Prophylaxis of medial compartment gonarthrosis in varus knee - current state of knowledge

Neuromuscular Adaptations Related to Medial Knee Osteoarthritis and Influence of Unloader Braces on Neuromuscular Activity in Knee Osteoarthritis Subjects-A Systematic Review

ABSTRACT

Unloader braces are a treatment modality for medial compartment knee osteoarthritis. The functional mechanisms involved are not yet fully understood. Therefore, this two-part systematic review examines the following research questions: How is muscle activation altered by medial compartment knee osteoarthritis, and do medial tibio-femoral compartment unloader braces alter muscle activation? If so, could this alteration be part of the unloading mechanism by affecting the altered muscle activity in medial compartment knee osteoarthritis?A systematic literature search was conducted using PubMed, LIVIVO, Web of Science, Google Scholar, and CENTRAL for articles published until August 2023. The first systematic review, examining neuromuscular alterations, identified 703 articles, with a final inclusion of 20. The second systematic review, which evaluated the neuromuscular effects of unloader braces, identified 123 articles with the final inclusion of 3. Individuals with medial compartment knee osteoarthritis demonstrated increased activity and co-contraction of the periarticular knee muscles, whereas medial tibio-femoral compartment unloader braces seemed to reduce activity and co-contraction. In contrast to the belief that unloader braces result in muscle weakness as they decrease muscle activity and co-contraction, our limited insights indicate that they rather might reduce the pathological increase. This may result in joint load reduction due to lower compressive forces. However, further investigation is required.

Gait variability and biomechanical distinctions in knee osteoarthritis: Insights from a 3D analysis in an adult elderly cohort

Background

This study employs 3D gait analysis to investigate normal gait patterns in individuals afflicted with knee Osteoarthritis (OA). Focusing on the adult osteoarthritic population, the research aims to establish reference values for joint angles, temporospatial parameters, Gait Profile Score (GPS), and Movement Analysis Profile (MAP) collected concurrently along a standardized walking path. Furthermore, the study delves into potential variations linked to gender and OA severity, comparing gait parameters between male and female participants and among individuals with grade 3 and grade 4 OA.

Method

The study involved 34 adults with a mean age of 68.6 ± 5.75 years, all experiencing OA knees and awaiting Total Knee Arthroplasty (TKA). Utilizing Qualisys Motion capture system, 3D gait analysis was conducted. Data were processed through Visual 3D C-Motion Software.

Results

Gait analysis revealed noteworthy differences between genders for various parameters, including stance time, GPS, MAP of the hip, and joint angle for the sagittal plane (ankle), coronal plane (knee), and transverse plane (hip and knee). Moreover, significant differences were observed between grade 3 and grade 4 OA knees in MAP and for the transverse plane joint angle (ankle).

Conclusion

This gait analysis study sheds light on distinctive gait patterns in the adult osteoarthritic population. The identified variations in temporospatial parameters, joint angles, GPS, and MAP provide valuable reference values for individuals suffering from knee OA. The observed differences between genders and across different OA severity grades emphasize the need for personalized approaches in managing knee OA and planning interventions like TKA.

Effect of total knee arthroplasty on contralateral knee: A prospective comparative gait analysis of non-operated legs in the Indian population

Introduction

Biomechanics plays a crucial function in osteoarthritis. Changes in the biomechanical parameters of the contralateral knee following total knee arthroplasty (TKA) may result in pain in the contralateral knee. The objective of this study was to examine preoperative and postoperative gait measurements on the contralateral leg following a TKA for a variety of gait measures at a self-selected normal gait pace in a similar speed population.

Method

There were 11 patients included in the study, and their average age was 68 (7 females and 4 males). Gait analysis was performed at a sampling frequency of 120 Hz using nine cameras Qualisys motion capture systems (Qualisys AB, Sweden). To process the kinematic data, Visual 3D C-Motion Software was used.

Results

Ankle plantar flexion (0.01), knee abduction during the terminal stance (0.002), and knee adduction during the initial swing (0.01) all showed a significant difference. In spatiotemporal data, walking speed (0.01), stance time (0.01), step length (0.005), and stride length (0.001) all showed significant differences. There were significant differences in knee flexion-extension (0.04) values.

Conclusion

A change in the contralateral knee's biomechanics as a result of TKA is strongly suggested by significant alterations in the knee's stance phase, joint angle, and MAP. The research may help to modify the stride of the contralateral leg to decrease the advancement of osteoarthritis.

A clinical test examination procedure to identify knee compartment overloading: A reliability and validity study using SPECT-CT as reference

BACKGROUND

Mechanical forces and joint misalignment are considered risk factors for the development of knee osteoarthritis (KOA). Early detection of KOA and distinction between lateral and medial compartment overloading (CO), might be important to inform appropriate preventative interventions. This study evaluated reliability and validity of a test battery consisting of ten clinical tests to predict knee CO.

METHODS

Independent observers examined 30 participants with symptoms of KOA. Inter-rater reliability of the ten tests, as well as the anticipated CO based on the whole test battery, was determined. All participants received a SPECT-CT, which served as reference standard for CO. The agreement for CO between SPECT-CT and clinical examination was assessed to determine criterion validity.

RESULTS

The Kappa coefficients (k) for the ten individual clinical tests ranged from 0.19 to 0.80. The k for determining CO was 0.52 (95% CI = 0.28-0.76). The agreement for CO between SPECT-CT and clinical examination (i.e. criterion validity) yielded a k of 0.26 (95% CI = -0.06 - 0.58). Logistic regression indicated that valgus alignment was strongly related with lateral CO. No other relationships were found between individual tests and CO.

CONCLUSION

Accurate measurement of frontal plane knee angle is important to determine CO. This particular test yielded good reliability, but low validity. Reliability of the nine remaining clinical tests was fair to moderate. Criterion validity of the clinical examination to predict CO was low. Therefore, this test battery in its current form cannot be used in practice to determine CO.