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Liu H, Gong H, Chen P, Zhang L, Cen H, Fan Y. Biomechanical effects of typical lower limb movements of Chen-style Tai Chi on knee joint. Med Biol Eng Comput 2023; 61:3087-3101. [PMID: 37624535 DOI: 10.1007/s11517-023-02906-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
The load and stress distribution on cartilage and meniscus of the knee joint in typical lower limb movements of Chen-style Tai Chi (TC) and deep squat (DS) were analyzed using finite element (FE) analysis. The loadings for this analysis consisted of muscle forces and ground reaction force (GRF), which were calculated through the inverse dynamic approach based on kinematics and force plate measurements obtained from motion capture experiments. Thirteen experienced practitioners performed four typical TC movements, namely, single whip (SW), brush knee and twist step (BKTS), stretch down (SD), and part the wild horse's mane (PWHM), which exhibit lower posture and greater lower limb force compared to other TC styles. The results indicated that TC required greater lower limb muscle strength than DS, resulting in greater knee joint forces. The stress on the medial cartilage in SW and BKTS fell within a range conductive to maintaining the balance between anabolism and catabolism of cartilage matrix. This was due to the fact that SW and BKTS reduce the medial to total tibiofemoral contact force ratios through knee abduction, which may effectively alleviate mild medial knee osteoarthritis (KOA). However, the greater medial contact force ratios observed in SD and PWHM resulted in great contact stresses that may aggravate the pain of patients with KOA. To mitigate these effects, practitioners should consider elevating their postures appropriately to reduce knee flexion angles, especially during the single-leg support phase. This adjustment can decrease the required muscle strength, load and stress on the knee joint.
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Affiliation(s)
- Haibo Liu
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - He Gong
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China.
| | - Peng Chen
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - Le Zhang
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - Haipeng Cen
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology (Beihang University) of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, 100083, People's Republic of China
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Peng H, Ou A, Huang X, Wang C, Wang L, Yu T, Zhang Y, Zhang Y. Osteotomy Around the Knee: The Surgical Treatment of Osteoarthritis. Orthop Surg 2021; 13:1465-1473. [PMID: 34110088 PMCID: PMC8313165 DOI: 10.1111/os.13021] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 12/22/2022] Open
Abstract
Osteoarthritis causes joint pain and functional disorder, of which knee osteoarthritis is the most common. Nowadays, clinically effective treatments mainly include conservative treatment, arthroplasty, and osteotomy. However, conservative treatment only offers symptomatic relief and arthroplasty is limited to the patients with a moderate to severe degree of osteoarthritis. For relatively young patients who require greater knee preservation, a surgical treatment with low operation trauma and revision rate is needed. Osteotomy around the knee, based on the notion of “knee preservation,” has been chosen as an alternative surgical treatment. Cutting and realigning the bones corrects the mechanical line of lower limb force bearing. As such, osteotomy around the knee retains normal anatomical structure and obtains good functional recovery of the knee joint. The techniques of osteotomy around the knee includes anti‐varus deformity and anti‐valgus deformity osteotomy, aiming to reallocate the force bearing in the compartment of the knee joint. By choosing the surgical section of the lower limbs, the osteotomy around the knee can achieve the correction of mechanical axis, such as the high tibial osteotomy (HTO), proximal fibular osteotomy (PFO), and distal femur osteotomy (DFO). Numerous modified techniques have been developed to meet the demands of patients based on traditional methods. These modified osteotomy have their own advantages and indications. This paper aims to guide clinical treatment by reviewing different types of osteotomies, and their effects, that have been studied and applied widely in clinical practices.
