Abnormal and cumulative loading in knee osteoarthritis

Maly, Monica R.

doi:10.1097/bor.0b013e328307f58c

Cited by 74 publications

(46 citation statements)

References 61 publications

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“…Further research investigating targeted use of lateral wedge insoles in biomechanical phenotypes likely to benefit is required to fully interrogate their potential to limit disease progression. An important issue regarding knee load exposure in OA is the concept of cumulative loading (50). Despite associations between the EKAM and disease progression, the KAAI has been proposed as a more useful measure to account for both the duration and magnitude of loading in knee OA.…”

Section: Discussionmentioning

confidence: 99%

Lateral Wedge Insoles for Reducing Biomechanical Risk Factors for Medial Knee Osteoarthritis Progression: A Systematic Review and Meta‐Analysis

Arnold

Wong

Jones

et al. 2016

Arthritis Care & Research

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Objective. Lateral wedge insoles are intended to reduce biomechanical risk factors of medial knee osteoarthritis (OA) progression, such as increased knee joint load; however, there has been no definitive consensus on this topic. The aim of this systematic review and meta-analysis was to establish the within-subject effects of lateral wedge insoles on knee joint load in people with medial knee OA during walking. Methods. Six databases were searched from inception until February 13, 2015. Included studies reported on the immediate biomechanical effects of lateral wedge insoles during walking in people with medial knee OA. Primary outcomes of interest relating to the biomechanical risk of disease progression were the first and second peak external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI). Eligible studies were pooled using random-effects metaanalysis.Results. Eighteen studies were included with a total of 534 participants. Lateral wedge insoles resulted in a small but statistically significant reduction in the first peak EKAM (standardized mean difference [SMD] 20.19; 95% confidence interval [95% CI] 20.23, 20.15) and second peak EKAM (SMD 20.25; 95% CI 20.32, 20.19) with a low level of heterogeneity (I 2 5 5% and 30%, respectively). There was a favorable but small reduction in the KAAI with lateral wedge insoles (SMD 20.14; 95% CI 20.21, 20.07, I 2 5 31%). Risk of methodologic bias scores (quality index) ranged from 8 to 13 out of 16. Conclusion. Lateral wedge insoles cause small reductions in the EKAM and KAAI during walking in people with medial knee OA. Current evidence demonstrates that lateral wedge insoles appear ineffective at attenuating structural changes in people with medial knee OA as a whole and may be better suited to targeted use in biomechanical phenotypes associated with larger reductions in knee load.

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Section: Discussionmentioning

confidence: 99%

Lateral Wedge Insoles for Reducing Biomechanical Risk Factors for Medial Knee Osteoarthritis Progression: A Systematic Review and Meta‐Analysis

Arnold

Wong

Jones

et al. 2016

Arthritis Care & Research

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“…Persons with lower limb loss develop knee/hip arthritis at an earlier age than the general population [2,12,14]. However, preventing the onset and progression of this disease is difficult because the mechanisms of the development of arthritis are still largely unknown [1,29].…”

Section: Discussionmentioning

confidence: 99%

“…Subjects with transfemoral limb loss at both time points also demonstrated increased vertical ground reaction force impulses, which could be attributed to longer stance times and increased loading rates. Degenerative joint changes and musculoskeletal injuries have also been suggested to result from cumulative exposures to increased magnitude, duration, and/or frequency of loading [10,14], potentially putting these subjects with persistent gait alterations at an increased risk for early onset and progression of knee/hip arthritis as they continue to ambulate with abnormal gait mechanics.…”

Section: Discussionmentioning

confidence: 99%

Does Intact Limb Loading Differ in Servicemembers With Traumatic Lower Limb Loss?

