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Tse CTF, Ryan MB, Krowchuk NM, Scott A, Hunt MA. Osteoarthritic Tibiofemoral Joint Contact Characteristics During Weightbearing With Arch-Supported and Standalone Lateral Wedge Insoles. J Appl Biomech 2024; 40:270-277. [PMID: 38834183 DOI: 10.1123/jab.2023-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/11/2023] [Accepted: 03/25/2024] [Indexed: 06/06/2024]
Abstract
Imbalanced joint load distribution across the tibiofemoral surface is a risk factor for osteoarthritic changes to this joint. Lateral wedge insoles, with and without arch support, are a form of biomechanical intervention that can redistribute tibiofemoral joint load, as estimated by external measures of knee load. The objective of this study was to examine the effect of these insoles on the internal joint contact characteristics of osteoarthritic knees during weightbearing. Fifteen adults with tibiofemoral osteoarthritis underwent magnetic resonance imaging of the affected knee, while standing under 3 insole conditions: flat control, lateral wedge alone, and lateral wedge with arch support. Images were processed, and the surface area and centroid location of joint contact were quantified separately for the medial and lateral tibiofemoral compartments. Medial contact surface area was increased with the 2 lateral wedge conditions compared with the control (P ≤ .012). A more anterior contact centroid was observed in the medial compartment in the lateral wedge with arch support compared with the lateral wedge alone (P = .009). Significant changes in lateral compartment joint contact outcomes were not observed. These findings represent early insights into how loading at the tibiofemoral interface may be altered by lateral wedge insoles as a potential intervention for knee osteoarthritis.
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Affiliation(s)
- Calvin T F Tse
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
- Kintec Footlabs Inc, Surrey, BC, Canada
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Michael B Ryan
- Kintec Footlabs Inc, Surrey, BC, Canada
- School of Mechatronics Systems Engineering, Simon Fraser University, Burnaby, BC, Canada
| | - Natasha M Krowchuk
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Scott
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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Parian S, Farahmand B, Saeedi H, Cham MB. Effectiveness of gait plate insole and lateral sole wedged shoes on foot progression angle in children with in-toeing gait: A prospective randomized control trial. Gait Posture 2024; 109:120-125. [PMID: 38301334 DOI: 10.1016/j.gaitpost.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 11/08/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND In-toeing gait is defined as the internal rotation of the long axis of the foot to the line of progression. Although most of the time it is corrected spontaneously but sometimes causes torsional misalignment syndrome and maybe patellofemoral instability and arthritis of the knee. RESEARCH QUESTION What is the effect of gait plate insoles and lateral sole wedged shoes on foot progression angle (FPA) in children with in-toeing? METHOD In this study, a randomized control trial was conducted with 11 participants (18 feet) who were girls aged between seven and ten years old. They were randomly assigned to either the gait plate group (6 girls, 11 feet) or the lateral sole wedge group (5 girls, 11 feet). The foot progression angle was measured using the RS scanner pressure platform before and after four weeks of intervention, both with and without interventions. The interaction effects of time and group on outcomes were analyzed using Mixed ANOVA and post-hoc complementary tests with a confidence interval of 95%. RESULTS It was observed that none of the interventions had an immediate impact on the FPA (P > 0.05). However, after four weeks, the FPA increased by 9.96 degrees with the lateral sole wedge and by 3.51 degrees with the gate plate insole. During the immediate and short-term evaluation, no significant difference was noticed between the two groups (P > 0.05). However, there was a large effect size (eta square = 0.269) observed in the time group interaction between the two groups (P = 0.028). SIGNIFICANCE Conservative methods like using a gait plate insole or modifying shoes with a lateral sole wedge can improve the foot progression angle in children with in-toeing gait. However, longer studies with larger sample sizes are needed to reach a conclusion.