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Affiliation(s)
- Haining Peng
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Aichun Ou
- Department of Operating Room, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaohong Huang
- Institute of Neuroregeneration and Neurorehabilitation, Qingdao University, Qingdao, China
| | - Chen Wang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lei Wang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tengbo Yu
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China.,Institute of Sports Medicine and Rehabilitation, Qingdao University, Qingdao, China
| | - Yingze Zhang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yi Zhang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China.,Institute of Sports Medicine and Rehabilitation, Qingdao University, Qingdao, China.,Shandong Institute of Traumatic Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
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Harms A, Heredia-Rizo AM, Moseley GL, Hau R, Stanton TR. A feasibility study of brain-targeted treatment for people with painful knee osteoarthritis in tertiary care. Physiother Theory Pract 2018; 36:142-156. [PMID: 29889597 DOI: 10.1080/09593985.2018.1482391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: To assess the feasibility and clinical impact of brain-targeted treatment (BT; aiming to target sensorimotor processing) in knee osteoarthritis patients attending tertiary care. Methods: Randomized replicated case series. The study involved three phases, each of 2 weeks duration: (1) no-treatment phase; (2) BT phase (left/right judgments and touch discrimination training); and (3) usual care (education, strengthening, and stretching training). Primary outcomes were: timely recruitment; number of participants completing the interventions; treatment compliance and barriers; follow-up rates; and treatment impact on pain and function. Fear-avoidance beliefs and clinical measures of cortical body representation (tactile acuity and left/right judgment performance) were secondary outcomes. Results: A total of 5% (19/355) of all assessed patients were eligible to participate and of these, 58% (11/19) agreed to participate. Ten patients completed the study, and 9 were successfully followed up, with treatment compliance varying between interventions. Compliance was poor for the touch discrimination component of BT. No significant effects were observed for pain relief or knee function after any treatment. A positive impact of treatment was found for fear-avoidance beliefs (usual care vs. washout, p = 0.007; BT vs. washout, p = 0.029) and left/right judgment accuracy (usual care vs. washout; p = 0.006). Conclusions: Clear barriers were identified to implementing BT in tertiary care for knee osteoarthritis. Access to all available services (especially the use of interpreters), and treatment options that do not require additional assistance to perform (e.g., touch discrimination training) represent the main lessons learned.
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Affiliation(s)
- Anton Harms
- Department of Physiotherapy, Northern Hospital, Epping, Victoria, Australia
| | - Alberto M Heredia-Rizo
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, Sevilla, Spain.,School of Health Sciences, University of South Australia, Adelaide, South Australia
| | - G Lorimer Moseley
- School of Health Sciences, University of South Australia, Adelaide, South Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Raphael Hau
- Northern Clinical School of Melbourne Medical School, Northern Hospital, Epping, Victoria, Australia
| | - Tasha R Stanton
- School of Health Sciences, University of South Australia, Adelaide, South Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia
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Bettoni E, Ferriero G, Bakhsh H, Bravini E, Massazza G, Franchignoni F. A systematic review of questionnaires to assess patient satisfaction with limb orthoses. Prosthet Orthot Int 2016; 40:158-69. [PMID: 25428901 DOI: 10.1177/0309364614556836] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/02/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Assessment of patient satisfaction with orthosis is a key point for clinical practice and research, requiring questionnaires with robust psychometric properties. OBJECTIVES To identify which validated questionnaires are used to investigate patient satisfaction with orthosis in limb orthotics and to analyse (1) their main fields of clinical application, (2) the orthosis-related features analysed by the questionnaires and (3) the strength of their psychometric properties. STUDY DESIGN Systematic review. METHODS A literature search using MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases for original articles published within the last 20 years was performed. RESULTS A total of 106 papers pertaining to various clinical fields were selected. The main features of patient satisfaction with orthosis analysed were as follows: aesthetic, ease in donning and doffing the device, time of orthotic use and comfort. CONCLUSION Of the questionnaires used to investigate patient satisfaction with orthosis, only four are adequately validated for this purpose: two for generic orthotic use (Quebec User Evaluation of Satisfaction with assistive Technology 2.0 and Client Satisfaction with Device of Orthotics and Prosthetic Users' Survey) and two for specific application with orthopaedic shoes (Questionnaire for the Usability Evaluation of orthopaedic shoes and Monitor Orthopaedic Shoes). Further development, refinement and validation of outcome measures in this field are warranted. CLINICAL RELEVANCE Given the importance of analysing patient satisfaction with orthosis (PSwO), appropriate instruments to assess outcome are needed. This article reviews the currently available instruments and reflects on how future studies could be focused on the development, refinement and validation of outcome measures in this field.
