Relationship between knee joint contact forces and external knee joint moments in patients with medial knee osteoarthritis: effects of gait modifications

Richards, R.; Andersen, Michael Skipper; Harlaar, Jaap; Noort, Josien C. van den

doi:10.1016/j.joca.2018.04.011

Cited by 121 publications

(100 citation statements)

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“…The second peak value of the KAM, as shown in Figure 5, is higher than the first peak which is inconsistent with those in the literature during the natural and toe-in gaits. It might be due to variations in the placement of markers and because healthy individuals were measured in this paper while other studies measured subjects with OA or TKA [14,17,35]. However, the results in Figures 4 and 6 showed that the toe-in and toe-out gaits had little effects on the GRFs and TF joint contact forces (p > 0.05) but that it has significant influence on the KAM and KFM during the stance phase (p < 0.05), as shown in Figure 5.…”

Section: Discussionmentioning

confidence: 99%

“…Trunk lean is reported to be highly efficient in reducing peak KAM values, while potential adverse effects including lower back discomfort, imbalance, and difficulty in maintenance for a long time [12,13]. Although the toe-in and toe-out gait patterns could alleviate the progression of knee OA (osteoarthritis), the detailed mechanism is still vague [14,15]. Gait modification has showed positive benefits at the knee joint, but it might be associated with negative effects on other joints; the longer-term effects of the toe-in and toe-out gait modifications in patients with knee OA is unknown.…”

Section: Introductionmentioning

confidence: 99%

“…Higher KAM is related to radiographic structure changes at knee joints and cartilage degeneration [1,20]. Some research work also has suggested that the knee flexion moment (KFM) also plays an important role in knee loading and that it should also be taken into account [14,21]. Richards et al [14] suggested that the combination of KAM and KFM yields an improved surrogate measure for TF contact force than KAM alone; however, it improved only the first peak values not the second peak values of knee contact force during the stance phase.…”

Section: Introductionmentioning

confidence: 99%

“…Some research work also has suggested that the knee flexion moment (KFM) also plays an important role in knee loading and that it should also be taken into account [14,21]. Richards et al [14] suggested that the combination of KAM and KFM yields an improved surrogate measure for TF contact force than KAM alone; however, it improved only the first peak values not the second peak values of knee contact force during the stance phase. While FPA gait modification showed that the first peak KAM is reduced, it remains unclear whether these treatments subsequently increased the peak KFM and TF contact force.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Toe-Out and Toe-In Gaits on Lower-Extremity Kinematics, Dynamics, and Electromyography

et al. 2019

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Toe-in and toe-out gait modifications have received increasing attention as an effective, conservative treatment for individuals without severe osteoarthritis because of its potential for improving knee adduction moment (KAM) and knee flexion moment (KFM). Although toe-in and toe-out gaits have positive effects on tibiofemoral (TF) joint pain in the short term, negative impacts on other joints of the lower extremity may arise. The main purpose of this study was to quantitatively compare the effects of foot progression angle (FPA) gait modification with normal walking speeds in healthy individuals on lower-extremity joint, ground reaction force (GRF), muscle electromyography, joint moment, and TF contact force. Experimental measurements using the Vicon system and multi-body dynamics musculoskeletal modelling using OpenSim were conducted in this study. Gait analysis of 12 subjects (n = 12) was conducted with natural gait, toe-in gait, and toe-out gait. One-way repeated measures of ANOVA (p < 0.05) with Tukey’s test was used for statistical analysis. Results showed that the toe-in and toe-out gait modifications decreased the max angle of knee flexion by 8.8 and 12.18 degrees respectively (p < 0.05) and the max angle of hip adduction by 1.28 and 0.99 degrees respectively (p < 0.05) compared to the natural gait. Changes of TF contact forces caused by FPA gait modifications were not statistically significant; however, the effect on KAM and KFM were significant (p < 0.05). KAM or combination of KAM and KFM can be used as surrogate measures for TF medial contact force. Toe-in and toe-out gait modifications could relieve knee joint pain probably due to redistribution of TF contact forces on medial and lateral condylar through changing lateral contact centers and shifting bilateral contact locations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of Toe-Out and Toe-In Gaits on Lower-Extremity Kinematics, Dynamics, and Electromyography