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Affiliation(s)
- Shahab Parian
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Behshid Farahmand
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Hassan Saeedi
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Masumeh Bagherzadeh Cham
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran; Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran
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Marriott KA, Birmingham TB. Fundamentals of osteoarthritis. Rehabilitation: Exercise, diet, biomechanics, and physical therapist-delivered interventions. Osteoarthritis Cartilage 2023; 31:1312-1326. [PMID: 37423596 DOI: 10.1016/j.joca.2023.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Insights related to the pathogenesis of osteoarthritis (OA) have informed rehabilitative treatments that aim to mitigate the influence of several known impairments and risk factors for OA, with the goal to improve pain, function, and quality of life. The purpose of this invited narrative review is to provide fundamental knowledge to non-specialists about exercise and education, diet, biomechanical interventions, and other physical therapist-delivered treatments. In addition to summarizing the rationale for common rehabilitative therapies, we provide a synthesis of current core recommendations. Robust evidence based on randomized clinical trials supports exercise with education and diet as core treatments for OA. Structured, supervised exercise therapy is advised. The mode of exercise may vary but should be individualized. The dose should be based on an initial assessment, the desired physiological changes, and progressed when appropriate. Diet combined with exercise is strongly recommended and studies demonstrate a dose-response relationship between the magnitude of weight loss and symptom improvement. Recent evidence suggests the use of technology to remotely deliver exercise, diet and education interventions is cost-effective. Although several studies support the mechanisms for biomechanical interventions (e.g., bracing, shoe inserts) and physical therapist-delivered (passive) treatments (e.g., manual therapy, electrotherapeutic modalities) fewer rigorous randomized trials support their clinical use; these therapies are sometimes recommended as adjuncts to core treatments. The mechanisms of action for all rehabilitative interventions include contextual factors such as attention and placebo effects. These effects can challenge our interpretation of treatment efficacy from clinical trials, yet also provide opportunities to maximize patient outcomes in clinical practice. When evaluating rehabilitative interventions, the field may benefit from increased emphasis on research that considers contextual factors while evaluating mechanistic, longer-term, clinically-important and policy-relevant outcome measures.
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Affiliation(s)
- Kendal A Marriott
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.
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Misu S, Tanaka S, Miura J, Ishihara K, Asai T, Nishigami T. Association of the Degree of Varus Thrust during Gait Assessed by an Inertial Measurement Unit with Patient-Reported Outcome Measures in Knee Osteoarthritis. SENSORS (BASEL, SWITZERLAND) 2023; 23:4578. [PMID: 37430491 DOI: 10.3390/s23104578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 07/12/2023]
Abstract
This study aimed to assess the association between the degree of varus thrust (VT) assessed by an inertial measurement unit (IMU) and patient-reported outcome measures (PROMs) in patients with knee osteoarthritis. Seventy patients (mean age: 59.8 ± 8.6 years; women: n = 40) were instructed to walk on a treadmill with an IMU attached to the tibial tuberosity. For the index of VT during walking (VT-index), the swing-speed adjusted root mean square of acceleration in the mediolateral direction was calculated. As the PROMs, the Knee Injury and Osteoarthritis Outcome Score were used. Data on age, sex, body mass index, static alignment, central sensitization, and gait speed were collected as potential confounders. After adjusting for potential confounders, multiple linear regression analysis revealed that the VT-index was significantly associated with the pain score (standardized β = -0.295; p = 0.026), symptoms score (standardized β = -0.287; p = 0.026), and activities of the daily living score (standardized β = -0.256; p = 0.028). Our results indicated that larger VT values during gait are associated with worse PROMs, suggesting that an intervention to reduce VT might be an option for clinicians trying to improve PROMs.
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Affiliation(s)
- Shogo Misu
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, 6-2-13 Morikita-machi, Higashinada-ku, Kobe 658-0001, Hyogo, Japan
| | - So Tanaka
- Department of Rehabilitation, Fukuoka Orthopaedic Hospital, 2-10-50 Yanagochi, Minami-ku, Fukuoka 815-0063, Fukuoka, Japan
| | - Jun Miura
- Department of Rehabilitation, Fukuoka Orthopaedic Hospital, 2-10-50 Yanagochi, Minami-ku, Fukuoka 815-0063, Fukuoka, Japan
| | - Kohei Ishihara
- Department of Orthopaedic Surgery, Fukuoka Orthopaedic Hospital, 2-10-50 Yanagochi, Minami-ku, Fukuoka 815-0063, Fukuoka, Japan
| | - Tsuyoshi Asai
- Faculty of Rehabilitation, Kansai Medical University, 18-89 Uyamahigashicho, Hirakata 573-1136, Osaka, Japan
| | - Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, 1-1 Gakuen-tyou, Mihara 723-0053, Hiroshima, Japan
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Baniasad M, Martin R, Crevoisier X, Pichonnaz C, Becce F, Aminian K. Knee adduction moment decomposition: Toward better clinical decision-making. Front Bioeng Biotechnol 2022; 10:1017711. [PMID: 36466350 PMCID: PMC9715598 DOI: 10.3389/fbioe.2022.1017711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/19/2022] [Indexed: 12/05/2023] Open
Abstract
Knee adduction moment (KAM) is correlated with the progression of medial knee osteoarthritis (OA). Although a generic gait modification can reduce the KAM in some patients, it may have a reverse effect on other patients. We proposed the "decomposed ground reaction vector" (dGRV) model to 1) distinguish between the components of the KAM and their contribution to the first and second peaks and KAM impulse and 2) examine how medial knee OA, gait speed, and a brace influence these components. Using inverse dynamics as the reference, we calculated the KAM of 12 healthy participants and 12 patients with varus deformity and medial knee OA walking with/without a brace and at three speeds. The dGRV model divided the KAM into four components defined by the ground reaction force (GRF) and associated lever arms described with biomechanical factors related to gait modifications. The dGRV model predicted the KAM profile with a coefficient of multiple correlations of 0.98 ± 0.01. The main cause of increased KAM in the medial knee OA group, the second component (generated by the vertical GRF and mediolateral distance between the knee and ankle joint centers), was decreased by the brace in the healthy group. The first peak increased, and KAM impulse decreased with increasing velocity in both groups, while no significant change was observed in the second peak. The four-component dGRV model successfully estimated the KAM in all tested conditions. It explains why similar gait modifications produce different KAM reductions in subjects. Thus, more personalized gait rehabilitation, targeting elevated components, can be considered.
