Dynamic Versus Radiographic Alignment in Relation to Medial Knee Loading in Symptomatic Osteoarthritis

2012 ◽  
Vol 28 (5) ◽  
pp. 551-559 ◽  
Author(s):  
Joaquin A. Barrios ◽  
Todd D. Royer ◽  
Irene S. Davis
Keyword(s):  
Frontal Plane ◽  
Epidemiological Studies ◽  
Knee Adduction Moment ◽  
Knee Alignment ◽  
Radiographic Findings ◽  
Medial Knee ◽  
Knee Oa ◽  
Peak Knee ◽  
Knee Loading ◽  
Radiographic Alignment

Dynamic knee alignment is speculated to have a stronger relationship to medial knee loading than radiographic alignment. Therefore, we aimed to determine what frontal plane knee kinematic variable correlated most strongly to the knee adduction moment. That variable was then compared with radiographic alignment as a predictor of the knee adduction moment. Therefore, 55 subjects with medial knee OA underwent three-dimensional gait analysis. A subset of 21 subjects also underwent full-limb radiographic assessment for knee alignment. Correlations and regression analyses were performed to assess the relationships between the kinematic, kinetic and radiographic findings. Peak knee adduction angle most strongly correlated to the knee adduction moment of the kinematic variables. In comparison with radiographic alignment, peak knee adduction angle was the stronger predictor. Given that most epidemiological studies on knee OA use radiographic alignment in an attempt to understand progression, these results are meaningful.

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 Sensor-Based Gait Retraining Lowers Knee Adduction Moment and Improves Symptoms in Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Sensors ◽  
2021 ◽  
Vol 21 (16) ◽  
pp. 5596
Author(s):  
Sizhong Wang ◽  
Peter P. K. Chan ◽  
Ben M. F. Lam ◽  
Zoe Y. S. Chan ◽  
Janet H. W. Zhang ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Controlled Trial ◽  
Pain Scale ◽  
Exercise Group ◽  
Knee Adduction Moment ◽  
Gait Retraining ◽  
Medial Knee ◽  
Knee Oa ◽  
Knee Loading ◽  
Walking Exercise

The present study compared the effect between walking exercise and a newly developed sensor-based gait retraining on the peaks of knee adduction moment (KAM), knee adduction angular impulse (KAAI), knee flexion moment (KFM) and symptoms and functions in patients with early medial knee osteoarthritis (OA). Eligible participants (n = 71) with early medial knee OA (Kellgren-Lawrence grade I or II) were randomized to either walking exercise or gait retraining group. Knee loading-related parameters including KAM, KAAI and KFM were measured before and after 6-week gait retraining. We also examined clinical outcomes including visual analog pain scale (VASP) and Knee Injury and Osteoarthritis Outcome Score (KOOS) at each time point. After gait retraining, KAM1 and VASP were significantly reduced (both Ps < 0.001) and KOOS significantly improved (p = 0.004) in the gait retraining group, while these parameters remained similar in the walking exercise group (Ps ≥ 0.448). However, KAM2, KAAI and KFM did not change in both groups across time (Ps ≥ 0.120). A six-week sensor-based gait retraining, compared with walking exercise, was an effective intervention to lower medial knee loading, relieve knee pain and improve symptoms for patients with early medial knee OA.

Do Knee Moments Normalized to Measures of Knee Cartilage Area Better Classify the Severity of Knee Osteoarthritis?

2015 ◽  
Vol 31 (6) ◽  
pp. 415-422
Author(s):  
Nicholas M. Brisson ◽  
Paul W. Stratford ◽  
Saara Totterman ◽  
José G. Tamez-Peña ◽  
Karen A. Beattie ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Body Mass ◽  
Knee Adduction Moment ◽  
Medial Knee ◽  
Receiver Operating Characteristic Curves ◽  
Knee Oa ◽  
Tibial Bone ◽  
Peak Knee ◽  
Radiographic Disease ◽  
Knee Size

