scholarly journals Effect of real-time biofeedback on peak knee adduction moment in patients with medial knee osteoarthritis: Is direct feedback effective?

2018 ◽  
Vol 57 ◽  
pp. 150-158 ◽  
Author(s):  
Rosie E. Richards ◽  
Josien C. van den Noort ◽  
Martin van der Esch ◽  
Marjolein J. Booij ◽  
Jaap Harlaar
Keyword(s):  
Knee Osteoarthritis ◽  
Real Time ◽  
Knee Adduction Moment ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Peak Knee ◽  
Direct Feedback

scholarly journals Effect of Laterally Wedged Foot Orthoses on Rearfoot and Hip Mechanics in Patients with Medial Knee Osteoarthritis

2009 ◽  
Vol 33 (2) ◽  
pp. 107-116 ◽  
Author(s):  
Robert J. Butler ◽  
Joaquin A. Barrios ◽  
Todd Royer ◽  
Irene S. Davis
Keyword(s):  
Knee Osteoarthritis ◽  
Three Dimensional ◽  
Frontal Plane ◽  
Knee Adduction Moment ◽  
Orthotic Devices ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Peak Knee ◽  
Wedge Condition ◽  
Foot Orthotic

The purpose of this study was to examine the effects of laterally wedged foot orthotic devices, used to treat knee osteoarthritis, on frontal plane mechanics at the rearfoot and hip during walking. Thirty individuals with diagnosed medial knee osteoarthritis were recruited for this study. Three dimensional kinematics and kinetics were recorded as the subjects walked in the laboratory at an intentional walking speed. Peak eversion, eversion excursion and peak eversion moment were increased while the peak knee adduction moment was reduced in the laterally wedged orthotic condition compared to the no wedge condition. In contrast, no changes were observed in the variables of interest at the hip. There was no significant relationship between the change in the peak frontal plane moment at the rearfoot and change in the peak frontal plane moment at the knee or hip as a result of the lateral wedge. Laterally wedged foot orthotic devices, used to treat knee osteoarthritis, do not influence hip mechanics. However, they do result in increased rearfoot eversion and inversion moment. Therefore, a full medical screen of the foot should occur before laterally wedged foot orthotic devices are prescribed as a treatment for knee osteoarthritis.

scholarly journals The 2- and 8-week effects of decompressive brace use in people with medial compartment knee osteoarthritis

2015 ◽  
Vol 40 (4) ◽  
pp. 447-453 ◽  
Author(s):  
Eric M Lamberg ◽  
Robert Streb ◽  
Marc Werner ◽  
Ian Kremenic ◽  
James Penna
Keyword(s):  
Knee Osteoarthritis ◽  
Repeated Measures ◽  
Knee Adduction Moment ◽  
Knee Brace ◽  
Knee Motion ◽  
Noninvasive Treatment ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Peak Knee ◽  
Second Peak

Background: Knee osteoarthritis is a prevalent disease. Unloading the affected compartment using a brace is a treatment option. Objectives: To determine whether a decompressive knee brace alters loading in medial knee osteoarthritis following 2 and 8 weeks of use. Study design: Within subjects; pre- and post-testing. Methods: A total of 15 individuals with medial knee osteoarthritis attended four sessions: baseline, fitting, 2 weeks after fitting (post), and 8 weeks after fitting (final). A gait analysis was performed at baseline (without knee brace), post and final. Knee adduction impulse, first and second peak knee adduction moment, knee motion, and walking velocity were calculated. Participants also recorded hours and steps taken while wearing the brace. Results: On average, the brace was worn for more than 6 h/day. Through use of repeated-measures analysis of variance, it was determined that the knee adduction impulse and second peak knee adduction moment were reduced ( p < 0.05) at post and final compared to baseline (36% and 34% reduction in knee adduction impulse, 26% reduction in second peak knee adduction moment for post and final, respectively). Furthermore, participants walked faster with increased knee motion during stance. Conclusion: The studied decompressive brace was effective in reducing potentially detrimental forces at the knee—knee adduction impulse and second peak knee adduction moment during the stance phase of gait. Clinical relevance The data from this study suggest that use of a medial unloading brace can reduce potentially detrimental adduction moments at the knee. Clinicians should use this evidence to advocate for use of this noninvasive treatment for people presenting with medial knee osteoarthritis.