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Affiliation(s)
- Mina Baniasad
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Robin Martin
- Department of Orthopaedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Xavier Crevoisier
- Department of Orthopaedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Claude Pichonnaz
- Department of Orthopaedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Physiotherapy, School of Health Sciences HESAV, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Quaranta M, Riccio I, Oliva F, Maffulli N. Osteoarthritis of the Knee in Middle-age Athletes: Many Measures are Practiced, but Lack Sound Scientific Evidence. Sports Med Arthrosc Rev 2022; 30:102-110. [PMID: 35533062 DOI: 10.1097/jsa.0000000000000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Osteoarthritis of the knee generally affects individuals from the fifth decade, the typical age of middle-age athletes. In the early stages, management is conservative and multidisciplinary. It is advisable to avoid sports with high risk of trauma, but it is important that patients continue to be physically active. Conservative management offers several options; however, it is unclear which ones are really useful. This narrative review briefly reports the conservative options for which there is no evidence of effectiveness, or there is only evidence of short-term effectiveness.
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Affiliation(s)
- Marco Quaranta
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Ivano Riccio
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London
- Faculty of Medicine, School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Keele University, Stoke-on-Trent, England
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Effectiveness of gait retraining interventions in individuals with hip or knee osteoarthritis: A systematic review and meta-analysis. Gait Posture 2022; 95:164-175. [PMID: 35500366 DOI: 10.1016/j.gaitpost.2022.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/31/2022] [Accepted: 04/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteoarthritis is a chronic synovial joint disease leading to pain, stiffness, and gait dysfunction, resulting in a significant health and economic burden. Gait retraining strategies and tools are used to address biomechanical gait dysfunction and symptoms in individuals with osteoarthritis. However, there is limited evidence relating to their effectiveness. QUESTION Do gait retraining strategies and tools improve gait biomechanics and symptoms in individuals with hip or knee osteoarthritis compared to control or alternate intervention? METHODS Seven databases were searched using key words relating to osteoarthritis, gait retraining, and biomechanics. A best evidence synthesis was conducted on included studies. Where available, a meta-analysis was performed, and the standardised mean difference (SMD) and 95% confidence internals (CI) were reported. RESULTS Eighteen studies were included. One study investigated gait retraining in participants with hip osteoarthritis and demonstrated limited evidence for improving gait biomechanics. Seventeen studies on knee osteoarthritis were included in the best evidence synthesis with six included in the meta-analysis. Gait retraining strategies which incorporated a real-time biofeedback tool, appear to have strong evidence for effectively modifying walking biomechanics. Moderate evidence was identified to support kinesiology taping improving pain scores. The meta-analysis pooled effect demonstrated significant improvements for knee adduction moment [SMD, -1.10; 95% CI. -1.85, -0.35] and the Western Ontario and McMaster Osteoarthritis Index in favour of gait retraining than a control intervention [SMD, -0.86; 95% CI. -1.33, -0.39]. All other interventions demonstrated evidence that was conflicting, limited, or not in favour of gait retraining. CONCLUSION Gait retraining may be beneficial for improving biomechanics and symptoms in knee osteoarthritis, however due to the high heterogeneity and limited studies in the analysis, further research is required. Further high quality randomised controlled trials for knee and especially hip osteoarthritis investigating the effects of gait retraining on biomechanics and symptoms are required.
