The knee is one of the most stressed joints of the human body, being susceptible to ligament injuries and degenerative diseases. Due to the rising incidence of knee pathologies, the number of knee X-rays acquired is also increasing. Such X-rays are obtained for the diagnosis of knee injuries, the evaluation of the knee before and after surgery, and the monitoring of the knee joint’s stability. These types of diagnosis and monitoring of the knee usually involve radiography under physical stress. This widely used medical tool provides a more objective analysis of the measurement of the knee laxity than a physical examination does, involving knee stress tests, such as valgus, varus, and Lachman. Despite being an improvement to physical examination regarding the physician’s bias, stress radiography is still performed manually in a lot of healthcare facilities. To avoid exposing the physician to radiation and to decrease the number of X-ray images rejected due to inadequate positioning of the patient or the presence of artefacts, positioning systems for stress radiography of the knee have been developed. This review analyses knee positioning systems for X-ray environment, concluding that they have improved the objectivity and reproducibility during stress radiographs, but have failed to either be radiolucent or versatile with a simple ergonomic set-up.

Level IV.

Background: Lateral wedge insoles adjusted by biomechanical analysis may improve the condition of patients with medial knee osteoarthritis. Design: This is a prospective, randomized, controlled, single-blind clinical trial. Setting: The study was conducted in a biomechanics laboratory. Subjects: A total of 38 patients with medial knee osteoarthritis were allocated to either an experimental group (lateral wedge insoles) or a control group (neutral insoles). Interventions: Experimental group ( n = 20) received an adjusted lateral wedge insole of 2, 4, 6, 8, or 10 degrees, after previous biomechanical analysis. Control group ( n = 18) received a neutral insole (0 degrees). All patients used the insoles for 12 weeks. Main measures: Visual analogue scale, Knee Injury and Osteoarthritis Outcome Score questionnaire, biomechanical parameters: first and second peak of the external knee adduction moment and knee adduction angular impulse, and physical performance tests: 30-second sit-to-stand test, the 40-m fast-paced walk test, and the 12-step stair-climb test. Results: After 12 weeks, between-group differences did not differ significantly for pain intensity (−12.5 mm, (95% CI −29.4–4.4)), biomechanical parameters ( p = 0.05), Knee Injury and Osteoarthritis Outcome Score, and physical performance tests, except on the Knee Injury and Osteoarthritis Outcome Score subscale other symptoms ( p = 0.002; 13.8 points, (95% CI 5.6–22.0)). Conclusion: Tailored wedge insoles were no more effective at improving biomechanical or clinically meaningful outcomes than neutral insoles, except on symptoms. More participants from the experimental group reported they felt some improvement. However, these effects were minimal and without clinical significance.

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