Combined Effects of a Valgus Knee Brace and Lateral Wedge Foot Orthotic on the External Knee Adduction Moment in Patients With Varus Gonarthrosis

Moyer, R.; Birmingham, Trevor B.; Dombroski, Colin E.; Walsh, Robert F.; Leitch, Kristyn M.; Jenkyn, Thomas R.; Giffin, J. Robert

doi:10.1016/j.apmr.2012.09.004

Cited by 48 publications

(54 citation statements)

References 52 publications

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“…Meta-analysis of the published randomized trials indicates valgus knee bracing improves pain and function in patients with medial knee osteoarthritis and is consistent with the majority of biomechanical studies that typically suggest a shift in knee loads when using these devices (12)(13)(14)(15). However, the size of effects on pain and function varies, depending on the type of control intervention that is used.…”

Section: Discussionsupporting

confidence: 62%

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Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

Moyer

Birmingham

Bryant

et al. 2015

Arthritis Care & Research

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Objective. To evaluate the effects of valgus knee bracing on pain and function, and compliance and complications, in patients with medial knee osteoarthritis (OA). Methods. A meta-analysis of randomized controlled trials that compared changes in patient-reported pain and/or function in patients with medial knee OA was performed. Seven databases were searched from their inception to January 2014. Two reviewers independently determined study eligibility, rated risk of bias, and extracted data. Pooled estimates and 95% confidence intervals (95% CIs) for standardized mean differences (SMDs) for the improvement in pain (and function) were calculated. Event rates (proportions) were calculated for studies that reported complications.

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Section: Discussionsupporting

confidence: 62%

“…Braces that apply a valgus torque to the knee are intended to shift load from the medial compartment and thereby improve pain and function (9 -11). Although numerous studies suggest valgus knee bracing can alter joint biomechanics to varying extents, the related effects on pain and function are unclear (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

Moyer

Birmingham

Bryant

et al. 2015

Arthritis Care & Research

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“…This combination, or the brace alone, decreases pain and somewhat shifts the load in the knee from the medial to the lateral side. [83][84][85][86][87][88][89] This change in load or contact stress might delay or prevent the onset of OA. In a randomized study in patients with patellofemoral OA, bracing was associated with pain relief and a decreased volume of bone marrow lesions in the affected compartment.…”

Section: Reviewsmentioning

confidence: 99%

Strategies for the prevention of knee osteoarthritis

2015

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Osteoarthritis (OA) has been thought of as a disease of cartilage that can be effectively treated surgically at severe stages with joint arthroplasty. Today, OA is considered a whole-organ disease that is amenable to prevention and treatment at early stages. OA develops slowly over 10-15 years, interfering with activities of daily living and the ability to work. Many patients tolerate pain, and many health-care providers accept pain and disability as inevitable corollaries of OA and ageing. Too often, health-care providers passively await final 'joint death', necessitating knee and hip replacements. Instead, OA should be viewed as a chronic condition, where prevention and early comprehensive-care models are the accepted norm, as is the case with other chronic diseases. Joint injury, obesity and impaired muscle function are modifiable risk factors amenable to primary and secondary prevention strategies. The strategies that are most appropriate for each patient should be identified, by selecting interventions to correct--or at least attenuate--OA risk factors. We must also choose the interventions that are most likely to be acceptable to patients, to maximize adherence to--and persistence with--the regimes. Now is the time to begin the era of personalized prevention for knee OA.

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“…All but 4 studies were withinsubjects repeated-measures designs, with the remaining being randomized trials (30)(31)(32)(33). Four studies reported the use of the ACR criteria (31,(34)(35)(36), with 10 stating cutoffs regarding the severity of knee pain (13,14,21,31,32,34,(36)(37)(38)(39), most commonly .3 of 10 on a visual analog scale (13,14,21,31,32,34,37). This definition varied across studies according to the activity, with pain recalled during walking (29,38), walking 2 blocks and/or climbing stairs (36), weight-bearing activities (37), and on most days of the past month (21,32,39).…”

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confidence: 99%

“…Fourteen studies prescribed the same insole to all participants, with the remaining 4 using a customized amount based on comfort and/or pain level (14,31,35,37). A flat insole was the comparison condition in 4 studies (14,31,34,37), 7 studies used participants' own footwear (13,21,30,32,36,40,43), 5 studies used standardized footwear (29,33,35,39,42), 1 study used both a flat insole and participants' own footwear (39), and 1 study did not report the type of footwear (41). Walking speed was either controlled across conditions within a threshold of each participants' preferred speed (13,14,21,31,32,37), (43).…”

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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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Combined Effects of a Valgus Knee Brace and Lateral Wedge Foot Orthotic on the External Knee Adduction Moment in Patients With Varus Gonarthrosis

Cited by 48 publications

References 52 publications

Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

Strategies for the prevention of knee osteoarthritis

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

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