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Sinclair J, Brooks D, Taylor PJ, Liles N. Effects of toe-in/ out toe-in gait and lateral wedge orthoses on lower extremity joint kinetics; an exploration using musculoskeletal simulation and Bayesian contrasts. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00762-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schwarze M, Bartsch LP, Block J, Alimusaj M, Jaber A, Schiltenwolf M, Wolf SI. A comparison between laterally wedged insoles and ankle-foot orthoses for the treatment of medial osteoarthritis of the knee: A randomized cross-over trial. Clin Rehabil 2021; 35:1032-1043. [PMID: 33781101 PMCID: PMC8193604 DOI: 10.1177/0269215521993636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective: To compare biomechanical and clinical outcome of laterally wedged insoles (LWI) and an ankle-foot orthosis (AFO) in patients with medial knee osteoarthritis. Design: Single-centre, block-randomized, cross-over controlled trial. Setting: Outpatient clinic. Subjects: About 39 patients with symptomatic medial knee osteoarthritis. Interventions: Patients started with either LWI or AFO, determined randomly, and six weeks later changed to the alternative. Main measures: Change in the 1st maximum of external knee adduction moment (eKAM) was assessed with gait analysis. Additional outcomes were other kinetic and kinematic changes and the patient-reported outcomes EQ-5D-5L, Oxford Knee Score (OKS), American Knee Society Clinical Rating System (AKSS), Hannover Functional Ability Questionnaire – Osteoarthritis and knee pain. Results: Mean age (SD) of the study population was 58 (8) years, mean BMI 30 (5). Both aids significantly improved OKS (LWI P = 0.003, AFO P = 0.001), AKSS Knee Score (LWI P = 0.01, AFO P = 0.004) and EQ-5D-5L Index (LWI P = 0.001, AFO P = 0.002). AFO reduced the 1st maximum of eKAM by 18% (P < 0.001). The LWI reduced both maxima by 6% (P = 0.02, P = 0.03). Both AFO and LWI reduced the knee adduction angular impulse (KAAI) by 11% (P < 0.001) and 5% (P = 0.05) respectively. The eKAM (1st maximum) and KAAI reduction was significantly larger with AFO than with LWI (P = 0.001, P = 0.004). Conclusions: AFO reduces medial knee load more than LWI. Nevertheless, no clinical superiority of either of the two aids could be shown.
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Affiliation(s)
- Martin Schwarze
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
| | - Leonie P Bartsch
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Block
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
| | - Merkur Alimusaj
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
| | - Ayham Jaber
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
| | - Marcus Schiltenwolf
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian I Wolf
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
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Schwarze M, Bartsch LP, Block J, Wolf SI, Alimusaj M. [Insoles, knee braces and ankle-foot orthoses in the treatment of medial gonarthrosis : A literature review]. DER ORTHOPADE 2020; 49:449-459. [PMID: 31471643 DOI: 10.1007/s00132-019-03802-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Osteoarthritis is the most common joint disease worldwide and mostly affects the knee joint (gonarthrosis). In treatment algorithms, technical aids in the form of laterally wedged insoles, valgizing knee braces and ankle-foot orthoses have an importance in the treatment of medial unicompartmental knee joint disease. However, national and international guidelines differ in their recommendations. INSOLES Taking into account a great amount of scientific work, the measurable effect of laterally wedged insoles appears to be low, so that a justifying indication only exists at low gonarthrosis levels. KNEE BRACES Valgizing knee braces have shown stronger biomechanical and clinical effects, but with a slightly increased complication potential and low compliance. Low to medium-grade arthrosis can be treated. ANKLE-FOOT ORTHOSES Ankle-foot arthroses have not yet been conclusively examined. Initial work indicates biomechanical and clinical efficacy. The overall effects and indications appear comparable to knee braces, probably with less complication potential.
