scholarly journals Effect of an ankle–foot orthosis on knee joint mechanics: A novel conservative treatment for knee osteoarthritis

2013 ◽  
Vol 38 (6) ◽  
pp. 481-491 ◽  
Author(s):  
Cynthia H Fantini Pagani ◽  
Steffen Willwacher ◽  
Rita Benker ◽  
Gert-Peter Brüggemann
Keyword(s):  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Frontal Plane ◽  
Knee Adduction Moment ◽  
Varus Alignment ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Ankle Foot Orthosis ◽  
Lever Arm ◽  
Foot Orthosis

Background: Several conservative treatments for medial knee osteoarthritis such as knee orthosis and laterally wedged insoles have been shown to reduce the load in the medial knee compartment. However, those treatments also present limitations such as patient compliance and inconsistent results regarding the treatment success. Objective: To analyze the effect of an ankle–foot orthosis on the knee adduction moment and knee joint alignment in the frontal plane in subjects with knee varus alignment. Study design: Controlled laboratory study, repeated measurements. Methods: In total, 14 healthy subjects with knee varus alignment were analyzed in five different conditions: without orthotic, with laterally wedged insoles, and with an ankle–foot orthosis in three different adjustments. Three-dimensional kinetic and kinematic data were collected during gait analysis. Results: Significant decreases in knee adduction moment, knee lever arm, and joint alignment in the frontal plane were observed with the ankle–foot orthosis in all three different adjustments. No significant differences could be found in any parameter while using the laterally wedged insoles. Conclusion: The ankle–foot orthosis was effective in reducing the knee adduction moment. The decreases in this parameter seem to be achieved by changing the knee joint alignment and thereby reducing the knee lever arm in the frontal plane. Clinical relevance This study presents a novel approach for reducing the load in the medial knee compartment, which could be developed as a new treatment option for patients with medial knee osteoarthritis.

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 Timing of Frontal Plane Trunk Lean, Not Magnitude, Mediates Frontal Plane Knee Joint Loading in Patients with Moderate Medial Knee Osteoarthritis

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Freyja Hálfdanardóttir ◽  
Dan K. Ramsey ◽  
Kristín Briem
Keyword(s):  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Frontal Plane ◽  
Joint Loading ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Hip Abductor ◽  
Knee Joint Loading ◽  
Abductor Strength ◽  
Rate Of Loading

The purpose of this study was to examine the influence of trunk lean and contralateral hip abductor strength on the peak knee adduction moment (KAM) and rate of loading in persons with moderate medial knee osteoarthritis. Thirty-one males (17 with osteoarthritis, 14 controls) underwent 3-dimensional motion analysis, strength testing of hip abductors, and knee range of motion (ROM) measures, as well as completing the knee osteoarthritis outcome score (KOOS). No differences were found between groups or limbs for gait cycle duration, but the osteoarthritis group had longer double-limb support during weight acceptance (p<0.001) and delayed frontal plane trunk motion towards the stance limb (p<0.01). This was reflected by a lower rate of loading for the osteoarthritis group compared to controls (p<0.001), whereas no differences were found for peak KAM. Trunk angle, contralateral hip abductor strength, and BMI explained the rate of loading at the involved knee (p<0.001), an association not found for the contralateral knee or control knees. Prolonged trunk lean over the stance limb may help lower peak KAM values. Rate of frontal plane knee joint loading may partly be mediated by the contralateral limb’s abductor strength, accentuating the importance of bilateral lower limb strength for persons with knee osteoarthritis.

scholarly journals Knee joint loadings are related to tibial torsional alignments in people with radiographic medial knee osteoarthritis

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255008
Author(s):  
Chen Huang ◽  
Ping Keung Chan ◽  
Kwong Yuen Chiu ◽  
Chun Hoi Yan ◽  
Desmond Shun Shing Yeung ◽  
...  
Keyword(s):  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Lower Limb ◽  
Knee Adduction Moment ◽  
Tibial Torsion ◽  
Cross Sectional ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Tibiofemoral Rotation ◽  
Joint Loads

Torsional malalignment was detected in subjects with medial knee osteoarthritis (KOA) but few studies have reported the effect of torsional deformity on knee joint loads during walking. Therefore, this study examined the relationships between lower limb torsional alignments and knee joint loads during gait in people with symptomatic medial KOA using cross-sectional study design. Lower limb alignments including tibial torsion, tibiofemoral rotation and varus/valgus alignments in standing were measured by EOS low-dose bi-planar x-ray system in 47 subjects with mild or moderate KOA. The external knee adduction moment (KAM), flexion moment (KFM) and the KAM index which was defined as (KAM/ (KAM+KFM)*100) during walking were analyzed using a motion analysis system so as to estimate the knee loads. Results revealed externaltibial torsion was positively associated with KAM in subjects with moderate KOA (r = 0.59, p = 0.02) but not in subjects with mild KOA. On the contrary, significant association was found between knee varus/valgus alignment and KAM in the mild KOA group (r = 0.58, p<0.001) and a sign of association in the moderate KOA group (r = 0.47, p = 0.08). We concluded tibial torsion and knee varus/valgus mal-alignments would be associated with joint loading in subjects with moderate medial KOA during walking. Radiographic severity might need to be considered when using gait modification as a rehabilitation strategy for this condition.

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.

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