Gait modification strategies for altering medial knee joint load: A systematic review

Abstract

Objective. To evaluate the effect of gait modification strategies on the external knee adduction moment (KAM), a marker of medial knee joint load; determine potentially adverse effects; assess the methodologic quality; and identify areas of future research. Methods. Five electronic databases were searched. Studies evaluating the effects of gait modifications on the KAM in either healthy individuals or those with knee osteoarthritis (OA) were included. Methodologic quality was evaluated by 2 reviewers using the Downs and Black checklist. Results. Twenty-four studies met the inclusion criteria, exploring 14 different gait modifications of varying sample sizes, age groups, and OA classifications. Contralateral cane use, increased step width, medial knee thrust, increased hip internal rotation, weight transfer to the medial foot, and increased lateral trunk lean demonstrated KAM reductions. Tai Chi gait, ipsilateral cane use, Nordic walking poles, and increased knee flexion exhibited increases in the KAM, demonstrating a potential detriment to their use. The effects of reduced stride length, as well as increases and reductions in either toe-out or gait speed, were inconsistent across the studies and gait cycle. Conclusion. This review demonstrates that some gait modifications have the ability to alter knee load. Future research is required to determine the magnitude of modification required to maximize beneficial effects, the best method of training, long-term patient adherence, and if these biomechanical changes can translate into clinically relevant changes in symptoms or disease progression risk.

The effect of laterally wedged shoes on the loading of the medial knee compartment‐in vivo measurements with instrumented knee implants

“…[8][9][10][11] Load reductions within or above 5-10% may also be achieved by other gait modifications such as increased lateral trunk lean, reduced walking speed or by using a contralateral crutch or cane. 33 Greater medial force reductions can also be expected when walking with (more inconvenient) valgus braces. 34 In conclusion, this study shows that in the given cohort, laterally wedged shoes did not reduce medial contact forces in the knee joint substantially.…”

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

“…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).…”

“…Some conservative gait modifications have been shown to reduce the KAM (9,20). Of these, increasing lateral trunk lean (or lateral flexion) toward the symptomatic knee during stance appears to give the greatest reduction in the early stance peak KAM (10).…”

Assessment instruments of functioning in Brazilian elderly and the ICF: a systematic review

“…In this review an adaptation was performed where only 26 items were used to evaluate the methodological quality of the article and have not used any cut-off point for selection. As already done by other authors, item 27 of the questionnaire corresponding to "power" session was not used (7,8).…”