Pruziner

Werner

Copple

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The initiation and progression of knee and hip arthritis have been related to limb loading during ambulation. Although altered gait mechanics with unilateral lower limb loss often result in larger and more prolonged forces through the intact limb, how these forces differ with traumatic limb loss and duration of ambulation have not been well described.Questions/purposes The purpose of this study was to determine whether biomechanical variables of joint and limb loading (external adduction moments, vertical ground reaction force loading rates, and impulses) are larger in the intact limb of servicemembers with versus without unilateral lower limb loss and whether intact limb loading differs between shorter (B 6 months) versus longer (C 2 years) durations of ambulation with a prosthesis. 4.45-16.79; 10.18-12.81] 4.64-14.47; 8.26-9.74 82-19.51; 12.98-15.05]; ES = 0.43; p = 0.001), respectively. Intact limb mean and peak vertical ground reaction force loading rates were also larger in subjects with transfemoral limb loss with B 6 months and C 2 years of experience ambulating with a prosthesis versus control subjects .68] versus 9.03 BW/s [4.64-14.47; 8.26-9.74]; ES C 0.53; p \ 0.001;.05]; ES C 0.68; p \ 0.001, respectively). Similarly, intact limb vertical ground reaction force impulses ; ES C 0.53, p \ 0.001) were also larger among both groups of transfemoral subjects versus control subjects, respectively. Limb loading variables were not statistically different between times ambulating with a prosthesis within groups with transtibial or transfemoral limb loss. Conclusions Larger intact limb loading in individuals with traumatic transtibial loss were only noted early in the rehabilitation process, but these variables were present early and late in the rehabilitation process for those with transfemoral limb loss. Such evidence suggests an increased risk for early onset and progression of arthritis in the intact limb, especially in those with transfemoral limb loss. Clinical Relevance Interventions should focus on correcting modifiable gait mechanics associated with arthritis, particularly among individuals with transfemoral limb loss, to potentially mitigate the development and progression in this population.versus 9.03 BW/s [

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“…Clinical implications of a large KAM are significant as the peak KAM is a strong predictor of medial compartment OA radiographic disease severity (16), rate of disease progression (6), and development of chronic knee pain (17). The KAM impulse has also received increasing research focus as it reflects both the mean KAM magnitude and the absolute duration of load (i.e., stance) (5,18,19). Due to the strong clinical relevance of elevated KAM parameters, the success of load-modifying interventions is typically evaluated using measures of the KAM (9).…”

Section: Introductionmentioning

confidence: 99%

Trunk lean gait modification and knee joint load in people with medial knee osteoarthritis: The effect of varying trunk lean angles

Simić¹,

Hunt²,

Bennell³

et al. 2012

Arthritis Care & Research

106

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Objective. To evaluate whether increased lateral trunk lean toward the symptomatic lower extremity during gait in people with medial knee osteoarthritis (OA) immediately alters symptoms or medial knee load, as measured by the external knee adduction moment (KAM). Methods. Participants with medial knee OA (n ‫؍‬ 22) underwent 3-dimensional gait analysis to measure KAM peaks (early and late stance) and KAM impulse. Following the analysis of natural gait, participants were trained to lean their trunk toward the symptomatic leg during ipsilateral stance over 3 randomly ordered conditions (6°, 9°, and 12°lean). A projection screen displayed real-time trunk angles and target levels. Pain/discomfort in the knees, the hip, and the back were measured across conditions. Load-modifying effects of increasing lean magnitudes were investigated using linear mixed models. Mediating effects of peak lean timing and participant characteristics (pain and malalignment) were evaluated. Results. Increased trunk lean reduced all KAM measures (P

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Abnormal and cumulative loading in knee osteoarthritis

Cited by 74 publications

References 61 publications

Lateral Wedge Insoles for Reducing Biomechanical Risk Factors for Medial Knee Osteoarthritis Progression: A Systematic Review and Meta‐Analysis

Lateral Wedge Insoles for Reducing Biomechanical Risk Factors for Medial Knee Osteoarthritis Progression: A Systematic Review and Meta‐Analysis

Does Intact Limb Loading Differ in Servicemembers With Traumatic Lower Limb Loss?

Trunk lean gait modification and knee joint load in people with medial knee osteoarthritis: The effect of varying trunk lean angles

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