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Affiliation(s)
- M Schwarze
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - L P Bartsch
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - J Block
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - S I Wolf
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - M Alimusaj
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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Da Cunha RJ, Kraszewski AP, Hillstrom HJ, Fragomen AT, Rozbruch SR. Biomechanical and Functional Improvements Gained by Proximal Tibia Osteotomy Correction of Genu Varum in Patients with Knee Pain. HSS J 2020; 16:30-38. [PMID: 32015738 PMCID: PMC6973828 DOI: 10.1007/s11420-019-09670-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mechanical axis malalignment contributes to abnormal forces across the knee joint. Genu varum, or increased medial mechanical axis deviation (MAD), increases force transmission and contact pressures to the medial compartment. With increasing MAD and femoral-tibial mechanical axis angle (MAA), contact forces within the medial or lateral compartment of the knee significantly increase with increasing deformity. This may lead to knee pain, further deformity, and medial compartment degenerative joint disease, which can interfere with participation in sports and diminish quality of life. PURPOSES/QUESTIONS We sought to evaluate patients with knee pain with bilateral genu varum and determine the effect of bilateral proximal tibial osteotomies on knee biomechanics, deformity correction, and functional outcomes. METHODS This was a single-center, prospective study of eight limbs in four patients. Consecutive patients presenting with knee pain and bilateral genu varum originating from the proximal tibia were included. All patients underwent staged bilateral proximal tibial osteotomies with gradual deformity correction with an external fixator. Subjects underwent a three-dimensional (3D) instrumented motion analysis during level walking. A 3D lower extremity model was built and bilateral knee frontal plane kinematics and kinetics during the stance phase of gait were determined. Radiographic analysis was performed including assessment of MAD, MAA, and medial proximal tibial angle (MPTA). Functional outcomes were assessed with the Knee Injury and Osteoarthritis Outcome Score (KOOS), the 36-item Short-Form Survey (SF-36), the Lower Limb Questionnaire (LLQ), and a visual analog scale (VAS) for pain. RESULTS The average time in the external fixator for a single limb was 97 days. The average follow-up period was 310 days. All biomechanical outcomes significantly improved, including knee adduction angle (7.8° to 1.8°), knee adduction moments (first peak, - 0.450 to - 0.281 nm/kg, and second peak, - 0.381 to - 0.244 nm/kg), and knee adduction moment impulse (- 0.233 to - 0.150 nm s/kg). There was a significant improvement in MAA, MAD, and MPTA. All patients showed qualitative improvement in mean scores on VAS (11.8 to 0.0), LLQ (77 to 93), KOOS (64 to 84), and SF-36 (71 to 88). CONCLUSION These findings suggest that bilateral proximal tibial osteotomy may be effective in improving knee biomechanics during gait and correcting mechanical alignment in patients with bilateral genu varum. Patients also demonstrated improvement in functional outcome scores. This technique should thus be considered in patients with varus knee osteoarthritis in the setting of genu varum to alleviate symptoms and potentially decrease further clinical deterioration.
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Affiliation(s)
- Rachael J. Da Cunha
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
- Kingston Health Sciences Centre, Division of Orthopaedic Surgery, Department of Surgery, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada
| | - Andrew P. Kraszewski
- Leon Root, MD, Motion Analysis Laboratory, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
- Weill Cornell Medicine, New York, NY 10065 USA
| | - Howard J. Hillstrom
- Leon Root, MD, Motion Analysis Laboratory, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
- Weill Cornell Medicine, New York, NY 10065 USA
| | - Austin T. Fragomen
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - S. Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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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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Chen S, Sun Y, Ma G, Yin X, Liang L. The wedge insole for the treatment of knee osteoarthritis: A systematic review protocol. Medicine (Baltimore) 2019; 98:e17168. [PMID: 31517869 PMCID: PMC6750282 DOI: 10.1097/md.0000000000017168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Functional limitations and pain are common presenting complaints for people suffering from knee osteoarthritis. Wedge insole can be sued for treatment of knee osteoarthritis. Hence, we conducted a systematic review and meta-analysis to explicit the efficacy of wedge insole in the treatment of knee osteoarthritis. METHODS A systematic literature search for studies will be performed in MEDLINE, Embase, the Chinese National Knowledge Infrastructure Database (CNKI), Cochrane Library, Web of Science. The methodological quality of the included studies using the risk bias assessment tool of Cochrane. Funnel plot will be used to assess the reporting bias. And the level of evidence for results are assessed by the GRADE method. Statistical analysis is conducted with Revman 5.3. RESULTS This systematic review and meta-analysis will provide a synthesis of evidences for wedge insole on knee osteoarthritis. CONCLUSION The conclusion of this study will provide recommendations to assess effectiveness of exercise on knee osteoarthritis, which may further guide clinical practice. PROSPERO REGISTRATION NUMBER CRD42018096804.