et al. 2019

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“…Поэтому наиболее частой локализацией заболевания является один из самых нагружаемых суставов -коленный (КС). ОА КС является одной из наиболее распространенных причин инвалидности в мире (20-40% у лиц старше 75 лет) [1,2]. Эндопротезирование (ЭП) КС оказалось экономически эффективным и надежным методом лечения ОА КС, что делает его одним из самых распространенных оперативных вмешательств на суставах, выполняемых ежегодно, с прогнозируемым увеличением спроса [3][4][5].…”

Section: Changes In Gait Parameters During Rehabilitation After Totalunclassified

Changes in gait parameters during rehabilitation after total knee arthroplasty

Skvortsov

Королева

2019

Naučno-praktičeskaâ revmatologiâ

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Из всех заболеваний опорно-двигательной системы остеоартрит (ОА) представляет наиболее сложную социально-экономиче-скую и медицинскую проблему. Увеличивающаяся средняя продолжительность жизни в популяции привела к тому, что ОА стал од-704 Научно-практическая ревматология. 2019;57(6):704-707 Р е в м о о р т о п е д и я и р е а б и л и т а ц и я

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How Foot Progression Angle Affects Knee Adduction Moment and Angular Impulse in Patients With and Without Medial Knee Osteoarthritis: A Meta‐Analysis

Wang

Chung

et al. 2021

Arthritis Care & Research

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Objective. To investigate effects of foot progression angle (FPA) modification on the first and second peaks of external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI) in individuals with and without medial knee osteoarthritis (OA) during level walking.Methods. PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and SPORTDiscus were searched from inception to February 2020 by 2 independent reviewers. Included studies compared FPA modification (toe-in or toe-out gait) interventions to lower EKAM and/or KAAI with natural walking. Studies were required to report the first or second peaks of EKAM or KAAI.Results. Sixteen studies were included, and >85% of included patients were graded with Kellgren/Lawrence grade II-IV knee OA. Toe-in gait reduced the first EKAM peak (standardized mean difference [SMD] -0.75 [95% confidence interval (95% CI) -1.05, -0.45]) and KAAI (SMD -0.46 [95% CI -0.86, -0.07]), while toe-out gait reduced the second EKAM peak (SMD -1.04 [95% CI -1.34, -0.75]) in healthy individuals. For patients with knee OA, toe-out gait reduced the second EKAM peak (SMD -0.53 [95% CI -0.75, -0.31]) and KAAI (SMD -0.26 [95% CI -0.49, -0.03]), while toe-in gait did not affect both EKAM peaks and KAAI.Conclusion. Discrepancy in biomechanical effects of FPA modification was demonstrated between individuals with and without medial knee OA. Compared with natural walking, both toe-in and toe-out gait may be more effective in lowering EKAM and KAAI in healthy individuals. Toe-out gait may reduce EKAM and KAAI in patients with mild-tosevere knee OA. There is insufficient data from patients with early-stage knee OA, indicating that future research is required.

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Relationship between knee joint contact forces and external knee joint moments in patients with medial knee osteoarthritis: effects of gait modifications

Cited by 121 publications

References 50 publications

Effects of Toe-Out and Toe-In Gaits on Lower-Extremity Kinematics, Dynamics, and Electromyography

Effects of Toe-Out and Toe-In Gaits on Lower-Extremity Kinematics, Dynamics, and Electromyography

Changes in gait parameters during rehabilitation after total knee arthroplasty

How Foot Progression Angle Affects Knee Adduction Moment and Angular Impulse in Patients With and Without Medial Knee Osteoarthritis: A Meta‐Analysis

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