scholarly journals Personalization improves the biomechanical efficacy of foot progression angle modifications in individuals with medial knee osteoarthritis

2020 ◽  
Author(s):  
Scott D Uhlrich ◽  
Julie A Kolesar ◽  
Łukasz Kidziński ◽  
Melissa A Boswell ◽  
Amy Silder ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Center Of Pressure ◽  
Knee Adduction Moment ◽  
Abduction Angle ◽  
Valgus Knee ◽  
Lasso Regression ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Foot Progression Angle ◽  
Peak Knee

Abstract Objectives The goal of this study was to evaluate the importance of personalization when selecting foot progression angle modifications that aim to reduce the peak knee adduction moment in individuals with medial knee osteoarthritis. Design One hundred seven individuals with medial knee osteoarthritis walked on an instrumented treadmill with biofeedback instructing them to toe-in and toe-out by 5° and 10° relative to their self-selected foot progression angle. We selected individuals’ personalized foot progression angle as the modification that maximally reduced their larger knee adduction moment peak. Additionally, we used lasso regression to identify which secondary changes in kinematics made a 10° toe-in gait modification more effective at reducing the first knee adduction moment peak. Results Sixty-six percent of individuals reduced their larger knee adduction moment peak by at least 5% with a personalized foot progression angle modification, which is more than (p<0.001) the 54% and 23% of individuals who reduced it with a uniformly-assigned 10° toe-in or toe-out modification, respectively. When toeing-in, greater reductions in the first knee adduction moment peak were related to an increased frontal-plane tibia angle (knee more medial than ankle), a more valgus knee abduction angle, reduced contralateral pelvic drop, and a more medialized center of pressure in the foot reference frame. Conclusions Personalization increases the proportion of individuals with medial knee osteoarthritis who may benefit from modification of their foot progression angle.

Effects of foot orthoses with medial arch support and lateral wedge on knee adduction moment in patients with medial knee osteoarthritis

2016 ◽  
Vol 41 (4) ◽  
pp. 356-363 ◽  
Author(s):  
Yoann Dessery ◽  
Étienne Belzile ◽  
Sylvie Turmel ◽  
Philippe Corbeil
Keyword(s):  
Knee Osteoarthritis ◽  
Effect Size ◽  
Knee Adduction Moment ◽  
Foot Orthoses ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Peak Knee ◽  
Significant Difference ◽  
Knee Loading ◽  
Arch Support

Background: There is contradictory evidence regarding whether the addition of medial arch supports to laterally wedged insoles reduces knee adduction moment, improves comfort, and reduces knee pain during the late stance phase of gait. Objectives: To verify if such effects occur in participants with medial knee osteoarthritis. Study design: Randomized single-blinded study. Methods: Gait analysis was performed on 18 patients affected by medial knee osteoarthritis. Pain and comfort scores, frontal plane kinematics and kinetics of ankle, knee, and hip were compared in four conditions: without foot orthosis, with foot orthoses, with medial arch support, and with foot orthoses with medial arch support and lateral wedge insoles with 6° and 10° inclination. Results: Lower-extremity gait kinetics were characterized by a significant decrease, greater than 6%, in second peak knee adduction moment in laterally wedged insole conditions compared to the other conditions ( p < 0.001; effect size = 0.6). No significant difference in knee adduction moment was observed between laterally wedged insole conditions. In contrast, a significant increase of 7% in knee adduction moment during the loading response was observed in the customized foot orthoses without lateral inclination condition ( p < 0.001; effect size = 0.3). No difference was found in comfort or pain ratings between conditions. Conclusion: Our study suggests that customized foot orthoses with a medial arch support may only be suitable for the management of medial knee osteoarthritis when a lateral wedge is included. Clinical relevance Our data suggest that customized foot orthoses with medial arch support and a lateral wedge reduce knee loading in patients with medial knee osteoarthritis (KOA). We also found evidence that medial arch support may increase knee loading, which could potentially be detrimental in KOA patients.