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Affiliation(s)
| | - Giorgio Ferriero
- Scientific Institute of Veruno, Fondazione Salvatore Maugeri, Veruno, Italy
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Parkes MJ, Maricar N, Lunt M, LaValley MP, Jones RK, Segal NA, Takahashi-Narita K, Felson DT. Lateral wedge insoles as a conservative treatment for pain in patients with medial knee osteoarthritis: a meta-analysis. JAMA 2013; 310:722-30. [PMID: 23989797 PMCID: PMC4458141 DOI: 10.1001/jama.2013.243229] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE There is no consensus regarding the efficacy of lateral wedge insoles as a treatment for pain in medial knee osteoarthritis. OBJECTIVE To evaluate whether lateral wedge insoles reduce pain in patients with medial knee osteoarthritis compared with an appropriate control. DATA SOURCES Databases searched include the Cochrane Central Register of Controlled Trials, EMBASE, AMED, MEDLINE, CINAHL Plus, ScienceDirect, SCOPUS, Web of Science, and BIOSIS from inception to May 2013, with no limits on study date or language. The metaRegister of Controlled Trials and the NHS Evidence website were also searched. STUDY SELECTION Included were randomized trials comparing shoe-based treatments (lateral heel wedge insoles or shoes with variable stiffness soles) aimed at reducing medial knee load, with a neutral or no wedge control condition in patients with painful medial knee osteoarthritis. Studies must have included patient-reported pain as an outcome. DATA EXTRACTION AND SYNTHESIS Trial data were extracted independently by 2 researchers using a standardized form. Risk of bias was assessed using the Cochrane Risk of Bias tool by 2 observers. Eligible studies were pooled using a random-effects approach. MAIN OUTCOME AND MEASURES Change in self-reported knee pain at follow-up. RESULTS Twelve trials met inclusion criteria with a total of 885 participants of whom 502 received lateral wedge treatment. The pooled standardized mean difference (SMD) suggested a favorable association with lateral wedges compared with control (SMD, -0.47; 95% CI, -0.80 to -0.14); however, substantial heterogeneity was present (I2 = 82.7%). This effect size represents an effect of -2.12 points on the 20-point Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scale. Larger trials with a lower risk of bias suggested a null association. Meta-regression analyses showed that higher effect sizes (unstandardized β, 1.07 [95% CI, 0.28 to 1.87] for trials using a no treatment control) were seen in trials using a no wedge treatment control group (n = 4 trials; SMD, -1.20 [95% CI, -2.09 to -0.30]) and lower effect sizes (unstandardized β, 0.26 [95% CI, 0.002 to 0.52] for each bias category deemed low risk) when the study method was deemed at low risk of bias. Among trials in which the control treatment was a neutral insole (n = 7), lateral wedges showed no association (SMD, -0.03 [95% CI, -0.18 to 0.12] on WOMAC; this represents an effect of -0.12 points), and results showed little heterogeneity (I2 = 7.1%). CONCLUSIONS AND RELEVANCE Although meta-analytic pooling of all studies showed a statistically significant association between use of lateral wedges and lower pain in medial knee osteoarthritis, restriction of studies to those using a neutral insole comparator did not show a significant or clinically important association. These findings do not support the use of lateral wedges for this indication.
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Affiliation(s)
- Matthew J Parkes
- Arthritis Research UK Epidemiology Unit, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, England.
