).
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Affiliation(s)
- Mehmet E. Tezcan
- Gazi University, School of Medicine, Department of Internal Medicine, Section of Rheumatology, Ankara, Turkey
| | - Berna Goker
- Gazi University, School of Medicine, Department of Internal Medicine, Section of Rheumatology, Ankara, Turkey
| | - Roy Lidtke
- Rush Medical College, Department of Internal Medicine, Section of Rheumatology, Department of Biochemistry, Chicago, IL, USA
| | - Joel A. Block
- Rush Medical College, Department of Internal Medicine, Section of Rheumatology, Department of Biochemistry, Chicago, IL, USA
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Lamberg EM, Streb R, Werner M, Kremenic I, Penna J. The 2- and 8-week effects of decompressive brace use in people with medial compartment knee osteoarthritis. Prosthet Orthot Int 2016; 40:447-53. [PMID: 26112467 DOI: 10.1177/0309364615589537] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/16/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Knee osteoarthritis is a prevalent disease. Unloading the affected compartment using a brace is a treatment option. OBJECTIVES To determine whether a decompressive knee brace alters loading in medial knee osteoarthritis following 2 and 8 weeks of use. STUDY DESIGN Within subjects; pre- and post-testing. METHODS A total of 15 individuals with medial knee osteoarthritis attended four sessions: baseline, fitting, 2 weeks after fitting (post), and 8 weeks after fitting (final). A gait analysis was performed at baseline (without knee brace), post and final. Knee adduction impulse, first and second peak knee adduction moment, knee motion, and walking velocity were calculated. Participants also recorded hours and steps taken while wearing the brace. RESULTS On average, the brace was worn for more than 6 h/day. Through use of repeated-measures analysis of variance, it was determined that the knee adduction impulse and second peak knee adduction moment were reduced (p < 0.05) at post and final compared to baseline (36% and 34% reduction in knee adduction impulse, 26% reduction in second peak knee adduction moment for post and final, respectively). Furthermore, participants walked faster with increased knee motion during stance. CONCLUSION The studied decompressive brace was effective in reducing potentially detrimental forces at the knee-knee adduction impulse and second peak knee adduction moment during the stance phase of gait. CLINICAL RELEVANCE The data from this study suggest that use of a medial unloading brace can reduce potentially detrimental adduction moments at the knee. Clinicians should use this evidence to advocate for use of this noninvasive treatment for people presenting with medial knee osteoarthritis.
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Affiliation(s)
| | | | - Marc Werner
- Long Island Orthotics and Prosthetics, West Babylon, NY, USA
| | | | - James Penna
- Stony Brook University, Stony Brook, NY, USA
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Lewinson RT, Stefanyshyn DJ. Wedged Insoles and Gait in Patients with Knee Osteoarthritis: A Biomechanical Review. Ann Biomed Eng 2016; 44:3173-3185. [PMID: 27436294 DOI: 10.1007/s10439-016-1696-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/08/2016] [Indexed: 01/04/2023]
Abstract
The study of gait biomechanics in individuals with knee osteoarthritis has become widespread, especially in regards to the knee adduction moment-a variable commonly believed to be associated with knee osteoarthritis progression. Unfortunately, this variable is often studied clinically without considering how it is derived, or what it means in a mechanical context. The use of footwear for knee osteoarthritis management has received much attention as well. However, in many cases, footwear is studied without regard for the mechanical effects they actually induce on the patient. Therefore, this review aims to summarize the current state of knowledge in regards to knee osteoarthritis gait and footwear biomechanics, by taking a step back to review the foundations of these two research areas. First, an overview of the calculation of the knee adduction moment is provided, along with mechanical considerations. Then, this is used to discuss current evidence for wedged insoles and highlight knowledge gaps. The intent was to place this mechanical information in a clinically-oriented framework for approachability by scientists, engineers and clinicians alike. Based on this discussion, areas for future investigation are proposed.
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Affiliation(s)
- Ryan T Lewinson
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada. .,Schulich School of Engineering, University of Calgary, Calgary, AB, Canada. .,Cumming School of Medicine, University of Calgary, 3330 Hospital Drive N.W., Calgary, AB, T2N 4N1, Canada.
