A New Approach to Prevention of Knee Osteoarthritis: Reducing Medial Load in the Contralateral Knee

Objective.Few if any prevention strategies are available for knee osteoarthritis (OA). In those with symptomatic medial OA, the contralateral knee may be at high risk of disease, and a reduction in medial loading in that knee might prevent disease or its progression there. Our aim was to determine how often persons with medial OA on 1 side had either concurrent or later medial OA on the contralateral side, and whether an intervention known to reduce medial loading in affected knees with medial OA might reduce medial loading in the contralateral knee. Lateral wedge insoles reduce loading across an affected medial knee but their effect on the contralateral knee is unknown.Methods.To determine the proportion of persons with medial knee OA who had concurrent medial contralateral OA or developed contralateral medial OA later, we examined knee radiographs from the longitudinal Framingham Osteoarthritis Study. Then, to examine an approach to reducing medial load in the contralateral knee, 51 people from a separate study with painful medial tibiofemoral OA underwent gait analysis wearing bilateral controlled shoes with no insoles, and then with 2 types of wedge insoles laterally posted by 5°. Primary outcome was the external knee adduction moment (EKAM) in the contralateral knee. Nonparametric CI were constructed around the median differences in percentage change in the affected and contralateral sides.Results.Of Framingham subjects with medial radiograph knee OA, 137/152 (90%) either had concurrent contralateral medial OA or developed it within 10 years. Of those with medial symptomatic knee OA, 43/67 (64%) had or developed the same disease state in the contralateral knee. Compared to a control shoe, medial loading was reduced substantially on both the affected (median percentage EKAM change −4.84%; 95% CI −11.33% to −0.65%) and contralateral sides (median percentage EKAM change −9.34%; 95% CI −10.57% to −6.45%).Conclusion.In persons with medial OA, the contralateral knee is also at high risk of medial OA. Bilateral reduction in medial loading in knees by use of strategies such as lateral wedge insoles might not only reduce medial load in affected knees but prevent knee OA or its progression on the contralateral side.

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

Sensors ◽

10.3390/s21165596 ◽

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.

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

Journal of Applied Biomechanics ◽

10.1123/jab.2014-0249 ◽

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.

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The Relationship between Knee Adduction Moment and Knee Osteoarthritis Symptoms according to Static Alignment and Pelvic Drop

BioMed Research International ◽

10.1155/2019/7603249 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Yong Nie ◽

Hua Wang ◽

Bin Xu ◽

ZongKe Zhou ◽

Bin Shen ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Linear Models ◽

Knee Adduction Moment ◽

Radiographic Severity ◽

Negatively Associated ◽

Knee Oa ◽

Symptomatic Knee ◽

Radiographic Disease ◽

The Relationship ◽

Hss Score

Objectives. To investigate the relationship between external knee adduction moment (KAM) and knee osteoarthritis (OA) symptoms according to static alignment and pelvic drop. Methods. Ninety-five participants with symptomatic knee OA were included. Radiographic severity was graded by Kellgren and Lawrence (KL) scale. The hip-knee-ankle (HKA) angle was used to assess limb alignment from a full-length lower-limb radiograph. KAM-related variables (peak KAM and KAM impulse) and pelvic drop angle were determined from 3D gait analysis. Symptoms were assessed via visual analog scale (VAS) for pain and hospital for special surgery (HSS) score for physical function. The relationship between KAM and symptoms was evaluated according to radiographic severity and pelvic drop using linear models. Results. According to the more affected knee in the varus group, both the two KAM-related measures (peak KAM and KAM impulse) were positively associated with greater VAS pain and were negatively associated with HSS score. Only peak KAM was correlated with VAS and HSS in the valgus group. VAS pain score of the more affected knee was positively correlated with pelvic drop angle. Stratified by pelvic drop angle, KAM-related variables were more positively associated with VAS pain and negatively associated with HSS score for patients with pelvic drop angle ≤3 degrees. The relationships between KAM and symptoms according to radiographic disease severity remained confusing. Conclusions. Static alignment and pelvic drop angle significantly affected relationships between KAM-related variables and knee OA symptoms, which may explain the confusing results as shown by previous studies.

