Acute effects of different orthotic interventions on knee loading parameters in knee osteoarthritis patients with varus malalignment

Mauricio, Elsa; Sliepen, Maik; Rosenbaum, Dieter

doi:10.1016/j.knee.2018.06.017

Cited by 13 publications

(14 citation statements)

References 40 publications

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“…31 Preliminary examinations described an unfavorable increase of up to 71% by ankle-foot orthosis. 8,32 This effect was smaller in our collective. A possible reason is an overall weakened biomechanical effect of the ankle-foot orthosis due to the individual adaptation to the gait pattern of the patient without exhausting the maximum achievable effects.…”

Section: Discussioncontrasting

confidence: 54%

“…These effects were also confirmed in patients with knee osteoarthritis. 8 , 23 Miyazaki described a 6.46 times higher risk of osteoarthritis progression with each 20% increase of overall peak external knee adduction moment. 6 For this reason, the authors concluded that the 5%–10% reduction typically achieved with lateral wedge insoles may already be clinically meaningful.…”

Section: Discussionmentioning

confidence: 99%

“…In a healthy study population, the knee adduction moment was reduced more effectively by the orthosis than by a lateral wedge insole. 7 Although this difference was reproduced in a population with knee osteoarthritis, 8 both studies worked with a one-day laboratory assessment.…”

Section: Introductionmentioning

confidence: 99%

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A comparison between laterally wedged insoles and ankle-foot orthoses for the treatment of medial osteoarthritis of the knee: A randomized cross-over trial

et al. 2021

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Objective: To compare biomechanical and clinical outcome of laterally wedged insoles (LWI) and an ankle-foot orthosis (AFO) in patients with medial knee osteoarthritis. Design: Single-centre, block-randomized, cross-over controlled trial. Setting: Outpatient clinic. Subjects: About 39 patients with symptomatic medial knee osteoarthritis. Interventions: Patients started with either LWI or AFO, determined randomly, and six weeks later changed to the alternative. Main measures: Change in the 1st maximum of external knee adduction moment (eKAM) was assessed with gait analysis. Additional outcomes were other kinetic and kinematic changes and the patient-reported outcomes EQ-5D-5L, Oxford Knee Score (OKS), American Knee Society Clinical Rating System (AKSS), Hannover Functional Ability Questionnaire – Osteoarthritis and knee pain. Results: Mean age (SD) of the study population was 58 (8) years, mean BMI 30 (5). Both aids significantly improved OKS (LWI P = 0.003, AFO P = 0.001), AKSS Knee Score (LWI P = 0.01, AFO P = 0.004) and EQ-5D-5L Index (LWI P = 0.001, AFO P = 0.002). AFO reduced the 1st maximum of eKAM by 18% ( P < 0.001). The LWI reduced both maxima by 6% ( P = 0.02, P = 0.03). Both AFO and LWI reduced the knee adduction angular impulse (KAAI) by 11% ( P < 0.001) and 5% ( P = 0.05) respectively. The eKAM (1st maximum) and KAAI reduction was significantly larger with AFO than with LWI ( P = 0.001, P = 0.004). Conclusions: AFO reduces medial knee load more than LWI. Nevertheless, no clinical superiority of either of the two aids could be shown.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

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A comparison between laterally wedged insoles and ankle-foot orthoses for the treatment of medial osteoarthritis of the knee: A randomized cross-over trial

et al. 2021

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“…A systematic review showed that foot orthotics were effective in decreasing pain, knee stiffness and drug dosage of analgesic medications [ 119 ]. In patients with medial compartment OA, lateral-wedged insoles reduced KAM and KAM impulse, compared to those without insoles [ 120 ]. Application of medial-wedge insoles on knee OA patients with valgus-deformity has demonstrated an effective reduction in in knee pain and improvement in functionality [ 121 ].…”

Section: Therapeutic Strategies For Obesity-related Oamentioning

confidence: 99%

Pathogenesis and clinical management of obesity-related knee osteoarthritis: Impact of mechanical loading