| | - Darren J Stefanyshyn
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
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Arnold JB, Wong DX, Jones RK, Hill CL, Thewlis D. Lateral Wedge Insoles for Reducing Biomechanical Risk Factors for Medial Knee Osteoarthritis Progression: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2016; 68:936-51. [DOI: 10.1002/acr.22797] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/21/2015] [Accepted: 11/17/2015] [Indexed: 12/20/2022]
Affiliation(s)
- John B. Arnold
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia; Adelaide South Australia Australia
| | - Daniel X. Wong
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia; Adelaide South Australia Australia
| | - Richard K. Jones
- University of Salford, Salford, UK, and Centre for Musculoskeletal Research, University of Manchester; Manchester UK
| | - Catherine L. Hill
- Queen Elizabeth Hospital and Health Observatory, University of Adelaide; Adelaide South Australia Australia
| | - Dominic Thewlis
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, and Centre for Orthopaedic and Trauma Research, University of Adelaide; Adelaide South Australia Australia
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30
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Maleki M, Arazpour M, Joghtaei M, Hutchins SW, Aboutorabi A, Pouyan A. The effect of knee orthoses on gait parameters in medial knee compartment osteoarthritis: A literature review. Prosthet Orthot Int 2016; 40:193-201. [PMID: 25160784 DOI: 10.1177/0309364614547411] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 07/21/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Knee osteoarthritis is a musculoskeletal condition which is most prevalent in the medial compartment. This injury causes considerable pain, disability, and negative changes in kinetic and kinematic parameters. The efficiency of unloader valgus brace as a conservative treatment for medial knee osteoarthritis is not well documented. OBJECTIVES The aim of this study was to review the previous research regarding the biomechanical effects of knee valgus braces on walking in medial compartment knee osteoarthritis patients. STUDY DESIGN Literature review METHODS According to the population intervention comparison outcome measure methods and based on selected keywords, 12 studies were chosen according to (met) the inclusion criteria. RESULTS The results indicated that treatment with knee braces was effective in decreasing pain, improving function, ameliorating improvement in range of motion, and increasing speed of walking and step length in conjunction with a reduction in the adduction moment applied to the knee. CONCLUSION Osteoarthritis knee braces may be considered for improvement of walking and treatment of medial compartment knee osteoarthritis. CLINICAL RELEVANCE Knee braces are an orthotic intervention that could potentially be significant in assisting in improving the walking parameters and treatment of medial compartment knee osteoarthritis.
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Affiliation(s)
- Maryam Maleki
- Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Mokhtar Arazpour
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Mahmoud Joghtaei
- Department of Automatic Control and Systems Engineering, University of Sheffield, UK
| | - Stephen W Hutchins
- IHSCR, Faculty of Health & Social Care, University of Salford, Salford, UK
| | - Atefeh Aboutorabi
- Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Ali Pouyan
- Department of Neurosurgery, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Baghaei Roodsari R, Esteki A, Aminian G, Ebrahimi I, Mousavi ME, Majdoleslami B, Bahramian F. The effect of orthotic devices on knee adduction moment, pain and function in medial compartment knee osteoarthritis: a literature review. Disabil Rehabil Assist Technol 2016; 12:441-449. [PMID: 26980073 DOI: 10.3109/17483107.2016.1151952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Knee braces and foot orthoses are commonly used to improve knee adduction moment, pain and function in subjects with knee osteoarthritis (OA). However, no literature review has been performed to compare the effects of foot orthoses and knee braces in this group of patients. Purpose The aim of this review was to evaluate the effects of foot orthoses and knee braces on knee adduction moment, pain and function in individuals with knee OA. Study design Literature review. Method The search strategy was based on the Population Intervention Comparison Outcome method. A search was performed in PubMed, Science Direct, Google Scholar and ISI web of knowledge databases using the PRISMA method and based on selected keywords. Thirty-one related articles were selected for final evaluation. Results The results of the analysis of these studies demonstrated that orthotic devices reduce knee adduction moment and also improve pain and function in individuals with knee OA. Conclusion Foot orthoses may be more effective in improving pain and function in subjects with knee OA. Both knee braces and foot orthoses reduce the knee adduction moment in knee OA and consequently patients typically do not need to use knee braces for a long period of time. Also, foot orthoses and knee braces may be more effective for medial compartment knee OA patients due to the fact that this treatment helps improve pain and function. Implications for Rehabilitation Knee braces and foot orthoses are commonly used for improving knee adduction moment, pain and function in subjects with knee osteoarthritis (OA). Orthotic devices can reduce knee adduction moment, pain and improve function in knee OA. The combined use of a knee braces and foot orthoses can provide more improvement in knee adduction moment, reduced pain and increased function.