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Estimation of the External Knee Adduction Moment during Gait Using an Inertial Measurement Unit in Patients with Knee Osteoarthritis

Sensors ◽

10.3390/s21041418 ◽

2021 ◽

Vol 21 (4) ◽

pp. 1418

Author(s):

Yu Iwama ◽

Kengo Harato ◽

Shu Kobayashi ◽

Yasuo Niki ◽

Naomichi Ogihara ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Motion Capture ◽

Inertial Measurement Unit ◽

Knee Adduction Moment ◽

Measurement Unit ◽

Motion Capture System ◽

Medial Knee ◽

Inertial Measurement ◽

Knee Oa ◽

External Knee Adduction Moment

Although the external knee adduction moment (KAM) during gait was shown to be a quantitative parameter of medial knee osteoarthritis (OA), it requires expensive equipment and a dedicated large space to measure. Therefore, it becomes a major reason to limit KAM measurement in a clinical environment. The purpose of this study was to estimate KAM using a single inertial measurement unit (IMU) during gait in patients with knee OA. A total of 22 medial knee OA patients (44 knee joints) performed conventional gait analysis using three-dimensional (3D) motion capture system. At the same time, we attached commercial IMUs to six body segments (sternum, pelvis, both thighs, and both shanks), and IMU signals during gait were recorded synchronized with the motion capture system. The peak-to-peak difference of acceleration in the lateral/medial axis immediately after heel contact was defined as the thrust acceleration (TA). We hypothesized that TA would represent the lateral thrust of the knee during the stance phase and correlate with the first peak of KAM. The relationship between the peak KAM and TA of pelvis (R = 0.52, p < 0.001), shanks (R = 0.57, p < 0.001) and thighs (R = 0.49, p = 0.001) showed a significant correlation. The root mean square error (RMSE) of linear regression models of pelvis, shanks, and thighs to estimate KAM were 0.082, 0.079, and 0.084 Nm/(kg·m), respectively. Our newly established parameter TA showed a moderate correlation with conventional KAM. The current study confirmed our hypothesis that a single IMU would predict conventional KAM during gait. Since KAM is known as an indicator for prognosis and severity of knee OA, this new parameter has the potential to become an accessible predictor for medial knee OA instead of KAM.

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THE EFFECT OF A TRIPOD CANE ON THE FUNCTIONAL MOBILITY OF PATIENTS WITH KNEE OSTEOARTHRITIS

Berkala Ilmiah Kedokteran Duta Wacana ◽

10.21460/bikdw.v5i1.164 ◽

2020 ◽

Vol 5 (1) ◽

pp. 29

Author(s):

Nelson Sudiyono

Keyword(s):

Knee Osteoarthritis ◽

Cross Sectional Study ◽

Functional Mobility ◽

Cross Sectional ◽

Knee Oa ◽

Walking Aids ◽

Symptomatic Knee Osteoarthritis ◽

Symptomatic Knee ◽

Contralateral Hand ◽

Painful Knee

Background: Canes have been recommended as walking aids for knee osteoarthritis to reduce the loading on the affected knee. Patients are usually recommended to hold the cane in the contralateral hand to the affected knee. Nevertheless, some patients prefer to hold the cane ipsilateral to the affected knee. However, the effect of using ipsilateral or contralateral tripod cane on functional mobility in patients with knee osteoarthritis is still unknown Objective: To compare the immediate effect of ipsilateral and contralateral tripod cane usage on functional mobility in patients with symptomatic knee osteoarthritis Method: This cross-sectional study involved 30 overweight or obese patients with symptomatic unilateral or bilateral knee osteoarthritis (Kellgren Lawrence grade 2 and 3) who never use a cane. Functional mobility was evaluated with Time Up and Go test in three conditions; without walking aid, with tripod cane contralateral and ipsilateral to the more painful knee. Results: The TUG time of aid-free walking is 4.75 (p < 0.001, 95% CI 3.79 - 5.71) seconds faster than ipsilateral cane use and 6.69 (p < 0.001, 95%CI 5.35 - 8.03) seconds faster than contralateral cane use. The TUG time of ipsilateral cane use is 1,94 (95% CI, 1.13 - 2.79) seconds faster than contralateral. Conclusion: Patients with symptomatic knee OA who use tripod cane ipsilateral to the more painful knee have higher functional mobility than the contralateral.

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

Clinical Rehabilitation ◽

10.1177/0269215521993636 ◽

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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Association of Varus Thrust With Pain and Stiffness and Activities of Daily Living in Patients With Medial Knee Osteoarthritis

Physical Therapy ◽

10.2522/ptj.20140441 ◽

2016 ◽

Vol 96 (2) ◽

pp. 167-175 ◽

Cited By ~ 17

Author(s):

Naoto Fukutani ◽

Hirotaka Iijima ◽

Takahiko Fukumoto ◽

Daisuke Uritani ◽

Eishi Kaneda ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Activities Of Daily Living ◽