Investigations of joint loading in knee osteoarthritis (OA) typically normalize the knee adduction moment to global measures of body size (eg, body mass, height) to allow comparison between individuals. However, such measurements may not reflect knee size. This study used a morphometric measurement of the cartilage surface area on the medial tibial plateau, which better represents medial knee size. This study aimed to determine whether normalizing the peak knee adduction moment and knee adduction moment impulse during gait to the medial tibial bone–cartilage interface could classify radiographic knee OA severity more accurately than traditional normalization techniques. Individuals with mild (N = 22) and severe (N = 17) radiographic knee OA participated. The medial tibial bone–cartilage interface was quantified from magnetic resonance imaging scans. Gait analysis was performed, and the peak knee adduction moment and knee adduction moment impulse were calculated in nonnormalized units and normalized to body mass, body weight × height, and the medial tibial bone–cartilage interface. Receiver operating characteristic curves compared the ability of each knee adduction moment normalization technique to classify participants according to radiographic disease severity. No normalization technique was superior at distinguishing between OA severities. Knee adduction moments normalized to medial knee size were not more sensitive to OA severity.

Side-to-Side Differences in Varus Thrust and Knee Abduction Moment in High-Functioning Individuals With Chronic Anterior Cruciate Ligament Deficiency

2018 ◽  
Vol 47 (3) ◽  
pp. 590-597 ◽  
Author(s):  
Shiek Abdullah Ismail ◽  
Milena Simic ◽  
Lucy J. Salmon ◽  
Justin P. Roe ◽  
Leo A. Pinczewski ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Angular Velocity ◽  
Cruciate Ligament ◽  
Frontal Plane ◽  
Knee Alignment ◽  
Medial Knee ◽  
High Functioning ◽  
Peak Knee ◽  
Anterior Cruciate ◽  
Knee Load

Background: There is evidence that frontal plane knee joint motion plays a crucial role in the pathogenesis of knee osteoarthritis, yet investigation of individuals with chronic anterior cruciate ligament–deficient (ACLD) knees remains sparse. Purpose: To investigate (1) if individuals with chronic ACLD knees demonstrate higher biomechanical measures of medial knee load as compared with their anterior cruciate ligament–intact (ACLI) knees, (2) if differences in static knee alignment of the ACLD knee will demonstrate a difference in the magnitude of biomechanical measures of medial knee load when compared with the ACLI knee, and (3) the side-to-side concordance of varus thrust among individuals with chronic ACLD knees. Study Design: Descriptive laboratory study. Methods: Participants were sourced from a metropolitan orthopaedic surgeon group. Those who met the inclusion criteria and agreed to participate underwent a 3-dimensional gait analysis assessment to measure knee adduction moment (KAM), knee flexion moment (KFM), KAM peaks, KAM impulse, and varus thrust. Frontal plane knee static alignment was measured with a digital inclinometer fixed to medical calipers. The participants were divided according to their static knee alignment (neutral, varus, and valgus) for subgroup analysis. Peak knee angular velocity and frontal plane knee angle were used to establish if a participant was walking with a knee thrust. An individual was deemed to have knee thrust during gait if the largest frontal plane knee movement coincided with the peak knee angular velocity that occurred within the first 30% of stance phase. Results: Forty-five participants were recruited. The mean (SD) time from injury was 34.5 (55.6) months. ACLD knees did not demonstrate higher mean KAM and KFM ( P > .5) or early-stance peak KAM ( P = .3-.8) and KAM impulse ( P = .3-.9) as compared with ACLI knees as a whole group or when the varus, neutral, and valgus alignment subgroups were investigated separately. Twenty-three percent (n = 9) of the participants had a varus thrust at the ACLD or ACLI knee, 44% (n = 4) had a varus thrust at the ACLD knee, and 22% (n = 2) had varus thrust at both knees. Conclusion: There were no side-to-side differences in mean KAM and KFM and early-stance peak KAM and KAM impulse among high-functioning individuals with chronic unilateral ACLD knees. There was a low prevalence of varus thrust among high-functioning individuals with chronic unilateral ACLD knees.