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Affiliation(s)
- Roshanak Baghaei Roodsari
- a Department of Orthotics and Prosthetics , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
| | - Ali Esteki
- b Shahid Beheshti University of Medical Sciences , Tehran , Islamic Republic of Iran
| | - Gholamreza Aminian
- a Department of Orthotics and Prosthetics , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
| | - Ismaeil Ebrahimi
- c School of Rehabilitation Sciences, Iran University of Medical Sciences , Tehran , Islamic Republic of Iran
| | - Mohammad Ebramim Mousavi
- a Department of Orthotics and Prosthetics , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
| | - Basir Majdoleslami
- a Department of Orthotics and Prosthetics , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
| | - Fatemeh Bahramian
- a Department of Orthotics and Prosthetics , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
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Association of Varus Thrust With Pain and Stiffness and Activities of Daily Living in Patients With Medial Knee Osteoarthritis. Phys Ther 2016; 96:167-75. [PMID: 26089038 DOI: 10.2522/ptj.20140441] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 06/08/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Increasing evidence highlights potential associations between varus thrust and health domains associated with knee osteoarthritis (OA). OBJECTIVE The aim of this study was to investigate the association between varus thrust and 2 subcategories-"pain and stiffness" and "activities of daily living (ADL)"-of the Japanese Knee Osteoarthritis Measure (JKOM). DESIGN This was a cross-sectional study. METHODS In total, 296 outpatients with knee OA visiting orthopedic clinics were enrolled. The inclusion criteria were age ≥50 years, medial knee OA and Kellgren-Lawrence (K/L) grade ≥1 in one or both knees, and the ability to walk independently. Standard posterior-anterior knee radiographs were measured for varus alignment. Participants were video recorded while walking and were evaluated for the presence or absence of varus thrust. Pain and stiffness of the knee joint and ADL were evaluated using the JKOM. Multivariate regressions (outcomes: pain and stiffness and ADL; predictor variable: varus thrust) were performed. RESULTS Varus thrust was present in 46 (16.2%) of 284 patients. Multivariate regression analyses demonstrated that varus thrust is independently associated with pain and stiffness, adjusted for age, sex, body mass index, K/L grade, and varus alignment (β=.17, P=.005). However, the association between varus thrust and ADL was not significant (β=.11, P=.058). Based on sensitivity analyses, including participants of K/L grade 1 had little influence on this analysis. LIMITATIONS Only 16.2% of participants had a varus thrust. Moreover, a cause-effect relationship between varus thrust and pain and stiffness remains unknown due to the cross-sectional design of this study. CONCLUSIONS Varus thrust was associated with pain and stiffness in patients with medial knee OA. However, the association between varus thrust and ADL did not reach significance.
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Biomechanical effect of unloader braces for medial osteoarthritis of the knee: a systematic review (CRD 42015026136). Arch Orthop Trauma Surg 2016; 136:649-56. [PMID: 26739139 PMCID: PMC4842213 DOI: 10.1007/s00402-015-2388-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Indexed: 10/26/2022]
Abstract
PURPOSE There is a lack of consensus regarding biomechanical effects of unloader braces for the treatment of medial osteoarthritis (OA) of the knee. The purpose of this study was to perform a systematic review of studies examining the biomechanical effect of unloader braces. METHODS A systematic search for articles about the biomechanical effect of unloader braces was performed. Primary outcome measure was the influence of the brace on the knee adduction moment. Data sources were Pubmed central and google scholar. RESULTS Twenty-four articles were included. Twenty articles showed that valgus unloader braces significantly decrease the knee adduction moment. Seven of those studies reported a decrease of pain in braced patients (secondary outcome measure). Positive effects on the knee adduction moment could be found for custom made braces for conventional knee braces and for a foot ankle orthosis. Four studies could not show any effect of knee unloader braces on the knee adduction moment although one of these studies found decreased pain in braced patients. One of these studies examined healthy patients with a neutral axis. CONCLUSION This systematic review could demonstrate evidence that unloader braces reduce the adduction moment of the knee. Foresighted, a systematic review about the clinical effect of unloader braces is required.
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Iijima H, Fukutani N, Aoyama T, Fukumoto T, Uritani D, Kaneda E, Ota K, Kuroki H, Matsuda S. Clinical Phenotype Classifications Based on Static Varus Alignment and Varus Thrust in Japanese Patients With Medial Knee Osteoarthritis. Arthritis Rheumatol 2015; 67:2354-62. [PMID: 26017348 PMCID: PMC5049626 DOI: 10.1002/art.39224] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 05/26/2015] [Indexed: 11/11/2022]
Abstract
Objective To investigate the association between knee pain during gait and 4 clinical phenotypes based on static varus alignment and varus thrust in patients with medial knee osteoarthritis (OA). Methods Patients in an orthopedic clinic (n = 266) diagnosed as having knee OA (Kellgren/Lawrence [K/L] grade ≥1) were divided into 4 phenotype groups according to the presence or absence of static varus alignment and varus thrust (dynamic varus): no varus (n = 173), dynamic varus (n = 17), static varus (n = 50), and static varus + dynamic varus (n = 26). The knee range of motion, spatiotemporal gait parameters, visual analog scale scores for knee pain, and scores on the Japanese Knee Osteoarthritis Measure were used to assess clinical outcomes. Multiple logistic regression analyses identified the relationship between knee pain during gait and the 4 phenotypes, adjusted for possible risk factors, including age, sex, body mass index, K/L grade, and gait velocity. Results Multiple logistic regression analysis showed that varus thrust without varus alignment was associated with knee pain during gait (odds ratio [OR] 3.30, 95% confidence interval [95% CI] 1.08–12.4), and that varus thrust combined with varus alignment was strongly associated with knee pain during gait (OR 17.1, 95% CI 3.19–320.0). Sensitivity analyses applying alternative cutoff values for defining static varus alignment showed comparable results. Conclusion Varus thrust with or without static varus alignment was associated with the occurrence of knee pain during gait. Tailored interventions based on individual malalignment phenotypes may improve clinical outcomes in patients with knee OA.