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Affiliation(s)
- Shuling Chen
- Jinan Zhangqiu District Hospital of Traditional Chinese Medicine, Shandong Province
| | - Yicheng Sun
- Jinan Zhangqiu District Hospital of Traditional Chinese Medicine, Shandong Province
| | - Guanhua Ma
- Jinan Zhangqiu District Hospital of Traditional Chinese Medicine, Shandong Province
| | - Xunlu Yin
- Wangjing Hospital of Chinese Academy of Chinese Medical Sciences, Beijing, China
| | - Long Liang
- Wangjing Hospital of Chinese Academy of Chinese Medical Sciences, Beijing, China
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Effect of lateral wedged insoles on the knee internal contact forces in medial knee osteoarthritis. Gait Posture 2019; 68:443-448. [PMID: 30594873 DOI: 10.1016/j.gaitpost.2018.12.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 10/19/2018] [Accepted: 12/21/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lateral wedge insoles (LWIs) are non-surgical interventions used in medial knee osteoarthritis (KOA) aiming at restoring correct joint biomechanics. However, the mechanical efficacy of LWIs, based on modulation of the external knee adduction moment, is partially proved and high variability in response to these devices was observed. RESEARCH QUESTION The principal aim of the study was to employ subject-specific musculoskeletal models to investigate the immediate effect of LWIs on the medial compressive force (MCF) in a population with medial KOA and varus alignment. METHODS Fifteen adults (8 healthy controls age 56±3.4, BMI 25.2±2.2, hip-knee-ankle angle -1.3±2.3; and 7 KOA participants age 62±6.6, BMI 31.7±3.9, hip-knee-ankle angle 6.3±2) were recruited. Subject-specific LWIs were designed in CAD based on shape capture of the foot and manufactured via 3D printing. The required degree of heel post was added to the orthotic shell to create insoles with 0°, 5° and 10° of lateral wedge. Gait data were collected for each condition and a musculoskeletal model implemented in the Anybody Modeling System estimated the CFs normalised per bodyweight. The effect of the LWIs with respect to the baseline on the peak and the impulse of the MCF were tested with a Wilcoxon non-parametric test for paired samples. RESULTS For the KOA group, LWIs did not reduce significantly the impulse and the peak of the MCF. No dose-response trend according to the degree of wedging was observed. A high inter-subject variability was found: the impulse of the MCF varied between -12%, +10%, the peak between -5%, +7%. Moreover, LWIs had no consistent effect on shifting the load from the medial to the lateral compartment. SIGNIFICANCE Subject-specific response to LWIs in a cohort of medial KOA patients was observed. Further studies are necessary to maximise the mechanical effect of LWIs on restoring normal knee joint mechanics.
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Zhang B, Yu X, Liang L, Zhu L, Dong X, Xiong Y, Pan Q, Sun Y. Is the Wedged Insole an Effective Treatment Option When Compared with a Flat (Placebo) Insole: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:8654107. [PMID: 30622616 PMCID: PMC6304499 DOI: 10.1155/2018/8654107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 10/24/2018] [Accepted: 11/25/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Using the lateral wedge insole is a conservative management strategy for knee osteoarthritis. The theoretical basis for this intervention is to correct femorotibial angle, thereby reducing pain and optimising function. OBJECTIVE This systematic review evaluates the evidence on the effectiveness of wedge insole compared with flat insole for the treatment of knee osteoarthritis. METHODS A systematic review was performed, searching published (MEDLINE, EMBASE, CNKI, Cochrane Library, and Web of Science) and unpublished literature from their inception to April 2018. Randomized controlled trials (RCTs) that compared the use of wedge insole with a flat insole were included. Risk of bias and clinical relevance were assessed, and outcomes were analysed through meta-analysis. RESULT From a total of 413 citations, 8 studies adhered to the a priori eligibility criteria. The WOMAC pain was shown to be statistically nonsignificant change with the use of wedge insole (SMD=0.07), and low heterogeneity (I2=22%) and a 95% CI that crossed zero (95% CI: -0.09 to 0.24). The 5 independent trials were not significant in improving pain score (SMD = -0.02, 95% CI: -0.19 to 0.16). This review also revealed no significance in improving Lequesne index (SMD = -0.27, 95% CI: -0.72 to 0.19). The meta-analysis from the 2 independent trials was significant in improving femorotibial angle (SMD = -0.41, 95% CI: -0.73 to -0.09). In conclusion, this meta-analysis suggested that lateral wedge insoles can improve femorotibial angle but are of no benefit with pain and functions in knee osteoarthritis.
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Affiliation(s)
- Bingbing Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Xing Yu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Long Liang
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Liguo Zhu
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Xiaopeng Dong
- First Affiliated Hospital of Anhui University of Chinese Medicine, Anhui 230031, China
| | - Yang Xiong
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Quan Pan
- Dezhou People's Hospital, Dezhou, Shandong 253000, China
| | - Yongsheng Sun
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China
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Cheung RTH, Ho KKW, Au IPH, An WW, Zhang JHW, Chan ZYS, Deluzio K, Rainbow MJ. Immediate and short-term effects of gait retraining on the knee joint moments and symptoms in patients with early tibiofemoral joint osteoarthritis: a randomized controlled trial. Osteoarthritis Cartilage 2018; 26:1479-1486. [PMID: 30081075 DOI: 10.1016/j.joca.2018.07.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 07/02/2018] [Accepted: 07/26/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a knee adduction moment (KAM) gait retraining in patients with early knee osteoarthritis up to 6 months post-training. METHOD We conducted a single blinded randomized controlled trial on a total of 23 patients with early knee osteoarthritis who were randomly allocated to the gait retraining group and walking exercise group. Twenty of them completed the corresponding training and the 6-month evaluation. We measured KAM, knee flexion moment (KFM) and western ontario and McMaster universities osteoarthritis index (WOMAC) osteoarthritis index before, immediate after, and 6 months after training. A repeated measures analysis of covariance (ANCOVA) was used to compare KAM, KFM and WOMAC osteoarthritis index scores across the three time points i.e., pre-training, post-training, and 6-month follow-up with gender, knee osteoarthritis severity, and pre-training KAM, KFM and WOMAC scores set as covariates. Post-hoc analyses were conducted when indicated. RESULTS Significant time × group interactions were found for both KAM and WOMAC osteoarthritis index scores (P < 0.002). No interaction was found for KFM (P = 0.123). KAM after gait retraining was significantly lower than the pre-training value (P < 0.001) and such effect was maintained at 6-month follow-up (P = 0.01). There was no significant difference in the KAM across time in the walking exercise group (P > 0.208). WOMAC osteoarthritis index score after training and score at the 6-month follow-up were significantly improved in the gait retraining group (P = 0.001), while the WOMAC osteoarthritis index score remained similar. CONCLUSIONS Gait retraining is an effective intervention to reduce KAM during walking and to improve the symptoms of patients with early knee osteoarthritis in short term.