scholarly journals Frontal Plane Knee Mechanics and Early Cartilage Degeneration in People With Anterior Cruciate Ligament Reconstruction: A Longitudinal Study

2017 ◽  
Vol 46 (2) ◽  
pp. 378-387 ◽  
Author(s):  
Deepak Kumar ◽  
Favian Su ◽  
Daniel Wu ◽  
Valentina Pedoia ◽  
Lauren Heitkamp ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Relaxation Times ◽  
Frontal Plane ◽  
Cartilage Degeneration ◽  
Medial Knee ◽  
Peak Knee ◽  
Knee Loading ◽  
Mr Relaxation ◽  
Injured Knee ◽  
Over Time

Background: Abnormal frontal plane gait mechanics are known risk factors for knee osteoarthritis, but their role in early cartilage degeneration after anterior cruciate ligament reconstruction (ACLR) is not well understood. Hypothesis/Purpose: The objective was to evaluate the association of frontal plane gait mechanics with medial knee cartilage magnetic resonance (MR) relaxation times over 1 year in patients with ACLR and controls. It was hypothesized that (1) there will be an increase in frontal plane medial knee loading and medial knee MR relaxation times over time in the patients with ACLR, and (2) increases in frontal plane medial knee loading will be associated with an increase in medial knee MR relaxation times. Study Design: Case-control study; Level of evidence, 3. Methods: Patients with ACLR (n = 37) underwent walking gait analyses and bilateral quantitative MR imaging (MRI) before surgery and at 6 and 12 months after ACLR. Healthy control participants (n = 13) were evaluated at baseline and 12 months. Gait variables included peak knee adduction moment (KAM), KAM impulse, and peak knee adduction angle. MRI variables included medial femur and medial tibia whole compartment and subregional T1ρ and T2 relaxation times. Statistical analyses included a comparison of changes over time for gait and MRI variables, correlations between changes in gait and MRI variables over time, and differences in change in MRI variables in patients who showed an increase versus decrease in KAM impulse. Results: There were significant increases in medial T1ρ (Δ 4%-11%) and T2 (Δ 2%-10%) relaxation times from baseline to 6 months for both knees in the ACLR group and in KAM (Δ 13%) for the injured knee. From baseline to 6 months, patients who had an increase in KAM impulse in the injured knee had a greater increase in medial T1ρ and T2 relaxation times as compared with those who did not have an increase in KAM impulse. Longitudinal changes for the control group were not significant. Conclusion: There is an increase in medial knee relaxation times over the first 6 months after ACLR. People with an increase in medial knee loading show an increase in medial knee relaxation times when compared with those who do not have an increase in medial knee loading over the first 6 months.

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 Biomechanical Effect of 3D-Printed Foot Orthoses in Patients with Knee Osteoarthritis

2020 ◽  
Author(s):  
Kuang-Wei Lin ◽  
Li-Wei Chou ◽  
Yi-Tien Su ◽  
Shun-Hwa Wei ◽  
Chen-Sheng Chen
Keyword(s):  
Center Of Pressure ◽  
Medial Knee ◽  
Knee Oa ◽  
Ankle Inversion ◽  
Ankle Eversion ◽  
Peak Knee ◽  
Flexion Moment ◽  
3D Printed ◽  
Lateral Wedges ◽  
Second Peak

Abstract Background: Lateral wedges comprise a common conservative treatment for medial knee osteoarthritis (OA). However, use of lateral wedges might increases the ankle eversion moment. To minimize the risk of ankle joint, lateral wedges with custom arch support are suggested. However, the manufacturing process of a custom foot orthosis (FO) is complicated, labor intensive, and time consuming. The technology of 3D printing is an ideal method for mass customization. Therefore. the purpose of this study was to develop custom FOs using 3D printing techniques and to evaluate the biomechanical effects of 3D-printed FOs in patients with medial knee OA.Methods: Fifteen patients with medial knee OA were enrolled into this study. Kinematic and kinetic data were collected during walking by using an optical motion capture system. A paired-sample t-test was conducted to compare biomechanical variables under two conditions: walking in standard shoes (Shoe) and walking in shoes embedded with 3D-printed FOs (Shoe + FO).Results: Under the Shoe + FO condition, the center of pressure at the peak knee adduction moment significantly shifted laterally by 2.71 mm compared with the Shoe condition. No significant difference in the peak knee flexion moment was observed between the two conditions. In addition, both the first and second peak knee adduction moments were significantly reduced by 4.08% and 9.09% under the Shoe + FO condition. The 3D-printed FOs did not affect the ankle eversion moment but caused a decrease in the peak ankle inversion moment.Conclusions: The 3D-printed FOs caused a decrease in the ankle inversion moment, the first and second peak knee adduction moments by changing the center of pressure path laterally. Although the decrease in the knee flexion moment from the use of 3D-printed FOs was nonsignificant, such FOs engender biomechanical changes and positively influence the biomechanics of patients with knee OA.