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Affiliation(s)
| | - Naoto Fukutani
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoki Aoyama
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | | - Kazuo Ota
- Ota Orthopaedic Clinic, Kyoto, Japan
| | - Hiroshi Kuroki
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Abstract
Osteoarthritis (OA) has been thought of as a disease of cartilage that can be effectively treated surgically at severe stages with joint arthroplasty. Today, OA is considered a whole-organ disease that is amenable to prevention and treatment at early stages. OA develops slowly over 10-15 years, interfering with activities of daily living and the ability to work. Many patients tolerate pain, and many health-care providers accept pain and disability as inevitable corollaries of OA and ageing. Too often, health-care providers passively await final 'joint death', necessitating knee and hip replacements. Instead, OA should be viewed as a chronic condition, where prevention and early comprehensive-care models are the accepted norm, as is the case with other chronic diseases. Joint injury, obesity and impaired muscle function are modifiable risk factors amenable to primary and secondary prevention strategies. The strategies that are most appropriate for each patient should be identified, by selecting interventions to correct--or at least attenuate--OA risk factors. We must also choose the interventions that are most likely to be acceptable to patients, to maximize adherence to--and persistence with--the regimes. Now is the time to begin the era of personalized prevention for knee OA.
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Affiliation(s)
- Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
| | - Nigel K Arden
- Botnar Research Centre, Nuffield Orthopedic Centre, Oxford OX3 7LD, UK
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Lewinson RT, Worobets JT, Stefanyshyn DJ. Calculation of external knee adduction moments: a comparison of an inverse dynamics approach and a simplified lever-arm approach. Knee 2015; 22:292-7. [PMID: 26006770 DOI: 10.1016/j.knee.2015.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/17/2015] [Accepted: 04/06/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The external knee adduction moment (EKAM) is often studied in knee osteoarthritis research. This study compared EKAMs between two methods of calculation: a method that only requires ground reaction force and knee position data (i.e. lever-arm), and an inverse dynamics link-segment method. METHODS Sixteen participants walked while wearing a control shoe with and without a six millimeter lateral wedge insole. Peak EKAMs between the lever-arm and inverse dynamics methods were compared for the control condition, and the %change in moment induced by the lateral wedge was compared between methods. RESULTS When comparing EKAMs between methods, no correlation was found (r=0.24, p=0.36); peak EKAMs with the lever-arm method (26.0Nm) were significantly lower than EKAMs with the inverse dynamics method (40.2Nm, pb0.001); and Bland-Altman plots showed poor agreement between methods. When assessing the %change in moment with a lateral wedge, a moderate correlation was found (r=0.55, p=0.03) between methods; Bland-Altman plots showed moderate agreement between methods; and the lever-arm method (-6.4%) was not significantly different from the inverse dynamics method (-11.4%, p=0.09); however, the two methods produced opposite results 31% of the time. CONCLUSION The lever-arm method cannot estimate peak EKAMs, and can only approximate the %change in moment induced by a lateral wedge; however, the error rate was 31%. Therefore, the lever-arm method is not recommended for use in its current form. CLINICAL RELEVANCE This study may help guide the development of a fast and simple method for determining EKAMs for individuals with knee osteoarthritis.
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Affiliation(s)
- Ryan T Lewinson
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada; Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Jay T Worobets
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Darren J Stefanyshyn
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
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Ferreira EI, Ávila CAV, Mastroeni MF. Use of custom insoles for redistributing plantar pressure, decreasing musculoskeletal pain and reducing postural changes in obese adults. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.002.ao01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Introduction Insoles are used for different purposes and they can be an additional factor aiding weight loss in obese people due to their contribution in reducing musculoskeletal pain. Objective The aim of the present study was to assess the effect of custom insoles for redistributing plantar pressure, decreasing musculoskeletal pain and reducing postural changes in obese adults. Materials and methods Data was obtained from morbidly obese people, who had a Body Mass Index (BMI) ≥ 35 and < 45 kg/m2, at three moments: before the insole was provided, immediately after insole use began and after two months of use. Anthropometric, postural, musculoskeletal pain and computerized baropodometry data were collected. Results When comparing the stages before the use of the insole and after two months of use, significant (p < 0.05) decreases were observed in the number of people with right lateral postural misalignment, in the intensity of the musculoskeletal pain of the body segments evaluated (except for the right knee), and in the mean of the peak plantar pressure values. In terms of total plantar contact area, the mean increased significantly (p < 0.05) in both right and left feet after the intervention. Conclusion This study demonstrated that the daily use of proprioceptive insoles contributed to reducing peak plantar pressure, musculoskeletal pain and lateral postural deviations. The use of proprioceptive insoles may be an important strategy to encourage obese people to exercise and, consequently, reduce weight.