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Hatef MR, Mirfeizi Z, Sahebari M, Jokar MH, Mirheydari M. Superiority of laterally elevated wedged insoles to neutrally wedged insoles in medial knee osteoarthritis symptom relief. Int J Rheum Dis 2013; 17:84-8. [DOI: 10.1111/1756-185x.12036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mohammad Reza Hatef
- Rheumatic Diseases Research Center (RDRC); Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences; Mashhad Iran
| | - Zahra Mirfeizi
- Rheumatic Diseases Research Center (RDRC); Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences; Mashhad Iran
| | - Maryam Sahebari
- Rheumatic Diseases Research Center (RDRC); Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences; Mashhad Iran
| | - Mohammad Hassan Jokar
- Rheumatic Diseases Research Center (RDRC); Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences; Mashhad Iran
| | - Mahyar Mirheydari
- Rheumatic Diseases Research Center (RDRC); Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences; Mashhad Iran
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Effectiveness of a long-term use of a minimalist footwear versus habitual shoe on pain, function and mechanical loads in knee osteoarthritis: a randomized controlled trial. BMC Musculoskelet Disord 2012; 13:121. [PMID: 22788574 PMCID: PMC3441481 DOI: 10.1186/1471-2474-13-121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 07/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent studies have shown an important reduction of joint overload during locomotion in elderly women with knee osteoarthritis (OA) after short-term use of minimalist shoes. Our aim is to investigate the chronic effect of inexpensive and minimalist footwear on the clinical and functional aspects of OA and gait biomechanics of elderly women with knee OA. METHODS/DESIGN Fifty-six elderly women with knee OA grade 2 or 3 (Kellgren and Lawrence) are randomized into blocks and allocated to either the intervention group, which will use flexible, non-heeled shoes- Moleca®-for six months for at least six hours daily, or the control group, which could not use these shoes. Neither group is undergoing physical therapy treatment throughout the intervention period. Moleca® is a women's double canvas, flexible, flat walking shoe without heels, with a 5-mm anti-slip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. Both groups will be followed for six months and will be assessed at baseline condition, after three months, and after six months (end of intervention). All the assessments will be performed by a physiotherapist that is blind to the group allocation. The primary outcome is the pain Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. The secondary outcomes are global WOMAC score; joint stiffness and disability WOMAC scores; knee pain with a visual analogue scale; walking distance in the six-minute walk test; Lequesne score; amount and frequency (number of days) of paracetamol (500 mg) intake over six months; knee adduction moment during gait; global medical assessment score; and global patient auto-assessment score. At baseline, all patients receive a diary to record the hours of daily use of the footwear intervention; every two weeks, the same physiotherapist makes phone calls to all patients in order to verify adherence to treatment. The statistical analysis will be based on intention-to-treat analysis, as well as general linear models of analysis of variance for repeated measure to detect treatment-time interactions (α = 5%). DISCUSSION This is the first randomized, clinical trial protocol to assess the chronic effect of minimalist footwear on the clinical and functional aspects and gait biomechanics of elderly women with knee osteoarthritis. We expect that the use of Moleca® shoes for six months will provide pain relief, reduction of the knee adduction moment when walking, and improve joint function in elderly women with knee OA, and that the treatment, thus, can be considered another inexpensive and easy-to-use option for conservative OA treatment. TRIAL REGISTRATION NCT01342458.
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Hinman RS, Bowles KA, Metcalf BB, Wrigley TV, Bennell KL. Lateral wedge insoles for medial knee osteoarthritis: effects on lower limb frontal plane biomechanics. Clin Biomech (Bristol, Avon) 2012; 27:27-33. [PMID: 21862189 DOI: 10.1016/j.clinbiomech.2011.07.010] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 04/03/2011] [Accepted: 07/19/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lateral wedges reduce the peak knee adduction moment and are advocated for knee osteoarthritis. However some patients demonstrate adverse biomechanical effects with treatment. Clinical management is hampered by lack of knowledge about their mechanism of effect. We evaluated effects of lateral wedges on frontal plane biomechanics, in order to elucidate mechanisms of effect. METHODS Seventy three participants with knee osteoarthritis underwent gait analysis with and without 5° lateral wedges. Frontal plane parameters at the foot, knee and hip were evaluated, including peak knee adduction moment, knee adduction angular impulse, center of pressure displacement, ground reaction force, and knee-ground reaction force lever arm. FINDINGS Lateral wedges reduced peak knee adduction moment and knee adduction angular impulse (-5.8% and -6.3% respectively, both P<0.001). Although reductions in peak moment were correlated with more lateral center of pressure (r=0.25, P<0.05), less varus malalignment (r values 0.25-0.38, P<0.05), reduced knee-ground reaction force lever arm (r=0.69, P<0.01), less hip adduction (r=0.24, P<0.05) and a more vertical frontal plane ground reaction force vector (r=0.67, P<0.001), only reduction in knee-ground reaction force lever arm was significantly predictive in regression analyses (B=0.056, adjusted R(2)=0.461, P<0.001). INTERPRETATION Lateral wedges significantly reduce peak knee adduction moment and knee adduction angular impulse. It seems a reduced knee-ground reaction force lever arm with lateral wedges is the central mechanism explaining their load-reducing effects. In order to understand why some patients do not respond to treatment, future evaluation of patient characteristics that mediate wedge effects on this lever arm is required.