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Affiliation(s)
- R T H Cheung
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
| | - K K W Ho
- Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - I P H Au
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - W W An
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - J H W Zhang
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Z Y S Chan
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - K Deluzio
- Department of Mechanical & Materials Engineering, Queen's University, Canada
| | - M J Rainbow
- Department of Mechanical & Materials Engineering, Queen's University, Canada
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Abstract
OBJECTIVES Taking into account that the role of orthoses in patients with knee osteoarthritis (OA) is unclear and controversial, the purpose of this article is to review recent literature with the aim of answering the following question: What is the current role of orthoses in the treatment of knee OA? METHODS A Cochrane Library and PubMed (MEDLINE) search related to the role of orthoses in knee OA was performed. RESULTS Unloader braces decrease the adduction moment of the knee. In patients with varus medial compartment knee OA bracing is beneficial for pain, stiffness, function and quality of life (low grade of evidence). Lateral wedge arch support insoles seem not to decrease knee load. Lateral wedge insoles appear inefficacious at attenuating structural changes in patients with medial knee OA. CONCLUSIONS The ideal option for an orthosis in patients with knee OA keeps on indeterminate, and long-run inferences are lacking.
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Li W, Pan Y, Yang Q, Guo ZG, Yue Q, Meng QG. Extracorporeal shockwave therapy for the treatment of knee osteoarthritis: A retrospective study. Medicine (Baltimore) 2018; 97:e11418. [PMID: 29979441 PMCID: PMC6076154 DOI: 10.1097/md.0000000000011418] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This retrospective study investigated the effect and safety of extracorporeal shockwave therapy (ESWT) for treatment of knee osteoarthritis (KOA).In this retrospective study, 105 patients with KOA were included. Of those, 60 patients underwent ESWT, whereas 45 patients received laser therapy. Effect was measured by the Numeric Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). In addition, adverse events (AEs) were also recorded in this study. All outcome measurements were evaluated at the end of weeks 1, 6, and 12.Compared with the laser therapy, ESWT showed greater effect in KOA symptoms relief with regard to NRS, WOMAC total, and its subscores at week 6 (P < .05) and week 12 (P < .01) after treatment. No AE, however, occurred in both groups.The results of this retrospective study found that ESWT may be efficacious and safe for the treatment of patients with KOA. It, however, had an intrinsic limitation as a retrospective study. Prospective study with larger sample size is still needed to warrant the result of this study in the future.