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Immediate effects of an elastic knee sleeve on frontal plane gait biomechanics in knee osteoarthritis. PLoS One 2015; 10:e0115782. [PMID: 25621488 PMCID: PMC4306516 DOI: 10.1371/journal.pone.0115782] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 12/01/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Osteoarthritis of the knee affects millions of people. Elastic knee sleeves aim at relieving symptoms. While symptomatic improvements have been demonstrated as a consequence of elastic knee sleeves, evidence for biomechanical alterations only exists for the sagittal plane. We therefore asked what effect an elastic knee sleeve would have on frontal plane gait biomechanics. METHODS 18 subjects (8 women, 10 men) with osteoarthritis of the medial tibiofemoral joint walked over ground with and without an elastic knee sleeve. Kinematics and forces were recorded and joint moments were calculated using an inverse dynamics approach. Conditions with sleeve and without sleeve were compared with paired t-Tests. RESULTS With the sleeve, knee adduction angle at ground contact was reduced by 1.9 ± 2.1° (P = 0.006). Peak knee adduction was reduced by 1.5 ± 1.6° (P = 0.004). The first peak knee adduction moment and positive knee adduction impulse were decreased by 10.1% (0.74 ± 0.9 Nm • kg-1; P = 0.002) and 12.9% (0.28 ± 0.3 Nm • s • kg-1; P < 0.004), respectively. CONCLUSION Our study provides evidence that wearing an elastic knee sleeve during walking can reduce knee adduction angles, moments and impulse in subjects with knee osteoarthritis. As a higher knee adduction moment has previously been identified as a risk factor for disease progression in patients with medial knee osteoarthritis, we speculate that wearing a knee sleeve may be beneficial for this specific subgroup.
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Duivenvoorden T, van Raaij TM, Horemans HLD, Brouwer RW, Bos PK, Bierma-Zeinstra SMA, Verhaar JAN, Reijman M. Do laterally wedged insoles or valgus braces unload the medial compartment of the knee in patients with osteoarthritis? Clin Orthop Relat Res 2015; 473:265-74. [PMID: 25267266 PMCID: PMC4390958 DOI: 10.1007/s11999-014-3947-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 09/09/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND The results of conservative treatment of knee osteoarthritis (OA) are generally evaluated in epidemiological studies with clinical outcome measures as primary outcomes. Biomechanical evaluation of orthoses shows that there are potentially beneficial biomechanical changes to joint loading; however, evaluation in relation to clinical outcome measures in longitudinal studies is needed. QUESTIONS/PURPOSES We asked (1) is there an immediate effect on gait in patients using a laterally wedged insole or valgus knee brace; (2) is there a late (6 weeks) effect; and (3) is there a difference between subgroups within each group with respect to patient compliance, body mass index, and OA status? METHODS This was a secondary analysis of data from a previous randomized controlled trial of patients with early medial knee OA. A total of 91 patients were enrolled in that trial, and 73 (80%) completed it after 6 months. Of the enrolled patients, 80 (88%) met prespecified inclusion criteria for analysis in the present study. The patients were randomized to an insole or brace. Gait was analyzed with and without wearing the orthosis (insole or brace) at baseline and after 6 weeks. Measurements were taken of the knee adduction moment, ground reaction force, moment arm, walking speed, and toe-out angle. Data were analyzed with regression analyses based on an intention-to-treat principle. RESULTS A mean reduction of 4% (±10) (95% confidence interval [CI], -0.147 to -0.03, p=0.003) of the peak knee adduction moment and 4% (±13) (95% CI, -0.009 to -0.001, p=0.01) of the moment arm at baseline was observed in the insole group when walking with an insole was compared with walking without an insole. A mean reduction of 1% (±10) (95% CI, -0.002 to -0.001, p=0.001) of the peak knee adduction moment and no reduction of the moment arm were measured after 6 weeks. No reduction of knee adduction moment, moment arm, or ground reaction force was seen in the brace group at baseline and after 6 weeks. Subgroup analysis showed no differences in biomechanical effect for obesity, stage of OA, and whether patients showed a clinical response to the treatment. CONCLUSIONS Laterally wedged insoles unload the medial compartment only at baseline in patients with varus alignment and by an amount that might not be clinically important. No biomechanical alteration was seen after 6 weeks of wearing the insole. Valgus brace therapy did not result in any biomechanical alteration. Taken together, this study does not show a clinically relevant biomechanical effect of insole and brace therapy in patients with varus medial knee OA. LEVEL OF EVIDENCE Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tijs Duivenvoorden
- Department of Orthopaedics, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands,
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Fantini Pagani CH, Willwacher S, Benker R, Brüggemann GP. Effect of an ankle-foot orthosis on knee joint mechanics: a novel conservative treatment for knee osteoarthritis. Prosthet Orthot Int 2014; 38:481-91. [PMID: 24327668 DOI: 10.1177/0309364613513297] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Several conservative treatments for medial knee osteoarthritis such as knee orthosis and laterally wedged insoles have been shown to reduce the load in the medial knee compartment. However, those treatments also present limitations such as patient compliance and inconsistent results regarding the treatment success. OBJECTIVE To analyze the effect of an ankle-foot orthosis on the knee adduction moment and knee joint alignment in the frontal plane in subjects with knee varus alignment. STUDY DESIGN Controlled laboratory study, repeated measurements. METHODS In total, 14 healthy subjects with knee varus alignment were analyzed in five different conditions: without orthotic, with laterally wedged insoles, and with an ankle-foot orthosis in three different adjustments. Three-dimensional kinetic and kinematic data were collected during gait analysis. RESULTS Significant decreases in knee adduction moment, 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. CONCLUSION The ankle-foot orthosis was effective in reducing the knee adduction moment. The decreases in this parameter seem to be achieved by changing the knee joint alignment and thereby reducing the knee lever arm in the frontal plane. CLINICAL RELEVANCE This study presents a novel approach for reducing the load in the medial knee compartment, which could be developed as a new treatment option for patients with medial knee osteoarthritis.