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Affiliation(s)
- Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
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Bennell KL, Bowles KA, Payne C, Cicuttini F, Williamson E, Forbes A, Hanna F, Davies-Tuck M, Harris A, Hinman RS. Lateral wedge insoles for medial knee osteoarthritis: 12 month randomised controlled trial. BMJ 2011; 342:d2912. [PMID: 21593096 PMCID: PMC3100910 DOI: 10.1136/bmj.d2912] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the effect of lateral wedge insoles compared with flat control insoles on improving symptoms and slowing structural disease progression in medial knee osteoarthritis. DESIGN Randomised controlled trial. SETTING Community in Melbourne, Australia. PARTICIPANTS 200 people aged 50 or more with clinical and radiographic diagnosis of mild to moderately severe medial knee osteoarthritis. INTERVENTIONS Full length 5 degree lateral wedged insoles or flat control insoles worn inside the shoes daily for 12 months. MAIN OUTCOME MEASURES Primary symptomatic outcome was change in overall knee pain (past week) measured on an 11 point numerical rating scale. Primary structural outcome was change in volume of medial tibial cartilage from magnetic resonance imaging scans. Secondary clinical outcomes included changes in measures of pain, function, stiffness, and health related quality of life. Secondary structural outcomes included progression of medial cartilage defects and bone marrow lesions. RESULTS Between group differences did not differ significantly for the primary outcomes of change in overall pain (-0.3 points, 95% confidence intervals -1.0 to 0.3) and change in medial tibial cartilage volume (-0.4 mm(3), 95% confidence interval -15.4 to 14.6), and confidence intervals did not include minimal clinically important differences. None of the changes in secondary outcomes showed differences between groups. CONCLUSION Lateral wedge insoles worn for 12 months provided no symptomatic or structural benefits compared with flat control insoles. Trial registration Australian New Zealand Clinical Trials Registry ACTR12605000503628 and ClinicalTrials.gov NCT00415259.
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Affiliation(s)
- Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Parkville, 3010 VIC, Australia.
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Creaby MW, Wang Y, Bennell KL, Hinman RS, Metcalf BR, Bowles KA, Cicuttini FM. Dynamic knee loading is related to cartilage defects and tibial plateau bone area in medial knee osteoarthritis. Osteoarthritis Cartilage 2010; 18:1380-5. [PMID: 20816980 DOI: 10.1016/j.joca.2010.08.013] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 06/28/2010] [Accepted: 08/20/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the relationship between dynamic mechanical loading, as indicated by external knee adduction moment (KAM) measures during walking, and measures of articular cartilage morphology and subchondral bone size in people with medial knee osteoarthritis (OA). DESIGN 180 individuals with radiographic medial tibiofemoral OA participated. Peak KAM and KAM angular impulse were measured by walking gait analysis. Tibial cartilage volume and plateau bone area, and tibiofemoral cartilage defects were determined from magnetic resonance imaging using validated methods. RESULTS Both peak KAM (coefficient=0.42, 95% confidence interval (CI) 0.04-0.79, P=0.03) and KAM impulse (coefficient=1.79, 95% CI 0.80-2.78, P<0.001) were positively associated with the severity of medial tibiofemoral cartilage defects. KAM impulse was also associated with the prevalence of medial tibiofemoral cartilage defects (odds ratio 4.78, 95% CI 1.10-20.76, P=0.04). Peak KAM (B=0.05, 95% CI 0.01-0.09, P=0.02) and KAM impulse (B=0.16, 95% CI 0.06-0.25, P=0.002) were positively associated with medial:lateral tibial plateau bone area, and KAM impulse was also associated with medial tibial plateau bone area (B=133.7, 95% CI 4.0-263.3, P=0.04). There was no significant association between KAM measures and tibial cartilage volume. CONCLUSION Peak KAM and KAM impulse are associated with cartilage defects and subchondral bone area in patients with medial knee OA, suggesting that increased mechanical loading may play a role in the pathological changes in articular cartilage and subchondral bone that occur with medial knee OA.