Chen

Zheng

et al. 2020

Journal of Orthopaedic Translation

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Summary Obesity-related osteoarthritis (OA) is a complex, multifactorial condition that can cause significant impact on patients’ quality of life. Whilst chronic inflammation, adipocytokines and metabolic factors are considered to be important pathogenic factors in obesity related OA, there has been limited investigation into the biomechanical impact of obesity on OA development. This review aims to demonstrate that mechanical factors are the major pathological cause of obesity-related OA. The effect of obesity on pathological changes to the osteochondral unit and surrounding connective tissues in OA is summarized, as well as the impact of obesity-related excessive and abnormal joint loading, concomitant joint malalignment and muscle weakness. An integrated therapeutic strategy based on this multi-factorial presentation is presented, to assist in the management of obesity related OA. The translational potential of this article Despite the high prevalence of obesity-related OA, there is no specific guideline available for obesity-related OA management. In this review, we demonstrated the pathological changes of obesity-related OA and summarized the impact of biomechanical factors by proposing a hypothetical model of obesity-related OA change. Therapeutic strategies based on adjusting abnormal mechanical effects are presented to assist in the management of obesity-related OA.

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“…Comfort was assessed on a scale from one (most comfortable) to five (uncomfortable). 22 Participants walked and completed the sit-to-stand task trials while wearing the orthosis in each of the two brace conditions and provided feedback on their comfort. Participants were blinded to adjustments and brace conditions.…”

Section: Methodsmentioning

confidence: 99%

The Effects of Knee Orthosis with Two Degrees of Freedom Joint Design on Gait and Sit-to-Stand Task in Patients with Medial Knee Osteoarthritis

Fesharaki

Farahmand

Saeedi

et al. 2020

Sultan Qaboos Univ Med J

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Objectives: Knee bracing as a conservative treatment option for patients with medial knee osteoarthritis (KOA) is of great interest to health practitioners and patients alike. Optimal orthotic knee joint structure is essential to achieve biomechanical and clinical effectiveness. Therefore, this study aimed to identify the effects of a knee orthosis with a new two-degrees-of-freedom (DOF) joint design on selected gait parameters and in a sit-to-stand task in patients with mild-to-moderate medial KOA. Methods: This study was conducted both at the Physical Medicine and Rehabilitation Clinic in Shahid Modarres Academic Hospital and the Biomechanical Laboratory of Rehabilitation Faculty of Iran University of medical Sciences in Tehran, Iran from September 2015 to October 2017. The gait performance of 16 patients was assessed without an orthosis, using a common one-DOF (DOF) knee orthosis and using the same knee orthosis with a two-DOF orthotic joint design. The interactive shearing force between limb and brace in the shell area during a sit-to-stand test was also identified. Repeated measures analysis of variance was used to analyse the data. Results: Compared with walking with no orthosis, both orthosis conditions reduced the external knee adduction moment significantly (P ≤0.05). A significant increase between the one-DOF and two-DOF conditions in terms of walking speed (P = 0.041 and P = 0.009, respectively) and stride length (P = 0.028 and P = 0.038, respectively) was observed. In a sit-to-stand test, wearing the orthosis significantly decreased knee transverse plane range of motion (P ≤0.05). There was a 41.31 ± 8.34 Newtons reduction in knee flexion constraint force. Conclusion: The two-DOF knee orthosis was more comfortable compared to the one-DOF knee orthosis during deep knee flexion. Otherwise, the one- DOF- and two-DOF-braces performed similarly. Keywords: Knee Osteoarthritis; Orthosis; Braces; Gait Analysis; Rotations; Kinematics; Kinetics; Patient Comfort.

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Acute effects of different orthotic interventions on knee loading parameters in knee osteoarthritis patients with varus malalignment

Cited by 13 publications

References 40 publications

A comparison between laterally wedged insoles and ankle-foot orthoses for the treatment of medial osteoarthritis of the knee: A randomized cross-over trial

A comparison between laterally wedged insoles and ankle-foot orthoses for the treatment of medial osteoarthritis of the knee: A randomized cross-over trial

Pathogenesis and clinical management of obesity-related knee osteoarthritis: Impact of mechanical loading

The Effects of Knee Orthosis with Two Degrees of Freedom Joint Design on Gait and Sit-to-Stand Task in Patients with Medial Knee Osteoarthritis

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