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Affiliation(s)
| | - Steffen Willwacher
- Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne, Germany
| | - Rita Benker
- Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne, Germany
| | - Gert-Peter Brüggemann
- Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne, Germany
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Dessery Y, Belzile EL, Turmel S, Corbeil P. Comparison of three knee braces in the treatment of medial knee osteoarthritis. Knee 2014; 21:1107-14. [PMID: 25156178 DOI: 10.1016/j.knee.2014.07.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/07/2014] [Accepted: 07/21/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Conservative orthotic treatments rely on different mechanisms, such as three-point bending systems or hinges forcing external rotation of the leg and knee stabilization, to alter the biomechanics of the lower limbs and thus reduce knee loading on the affected compartment in patients with knee osteoarthritis (KOA). No previous study had compared the effects of these mechanisms on external loading and leg kinematics in patients with KOA. METHODS Twenty-four patients with medial KOA (Kellgren-Lawrence grade II or III) wore three custom knee braces: a valgus brace with a three-point bending system (V3P-brace), an unloader brace with valgus and external rotation functions (VER-brace) and a functional knee brace used in ligament injuries (ACL-brace). Pain relief, comfort, lower extremity kinematics and kinetics during walking were compared with and without each knee brace. RESULTS Knee pain was alleviated with all three braces (p<0.01). The VER- and ACL-braces allowed a significant reduction in peak knee adduction moment (KAM) during terminal stance from 0.313 to 0.280 Nm/Bw∗Ht (p<0.001) and 0.293 to 0.268 (p<0.05), respectively, while no significant reduction was observed with the V3P-brace (p=0.52). Reduced knee adduction and lower ankle and knee external rotation were observed with the V3P-brace but not with the VER-brace. The ACL-brace did not modify lower limb kinematics. CONCLUSIONS No difference between the knee braces was found for pain reduction, discomfort or KAM. The VER-brace was slightly more comfortable, which could ensure better compliance with treatment over the long term.
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Affiliation(s)
- Yoann Dessery
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec, QC, Canada; Centre de recherche FRSQ du CHA universitaire de Québec, Québec, QC, Canada
| | - Etienne L Belzile
- Division de Chirurgie Orthopédique, CHUQ, Québec, QC, Canada; Département de Chirurgie, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Sylvie Turmel
- Division de Chirurgie Orthopédique, CHUQ, Québec, QC, Canada
| | - Philippe Corbeil
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec, QC, Canada; Centre de recherche FRSQ du CHA universitaire de Québec, Québec, QC, Canada.
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Dessery Y, Belzile ÉL, Turmel S, Doré J, Diallo B, Corbeil P. Modulation of physical activity to optimize pain sensation following an intra-articular corticosteroid injection in patients with knee osteoarthritis. ScientificWorldJournal 2014; 2014:209165. [PMID: 25478585 PMCID: PMC4249605 DOI: 10.1155/2014/209165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/25/2014] [Accepted: 10/27/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Intra-articular corticosteroid injection is often used to relieve pain caused by knee osteoarthritis. This study aims to assess the impact after an intra-articular corticosteroid injection treatment on objective and subjective measurement of physical function in knee osteoarthritis patients. METHODS Fourteen patients with unilateral knee osteoarthritis participated in this open-label uncontrolled trial. The intra-articular corticosteroid injection was given at the end of the second week. Physical activity was objectively measured by an accelerometer worn by the participants for eight weeks. Symptoms, quality of life and spatiotemporal parameters of gait were assessed every two weeks. RESULTS From the injection until six weeks later, pain and stiffness were reduced by approximately 60%. Patients' daily physical activity time was significantly improved after injection: participation in light and moderate physical activities increased during four and two weeks, respectively. CONCLUSIONS The beneficial effects after the intra-articular corticosteroid injection are visible in the duration and intensity of the knee osteoarthritis patients' daily physical activity. However, these effects declined gradually two weeks after injection. Modulating the intensity and duration of physical activity would allow patients to optimize pain sensation over a longer period following an intra-articular corticosteroid injection. Trial Registration. This trial was registered with ClinicalTrials: NCT02049879.