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

2021 ◽  
pp. 026921552199363
Author(s):  
Martin Schwarze ◽  
Leonie P Bartsch ◽  
Julia Block ◽  
Merkur Alimusaj ◽  
Ayham Jaber ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Controlled Trial ◽  
Oxford Knee Score ◽  
Knee Adduction Moment ◽  
Osteoarthritis Of The Knee ◽  
Knee Score ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Patient Reported ◽  
Angular Impulse

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.

A Sex Comparison of Ambulatory Mechanics Relevant to Osteoarthritis in Individuals With and Without Asymptomatic Varus Knee Alignment

2014 ◽  
Vol 30 (5) ◽  
pp. 632-636 ◽  
Author(s):  
Joaquin A. Barrios ◽  
Danielle E. Strotman
Keyword(s):  
Knee Osteoarthritis ◽  
Varus Knee ◽  
Knee Alignment ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Gait Parameters ◽  
Peak Knee ◽  
Gait Mechanics ◽  
Reaction Forces ◽  
Asymptomatic Individuals

The prevalence of medial knee osteoarthritis is greater in females and is associated with varus knee alignment. During gait, medial knee osteoarthritis has been linked to numerous alterations. Interestingly, there has been no research exploring sex differences during walking in healthy individuals with and without varus alignment. Therefore, the gait mechanics of 30 asymptomatic individuals with varus knees (15 females) and 30 normally-aligned controls (15 females) were recorded. Gait parameters associated with medial knee osteoarthritis were analyzed with two-factor analyses of variance. In result, varus males exhibited the greatest peak knee adduction moments, while normal females showed the greatest peak hip adduction angles and pelvic drop excursions. By sex, females exhibited greater peak hip adduction angles and moments and greater pelvic drop excursion, but lesser peak knee adduction angles. By alignment type, varus subjects exhibited greater peak knee adduction angles and moments, midstance knee flexion angles and excursion, and eversion angles and lateral ground reaction forces, but lesser peak hip adduction angles. In conclusion, females generally presented with proximal mechanics related to greater hip adduction, whereas males presented with more knee adduction. Varus subjects demonstrated a number of alterations associated with medial knee osteoarthritis. The differential sex effects were far less conclusive.

Effects of knee orthosis adjustment on biomechanical performance and clinical outcome in patients with medial knee osteoarthritis

2017 ◽  
Vol 41 (6) ◽  
pp. 587-594 ◽  
Author(s):  
Andreas Brand ◽  
Isabella Klöpfer-Krämer ◽  
Mario Morgenstern ◽  
Inga Kröger ◽  
Björn Michel ◽  
...  
Keyword(s):  
Pain Relief ◽  
Knee Osteoarthritis ◽  
Clinical Effectiveness ◽  
Knee Adduction Moment ◽  
Force Transmission ◽  
Pain Sensation ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Good Patient Compliance ◽  
Gait Function

Background: Valgus bracing in medial knee osteoarthritis aims to improve gait function by reducing the loading of the medial compartment. Orthosis composition and optimal adjustment is essential to achieve biomechanical and clinical effectiveness. Objectives: To investigate biomechanical functionality during gait, pain relief and compliance in patients with knee osteoarthritis using a lightweight adjustable knee unloader orthosis. Study Design: Prospective observational clinical trial. Methods: Instrumented gait analysis in 22 patients with unilateral medial knee osteoarthritis was performed after a 2-week orthosis acclimatisation period. Kinematics and kinetics during gait as well as force transmission from the orthosis to the knee were analysed. Measurements were performed without, at individualised and at reduced orthosis setting. The assessment was supplemented by patient-related pain sensation and compliance questionnaires. Results: Orthosis wear significantly reduced the knee adduction moment by up to 20% depending on orthosis adjustment, whereas pain sensation was significantly reduced by 16%. A significant positive correlation was found between force transmissions and knee adduction moment as well as for frontal knee angle. Compliance was good with a main daily use of 2–6 h. Conclusion: The orthosis provides significant biomechanical improvements, pain relief and good patient compliance. Patients had a biomechanical benefit for the individualised and reduced orthosis adjustments. Clinical relevance In patients with medial knee osteoarthritis, a lightweight medial unloader orthosis effectively reduced external knee adduction moment and pain sensation during daily activities. Thus, use of lightweight orthoses effectively supports conservative treatment in medial knee osteoarthritis.

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