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Affiliation(s)
- Wei Li
- Department of Medical Science, Institute of Harbin, The First Hospital of Harbin City, Harbin Medical University
| | - Yu Pan
- Department of Study Center, The First Affiliated Hospital of Harbin Medical University
| | - Qi Yang
- Department of Medical Science, Institute of Harbin, The First Hospital of Harbin City, Harbin Medical University
| | - Zheng-gui Guo
- Department of Medical Science, Institute of Harbin, The First Hospital of Harbin City, Harbin Medical University
| | - Qi Yue
- Department of Study Center, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qing-Gang Meng
- Department of Medical Science, Institute of Harbin, The First Hospital of Harbin City, Harbin Medical University
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Shoe-Insole Technology for Injury Prevention in Walking. SENSORS 2018; 18:s18051468. [PMID: 29738486 PMCID: PMC5982664 DOI: 10.3390/s18051468] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/23/2018] [Accepted: 04/29/2018] [Indexed: 12/22/2022]
Abstract
Impaired walking increases injury risk during locomotion, including falls-related acute injuries and overuse damage to lower limb joints. Gait impairments seriously restrict voluntary, habitual engagement in injury prevention activities, such as recreational walking and exercise. There is, therefore, an urgent need for technology-based interventions for gait disorders that are cost effective, willingly taken-up, and provide immediate positive effects on walking. Gait control using shoe-insoles has potential as an effective population-based intervention, and new sensor technologies will enhance the effectiveness of these devices. Shoe-insole modifications include: (i) ankle joint support for falls prevention; (ii) shock absorption by utilising lower-resilience materials at the heel; (iii) improving reaction speed by stimulating cutaneous receptors; and (iv) preserving dynamic balance via foot centre of pressure control. Using sensor technology, such as in-shoe pressure measurement and motion capture systems, gait can be precisely monitored, allowing us to visualise how shoe-insoles change walking patterns. In addition, in-shoe systems, such as pressure monitoring and inertial sensors, can be incorporated into the insole to monitor gait in real-time. Inertial sensors coupled with in-shoe foot pressure sensors and global positioning systems (GPS) could be used to monitor spatiotemporal parameters in real-time. Real-time, online data management will enable ‘big-data’ applications to everyday gait control characteristics.
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Yu FY, Xie CQ, Jiang CL, Sun JT, Huang XW. TNF‑α increases inflammatory factor expression in synovial fibroblasts through the toll‑like receptor‑3‑mediated ERK/AKT signaling pathway in a mouse model of rheumatoid arthritis. Mol Med Rep 2018; 17:8475-8483. [PMID: 29693122 DOI: 10.3892/mmr.2018.8897] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/09/2018] [Indexed: 11/06/2022] Open
Abstract
Osteoarthritis is a type of joint disease that may lead to other joint diseases. Previous research has demonstrated that tumor necrosis factor (TNF)‑α is associated with osteoarthritis activity and pathology. The possible mechanisms of the TNF‑α‑mediated signaling pathway have not been clearly elaborated in synovial fibroblasts. The present study aimed to investigate the potential mechanisms of TNF‑α in a mouse model of iodoacetate‑induced osteoarthritis. Reverse transcription‑quantitative polymerase chain reaction, ELISA, western blotting and immunohistochemistry were performed to evaluate the role of TNF‑α in the progression of osteoarthritis. The results revealed that the serum levels of TNF‑α, interleukin (IL)‑1β, IL‑4 and IL‑6 were significantly upregulated in a mouse model of iodoacetate‑induced osteoarthritis compared with healthy mice (P<0.01). TNF‑α, IL‑1β, IL‑4 and IL‑6 mRNA and protein levels were also significantly upregulated in synovial fibroblasts in the experimental mice (P<0.01). It was demonstrated that TNF‑α increased pro‑inflammation factors matrix metalloproteinase (MMP)‑3, MMP‑9, nuclear factor (NF)‑κB and receptor activator of NF‑κB ligand (RANKL) in synovial fibroblasts. It was also observed that the toll‑like receptor (TLR)‑3 was significantly upregulated and extracellular signal‑regulated kinase (ERK) and protein kinase B (AKT) were significantly downregulated in synovial fibroblasts in osteoarthritis mice (P<0.01). An in vitro assay demonstrated that TNF‑α inhibitor decreased mRNA and protein levels of IL‑1β, IL‑4 and IL‑6 in synovial fibroblasts. The knockdown of TLR‑3 abolished the TNF‑α upregulated mRNA and protein levels of IL‑1β, IL‑4 and IL‑6 in synovial fibroblasts. In addition, the knockdown of TLR‑3 also reversed TNF‑α‑upregulated ERK and AKT expression in synovial fibroblasts. In vivo assays demonstrated that TNF‑α inhibitor significantly decreased the deposition of IL‑1β, IL‑4 and IL‑6 as well as bone destruction and significantly increased the body weight and osteoarthritis score for osteoarthritic mice (P<0.01). TNF‑α inhibitor decreased TLR‑3 and significantly increased the expression and phosphorylation of ERK and AKT in articular cartilage (P<0.01). In conclusion the results of the present study indicate that TNF‑α serves an essential role in synovial fibroblasts in osteoarthritis, suggesting that inhibition of TNF‑α may decrease inflammation via the TLR‑3‑mediated ERK/AKT signaling pathway in a mouse model of monosodium iodoacetate‑induced osteoarthritis.
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Affiliation(s)
- Fang-Yuan Yu
- Department of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Cong-Qin Xie
- Department of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Chang-Liang Jiang
- Department of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Ji-Tong Sun
- Department of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
| | - Xun-Wu Huang
- Department of Orthopedics, The 309th Hospital of People's Liberation Army, Beijing 100091, P.R. China
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