Quantifying Achievable Levels of Improvement in Knee Joint Biomechanics During Gait After Total Knee Arthroplasty Relative to Osteoarthritis Severity

2020 ◽  
pp. 1-9
Author(s):  
Jereme B. Outerleys ◽  
Michael J. Dunbar ◽  
Glen Richardson ◽  
Cheryl L. Hubley-Kozey ◽  
Janie L. Astephen Wilson
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Knee Arthroplasty ◽  
Frontal Plane ◽  
Knee Adduction Moment ◽  
Patient Specific ◽  
Knee Biomechanics ◽  
Knee Oa ◽  
Joint Biomechanics ◽  
Total Knee

Total knee arthroplasty (TKA) surgery improves knee joint kinematics and kinetics during gait for most patients, but a lack of evidence exists for the level and incidence of improvement that is achieved. The objective of this study was to quantify patient-specific improvements in knee biomechanics relative to osteoarthritis (OA) severity levels. Seventy-two patients underwent 3-dimensional (3D) gait analysis before and 1 year after TKA surgery, as well as 72 asymptomatic adults and 72 with moderate knee OA. A combination of principal component analysis and discriminant analyses were used to categorize knee joint biomechanics for patients before and after surgery relative to asymptomatic, moderate, and severe OA. Post-TKA, 63% were categorized with knee biomechanics consistent with moderate OA, 29% with severe OA, and 8% asymptomatic. The magnitude and pattern of the knee adduction moment and angle (frontal plane features) were the most significant contributors in discriminating between pre-TKA and post-TKA knee biomechanics. Standard of care TKA improves knee biomechanics during gait to levels most consistent with moderate knee OA and predominately targets frontal plane features. These results provide evidence for the level of improvement in knee biomechanics that can be expected following surgery and highlight the biomechanics most targeted by surgery.

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.

Valgus Knee Alignment, Not Step Width or Toe-Out Cause Reduced Knee Adduction Moment in the Healthy Obese

2012 ◽  
Author(s):  
Katerina Blazek ◽  
Jessica Asay ◽  
Jennifer Erhart-Hledik ◽  
Thomas Andriacchi
Keyword(s):  
Cumulative Effect ◽  
Knee Adduction Moment ◽  
Valgus Knee ◽  
Step Width ◽  
Knee Alignment ◽  
Knee Oa ◽  
Strong Risk Factor ◽  
Increased Risk ◽  
Healthy Obese ◽  
Joint Load

Obesity is a strong risk factor for knee osteoarthritis (OA) [1], but the mechanism of OA initiation associated with obesity is not clear. Increases in ambulatory knee joint load due to obesity have been implicated as a cause of increased OA incidence, since an increased adduction moment has been associated with the severity and progression of medial compartment OA [2]. However, previous work has not consistently shown increases or decreases in the adduction moment in the obese. Step width and toe-out reduce the adduction moment [3] and are increased in the obese [4], suggesting that the adduction moment could also be reduced in the obese. Furthermore, obesity may be associated with knee malalignment, which may also alter the adduction moment. However, the cumulative effect of these gait alterations on the adduction moment is unclear, given the increased risk of medial knee OA in the obese. Understanding this interaction is important in understanding the link between obesity and knee OA.

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