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Affiliation(s)
- M W Creaby
- Centre for Health, Exercise and Sports Medicine, Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Victoria, Australia.
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Varus-valgus laxity and passive stiffness in medial knee osteoarthritis. Arthritis Care Res (Hoboken) 2010; 62:1237-43. [DOI: 10.1002/acr.20220] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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12
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Hinman RS, Bowles KA, Bennell KL. Laterally wedged insoles in knee osteoarthritis: do biomechanical effects decline after one month of wear? BMC Musculoskelet Disord 2009; 10:146. [PMID: 19939281 PMCID: PMC2791095 DOI: 10.1186/1471-2474-10-146] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 11/25/2009] [Indexed: 11/10/2022] Open
Abstract
Objective This study aimed to determine whether the effect of laterally wedged insoles on the adduction moment in knee osteoarthritis (OA) declined after one month of wear, and whether higher reported use of insoles was associated with a reduced effect on the adduction moment at one month. Methods Twenty people with medial compartment OA underwent gait analysis in their own shoes wearing i) no insoles and; ii) insoles wedged laterally 5° in random order. Testing occurred at baseline and after one month of use of the insoles. Participants recorded daily use of insoles in a log-book. Outcomes were the first and second peak external knee adduction moment and the adduction angular impulse, compared across conditions and time with repeated measures general linear models. Correlations were obtained between total insole use and change in gait parameters with used insoles at one month, and change scores were compared between high and low users of insoles using general linear models. Results There was a significant main effect for condition, whereby insoles significantly reduced the adduction moment (all p < 0.001). However there was no significant main effect for time, nor was an interaction effect evident. No significant associations were observed between total insole use and change in gait parameters with used insoles at one month, nor was there a difference in effectiveness of insoles between high and low users of the insoles at this time. Conclusion Effects of laterally wedged insoles on the adduction moment do not appear to decline after one month of continuous use, suggesting that significant wedge degradation does not occur over the short-term.
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Affiliation(s)
- Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, The University of Melbourne, Victoria, Australia.
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Konservative Therapie der Arthrose. ARTHROSKOPIE 2009. [DOI: 10.1007/s00142-008-0481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
PURPOSE OF REVIEW This review highlights recent research findings, including their clinical application, for insoles and footwear in knee osteoarthritis. In particular, it examines their effect on knee load, osteoarthritis symptoms and disease progression. RECENT FINDINGS Increased joint loading increases the risk of osteoarthritis progression, but is amenable to change. Given the prevalence of medial compartment osteoarthritis, insoles and footwear largely aim to reduce the knee adduction moment, an indicator of medial compartment load. Lateral wedged insoles can reduce this moment but do not appear to slow disease progression. Although nonexperimental and quasiexperimental studies report favourable effects of lateral wedges on symptoms, clinical trials have not been confirmatory. Medial wedged insoles show promise in relieving symptoms of lateral compartment disease. Walking in shoes increases joint load compared with walking in barefeet. Shoes with a flat or low heel and that are flexible rather than stabilizing may be optimal; however, effects of off-the-shelf shoes on osteoarthritis symptoms are unknown. Promising shoe modifications include shoes that promote foot mobility and those with variable stiffness or laterally wedged soles. SUMMARY Insoles and footwear offer great potential, as simple, inexpensive-treatment strategies for knee osteoarthritis. Further research is needed to evaluate efficacy and to determine which patient subgroups are most responsive.
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Lim BW, Kemp G, Metcalf B, Wrigley TV, Bennell KL, Crossley KM, Hinman RS. The association of quadriceps strength with the knee adduction moment in medial knee osteoarthritis. ACTA ACUST UNITED AC 2009; 61:451-8. [PMID: 19333982 DOI: 10.1002/art.24278] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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