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Affiliation(s)
- Yoann Dessery
- Département de Kinésiologie, Faculté de Médecine, Université Laval, 2300 rue de la Terrasse, Quebec City, QC, Canada G1V 0A6
- Unité de Recherche sur le Vieillissement, Centre de Recherche FRSQ du CHA Universitaire de Québec, 1050 Chemin Sainte-Foy, Quebec City, QC, Canada G1S 4L8
| | - Étienne L. Belzile
- Division de Chirurgie Orthopédique, CHUQ, 11 Côte du Palais, Quebec City, QC, Canada G1R 2J6
- Département de Chirurgie, Faculté de Médecine, Université Laval, 1050 avenue de la Médecine, Quebec City, QC, Canada G1V 0A6
| | - Sylvie Turmel
- Division de Chirurgie Orthopédique, CHUQ, 11 Côte du Palais, Quebec City, QC, Canada G1R 2J6
| | - Jean Doré
- Département de Kinésiologie, Faculté de Médecine, Université Laval, 2300 rue de la Terrasse, Quebec City, QC, Canada G1V 0A6
| | - Binta Diallo
- Département de Kinésiologie, Faculté de Médecine, Université Laval, 2300 rue de la Terrasse, Quebec City, QC, Canada G1V 0A6
- Unité de Recherche sur le Vieillissement, Centre de Recherche FRSQ du CHA Universitaire de Québec, 1050 Chemin Sainte-Foy, Quebec City, QC, Canada G1S 4L8
| | - Philippe Corbeil
- Département de Kinésiologie, Faculté de Médecine, Université Laval, 2300 rue de la Terrasse, Quebec City, QC, Canada G1V 0A6
- Unité de Recherche sur le Vieillissement, Centre de Recherche FRSQ du CHA Universitaire de Québec, 1050 Chemin Sainte-Foy, Quebec City, QC, Canada G1S 4L8
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Biomechanical effectiveness of a distraction-rotation knee brace in medial knee osteoarthritis: preliminary results. Knee 2014; 21:710-6. [PMID: 24642050 DOI: 10.1016/j.knee.2014.02.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/06/2014] [Accepted: 02/17/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Non-pharmacological therapies are recommended for the care of knee osteoarthritis patients. Unloader knee braces provide an interesting functional approach, which aims to modulate mechanical stress on the symptomatic joint compartment. We aimed to confirm the biomechanical effects and evaluate functional benefits of a new knee brace that combines a valgus effect with knee and tibial external rotation during gait in medial osteoarthritis patients. METHODS Twenty patients with unilateral symptomatic medial knee osteoarthritis were included and they performed two test sessions of 3D gait analysis with and without the brace at the initial evaluation (W0) and after 5weeks (W5) of wearing the brace. VAS-pain, satisfaction scores, WOMAC scores, spatio-temporal gait parameters (gait speed, stride length, stance and double stance phases, step width), and biomechanical data of the ipsilateral lower limb (hip, knee, ankle and foot progression angles) were recorded at each session. RESULTS VAS-pain and WOMAC significantly decreased at W5. Walking speed was not significantly modified by knee bracing at W0, but increased significantly at W5. Knee adduction moments and foot progression angles significantly decreased in the terminal stance and push off, respectively, with bracing at W0 and W5. Lower-limb joint angles, moments and powers were significantly modified by wearing the brace at W0 and W5. CONCLUSION This new knee brace with distraction-rotation effects significantly alters knee adduction moments and foot progression angles during gait, which might lead to significant functional gait improvements and have carry-over effects on pain at the short term in osteoarthritis patients (<2 months). LEVEL OF EVIDENCE level IV.
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Ebert JR, Hambly K, Joss B, Ackland TR, Donnelly CJ. Does an unloader brace reduce knee loading in normally aligned knees? Clin Orthop Relat Res 2014; 472:915-22. [PMID: 24065172 PMCID: PMC3916618 DOI: 10.1007/s11999-013-3297-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 09/16/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Unloading knee braces often are used after tibiofemoral articular cartilage repair. However, the experimental basis for their use in patients with normal tibiofemoral alignment such as those undergoing cartilage repair is lacking. QUESTIONS/PURPOSES The purpose of this study was to investigate the effect of varus and valgus adjustments to one commercially available unloader knee brace on tibiofemoral joint loading and knee muscle activation in populations with normal knee alignment. METHODS The gait of 20 healthy participants (mean age 28.3 years; body mass index 22.9 kg/m(2)) was analyzed with varus and valgus knee brace conditions and without a brace. Spatiotemporal variables were calculated as were knee adduction moments and muscle activation during stance. A directed cocontraction ratio was also calculated to investigate the relative change in the activation of muscles with medial (versus lateral) moment arms about the knee. Group differences were investigated using analysis of variance. The numbers available would have provided 85% power to detect a 0.05 increase or decrease in the knee adduction moment (Nm/kg*m) in the braced condition compared with the no brace condition. RESULTS With the numbers available, there were no differences between the braced and nonbraced conditions in kinetic or muscle activity parameters. Both varus (directed cocontraction ratio 0.29, SD 0.21, effect size 0.95, p = 0.315) and valgus (directed cocontraction ratio 0.28, SD 0.24, effect size 0.93, p = 0.315) bracing conditions increased the relative activation of muscles with lateral moment arms compared with no brace (directed cocontraction ratio 0.49, SD 0.21). CONCLUSIONS Results revealed inconsistencies in knee kinetics and muscle activation strategies after varus and valgus bracing conditions. Although in this pilot study the results were not statistically significant, the magnitudes of the observed effect sizes were moderate to large and represent suitable pilot data for future work. Varus bracing increased knee adduction moments as expected; however, they produced a more laterally directed muscular activation profile. Valgus bracing produced a more laterally directed muscular activation profile; however, it increased knee adduction moments. CLINICAL RELEVANCE When evaluating changes in knee kinetics and muscle activation together, this study demonstrated conflicting outcomes and questions the efficacy for the use of unloader bracing for people with normally aligned knees such as those after articular cartilage repair.