Daily Living ◽

Predictor Variable ◽

Cross Sectional Study ◽

Sensitivity Analyses ◽

Varus Alignment ◽

Cross Sectional ◽

Medial Knee ◽

Knee Oa

Background Increasing evidence highlights potential associations between varus thrust and health domains associated with knee osteoarthritis (OA). Objective The aim of this study was to investigate the association between varus thrust and 2 subcategories—“pain and stiffness” and “activities of daily living (ADL)”—of the Japanese Knee Osteoarthritis Measure (JKOM). Design This was a cross-sectional study. Methods In total, 296 outpatients with knee OA visiting orthopedic clinics were enrolled. The inclusion criteria were age ≥50 years, medial knee OA and Kellgren-Lawrence (K/L) grade ≥1 in one or both knees, and the ability to walk independently. Standard posterior-anterior knee radiographs were measured for varus alignment. Participants were video recorded while walking and were evaluated for the presence or absence of varus thrust. Pain and stiffness of the knee joint and ADL were evaluated using the JKOM. Multivariate regressions (outcomes: pain and stiffness and ADL; predictor variable: varus thrust) were performed. Results Varus thrust was present in 46 (16.2%) of 284 patients. Multivariate regression analyses demonstrated that varus thrust is independently associated with pain and stiffness, adjusted for age, sex, body mass index, K/L grade, and varus alignment (β=.17, P=.005). However, the association between varus thrust and ADL was not significant (β=.11, P=.058). Based on sensitivity analyses, including participants of K/L grade 1 had little influence on this analysis. Limitations Only 16.2% of participants had a varus thrust. Moreover, a cause-effect relationship between varus thrust and pain and stiffness remains unknown due to the cross-sectional design of this study. Conclusions Varus thrust was associated with pain and stiffness in patients with medial knee OA. However, the association between varus thrust and ADL did not reach significance.

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What’s the rate of knee osteoarthritis 10 years after anterior cruciate ligament injury? An updated systematic review

British Journal of Sports Medicine ◽

10.1136/bjsports-2018-099751 ◽

2019 ◽

Vol 53 (18) ◽

pp. 1162-1167 ◽

Cited By ~ 21

Author(s):

Marthe Mehus Lie ◽

May Arna Risberg ◽

Kjersti Storheim ◽

Lars Engebretsen ◽

Britt Elin Øiestad

Keyword(s):

Systematic Review ◽

Anterior Cruciate Ligament ◽

Knee Osteoarthritis ◽

Methodological Quality ◽

Cruciate Ligament ◽

Acl Tear ◽

Knee Oa ◽

Symptomatic Knee ◽

Anterior Cruciate

BackgroundThis updated systematic review reports data from 2009 on the prevalence, and risk factors, for knee osteoarthritis (OA) more than 10 years after anterior cruciate ligament (ACL) tear.MethodsWe systematically searched five databases (PubMed, EMBASE, AMED, Cinahl and SPORTDiscus) for prospective and retrospective studies published after 1 August 2008. Studies were included if they investigated participants with ACL tear (isolated or in combination with medial collateral ligament and/or meniscal injuries) and reported symptomatic and/or radiographic OA at a minimum of 10 years postinjury. We used a modified version of the Downs and Black checklist for methodological quality assessment and narrative synthesis to report results. The study protocol was registered in PROSPERO.ResultsForty-one studies were included. Low methodological quality was revealed in over half of the studies. At inclusion, age ranged from 23 to 38 years, and at follow-up from 31 to 51 years. Sample sizes ranged from 18 to 780 participants. The reported radiographic OA prevalence varied between 0% and 100% >10 years after injury, regardless of follow-up time. The studies with low and high methodological quality reported a prevalence of radiographic OA between 0%–100% and 1%–80%, respectively. One study reported symptomatic knee OA for the tibiofemoral (TF) joint (35%), and one study reported symptomatic knee OA for the patellofemoral (PF) joint (15%). Meniscectomy was the only consistent risk factor determined from the data synthesis.ConclusionRadiographic knee OA varied between 0% and 100% in line with our previous systematic review from 2009. Symptomatic and radiographic knee OA was differentiated in two studies only, with a reported symptomatic OA prevalence of 35% for the TF joint and 15% for PF joint. Future cohort studies need to include measurement of symptomatic knee OA in this patient group.PROSPERO registration numberCRD42016042693.

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Effect of Intra-articular Ketorolac Versus Corticosteroid Injection for Knee Osteoarthritis: A Retrospective Comparative Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120911126 ◽

2020 ◽

Vol 8 (4) ◽

pp. 232596712091112

Author(s):

Jianda Xu ◽

Yuxing Qu ◽

Huan Li ◽

Aixiang Zhu ◽

Tao Jiang ◽

...

