A non-invasive, home-based biomechanical therapy for patients with spontaneous osteonecrosis of the knee

Abstract

BackgroundThe purpose of the current study was to examine the effect of a non-invasive, home-based biomechanical treatment program for patients with spontaneous osteonecrosis of the knee (SONK).MethodsSeventeen patients with SONK, confirmed by MRI, participated in this retrospective analysis. Patients underwent a spatiotemporal gait analysis and completed the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Short-Form-36 (SF-36). Following an initial assessment, patients commenced the biomechanical treatment (AposTherapy). All patients were reassessed after 3 and 6 months of treatment.ResultsA significant reduction in pain and improvement in function was seen after 3 months of therapy with additional improvement after 6 months of therapy. Pain was reduced by 53% and functional limitation reduced by 43%. Furthermore, a significant improvement was also found in the SF-36 subscales, including the summary of physical and mental scores. Significant improvements were found in most of the gait parameters including a 41% increase in gait velocity and a 22% increase in step length. Patients also demonstrated improvement in limb symmetry, especially by increasing the single limb support of the involved limb.ConclusionsApplying this therapy allowed patients to be active, while walking more symmetrically and with less pain. With time, the natural course of the disease alongside the activity of the patients with the unique biomechanical device led to a significant reduction in pain and improved gait patterns. Therefore, we believe AposTherapy should be considered as a treatment option for patients with SONK.Trial registrationAssaf Harofeh Medical Center Institutional Helsinki Committee Registry, 141/08; ClinicalTrials.gov NCT00767780.

Spontaneous Osteonecrosis of the Knee: a Systematic Review of Conservative Treatment Approaches

“…Two case reports radiologically demonstrated the primary overlay of fracture lines by BME [28,29]. Some studies failed to report the MRI criteria used for diagnosis [30][31][32][33]. In total, BME were observed in 92.9% of patients, whereas fractures were reported to be present in 44.7%.…”

“…Sixteen of the twenty-two included studies (73%) reported positive clinical and/or radiological outcomes [7,13,17,[20][21][22][23][25][26][27][28][29][30][31][32][33]. Although RWB was the most thoroughly tested treatment modality, it has also been challenged by some authors.…”

“…Although RWB was the most thoroughly tested treatment modality, it has also been challenged by some authors. While four studies reported only moderate to poor results [14][15][16]24], nine observed favorable outcomes when testing one of the various forms of RWB [7,17,21,27,32] or a combination of RWB with bisphosphonates [20,25,29,33].…”

“…Given the lack of studies comparing different treatment modalities, evidence-based ranking of their effectiveness is not possible. However, considering the most robust body of evidence in its support, it is recommended to start conservative therapy with RWB assisted by adequate pain management [7,17,20,21,25,27,29,32,33]. Authors, that reported good outcomes with RWB, treated their patients for a mean of 3.3 months [7,20,21,25,27,29,32,33].…”

Osteonecrosis of the Knee

“…Naime, pokazalo se da je uzorak hoda u bole snika sa SONKom bitno drugačiji nego kod zdrave populacije, ali i drugačiji od uzorka hoda bolesnika koji imaju oštećenje meniska ili primarnu artrozu koljena. 54,55…”