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Affiliation(s)
- Jay R Ebert
- School of Sport Science, Exercise and Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Western Australia,
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Abstract
SYNOPSIS Altered knee joint biomechanics and excessive joint loading have long been considered as important contributors to the development and progression of knee osteoarthritis. Therefore, a better understanding of how various treatment options influence the loading environment of the knee joint could have practical implications for devising more effective physical therapy management strategies. The aim of this clinical commentary was to review the pertinent biomechanical evidence supporting the use of treatment options intended to provide protection against excessive joint loading while offering symptomatic relief and functional improvements for better long-term management of patients with knee osteoarthritis. The biomechanical and clinical evidence regarding the effectiveness of knee joint offloading strategies, including contralateral cane use, laterally wedged shoe insoles, variable-stiffness shoes, valgus knee bracing, and gait-modification strategies, within the context of effective disease management is discussed. In addition, the potential role of therapeutic exercise and neuromuscular training to improve the mechanical environment of the knee joint is considered. Management strategies for treatment of joint instability and patellofemoral compartment disease are also mentioned. Based on the evidence presented as part of this clinical commentary, it is argued that special considerations for the role of knee joint biomechanics and excessive joint loading are necessary in designing effective short- and long-term management strategies for treatment of patients with knee osteoarthritis. LEVEL OF EVIDENCE Therapy, level 5.
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Kean CO, Bennell KL, Wrigley TV, Hinman RS. Modified walking shoes for knee osteoarthritis: Mechanisms for reductions in the knee adduction moment. J Biomech 2013; 46:2060-6. [DOI: 10.1016/j.jbiomech.2013.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/17/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
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Influence of a valgus knee brace on muscle activation and co-contraction in patients with medial knee osteoarthritis. J Electromyogr Kinesiol 2013; 23:490-500. [DOI: 10.1016/j.jelekin.2012.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 10/08/2012] [Accepted: 10/11/2012] [Indexed: 11/21/2022] Open
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Moyer RF, Birmingham TB, Dombroski CE, Walsh RF, Leitch KM, Jenkyn TR, Giffin JR. Combined effects of a valgus knee brace and lateral wedge foot orthotic on the external knee adduction moment in patients with varus gonarthrosis. Arch Phys Med Rehabil 2012; 94:103-12. [PMID: 22995151 DOI: 10.1016/j.apmr.2012.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 09/04/2012] [Accepted: 09/09/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To test the hypothesis that a custom-fit valgus knee brace and custom-made lateral wedge foot orthotic will have greatest effects on decreasing the external knee adduction moment during gait when used concurrently. DESIGN Proof-of-concept, single test session, crossover trial. SETTING Biomechanics laboratory within a tertiary care center. PARTICIPANTS Patients (n=16) with varus alignment and knee osteoarthritis (OA) primarily affecting the medial compartment of the tibiofemoral joint (varus gonarthrosis). INTERVENTIONS Custom-fit valgus knee brace and custom-made full-length lateral wedge foot orthotic. Amounts of valgus angulation and wedge height were tailored to each patient to ensure comfort. MAIN OUTCOME MEASURES The external knee adduction moment (% body weight [BW]*height [Ht]), frontal plane lever arm (cm), and ground reaction force (N/kg), determined from 3-dimensional gait analysis completed under 4 randomized conditions: (1) control (no knee brace, no foot orthotic), (2) knee brace, (3) foot orthotic, and (4) knee brace and foot orthotic. RESULTS The reduction in knee adduction moment was greatest when concurrently using the knee brace and foot orthotic (effect sizes ranged from 0.3 to 0.4). The mean decrease in first peak knee adduction moment compared with control was .36% BW*Ht (95% confidence interval [CI], -.66 to -.07). This was accompanied by a mean decrease in frontal plane lever arm of .59cm (95% CI, -.94 to -.25). CONCLUSIONS These findings suggest that using a custom-fit knee brace and custom-made foot orthotic concurrently can produce a greater overall reduction in the knee adduction moment, through combined effects in decreasing the frontal plane lever arm.
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Affiliation(s)
- Rebecca F Moyer
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
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