Keyword(s):

Pain Relief ◽

Knee Osteoarthritis ◽

Sodium Hyaluronate ◽

Knee Oa ◽

Symptomatic Knee ◽

Group A ◽

Successful Outcomes ◽

Group B ◽

Corticosteroid Injections

Background: Intra-articular corticosteroid injections have been widely used and are considered a mainstay in the nonoperative treatment of symptomatic knee osteoarthritis (OA). However, their increased use can have negative implications, including chondral toxicity and a high risk of infections. As a result, nonsteroidal anti-inflammatory drugs have been considered as an alternative. Purpose: To determine the pain relief and safety of ketorolac versus a corticosteroid to supplement an intra-articular sodium hyaluronate injection for the treatment of symptomatic knee OA. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 84 patients with unilateral symptomatic knee OA receiving 5 weekly injections were enrolled in this retrospective study. Group A (n = 42) received 3 weekly intra-articular corticosteroid injections (0.5% lidocaine, 25 mg of triamcinolone acetonide, and 25 mg of sodium hyaluronate, followed by 2 weekly injections of 0.5% lidocaine and 25 mg of sodium hyaluronate), while group B (n = 42) received 5 weekly ketorolac injections (0.5% lidocaine, 10 mg of ketorolac, and 25 mg of sodium hyaluronate). The following parameters were used to evaluate pain relief and safety: visual analog scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and side effects before the injection and at 1, 2, and 5 weeks after treatment commencement as well as 3 months after the last injection. Results: Patients from both groups had a significant improvement in VAS and WOMAC scores from the first injection to final follow-up at 3 months. In the first week, the VAS score was lower in group A ( P = .041), but no significant between-group differences were found for either the VAS or the WOMAC score at the other time points. Of the 42 patients in group A, 34 (81.0%) and 25 (59.5%) achieved successful outcomes at 5 weeks after treatment commencement and 3 months after the last injection, respectively. In group B, 32 (76.2%) and 24 (57.1%) patients achieved successful outcomes at 5 weeks after treatment commencement and 3 months after the last injection, respectively. At final follow-up, no significant difference was found in the successful treatment rate between the groups ( P = .825). Conclusion: The current study demonstrated that intra-articular ketorolac and corticosteroid injections produce the same pain relief and functional improvement.

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A Randomized Controlled Single-Blind Study Demonstrating Superiority of Amniotic Suspension Allograft Injection Over Hyaluronic Acid and Saline Control for Modification of Knee Osteoarthritis Symptoms

The Journal of Knee Surgery ◽

10.1055/s-0039-1696672 ◽

2019 ◽

Vol 32 (11) ◽

pp. 1143-1154 ◽

Cited By ~ 3

Author(s):

Jack Farr ◽

Andreas H. Gomoll ◽

Adam B. Yanke ◽

Eric J. Strauss ◽

Katie C. Mowry ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Controlled Trial ◽

Saline Control ◽

Knee Oa ◽

Randomized Controlled ◽

Symptomatic Knee ◽

Multicenter Randomized Controlled Trial ◽

Patient Reported

AbstractPlacental-derived tissues are a known source of anti-inflammatory and immune modulating factors. Published pilot data on amniotic suspension allograft (ASA) for the treatment of osteoarthritis (OA) demonstrated safety and trends for improved pain and function. A multicenter randomized controlled trial was designed to evaluate the efficacy of symptom modulation with ASA compared with saline and hyaluronic acid (HA) in subjects with knee OA. A total of 200 subjects were randomized 1:1:1 to ASA, HA, or saline, with subjects blinded to their allocation. Changes from baseline of patient-reported outcomes (PROs)—EQ-5D-5L, Knee Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS), Tegner, and Single Assessment Numerical Evaluation (SANE)—were compared between groups. Patients reporting unacceptable pain at 3 months were considered treatment failures and withdrawn from the study. Statistical analysis was completed by comparing changes in PROs from baseline to 3 and 6 months for all groups. Comparison of demographics between treatment groups showed no significant differences between groups. Patients reporting unacceptable pain at 3 months in each group were ASA (13.2%), HA (68.8%), and saline (75%). Patients receiving ASA demonstrated significantly greater improvements from baseline for overall pain (VAS), KOOS pain, and KOOS-activities of daily living scores compared with those in the HA group (3 months) and both groups (6 months). ASA patients had significantly greater improvements in KOOS symptom scores compared with HA and saline at 3 and 6 months, respectively. OMERACT-OARSI responder rates for ASA, HA, and saline groups were 69.1, 39.1, and 42.6%, respectively (p = 0.0007). Subjects receiving ASA treatment showed greater improvements in PROs and fewer patients reported unacceptable pain compared with HA and saline. The evidence presented in this Level I Randomized Controlled Trial suggests that ASA injection is an effective treatment for the nonoperative management of symptomatic knee OA.

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