Kinetic and kinematic changes with the use of valgus knee brace and lateral wedge insoles in patients with medial knee osteoarthritis

The effect of a valgus knee brace and a lateral wedged insole on knee and ankle kinematics and kinetics was evaluated in ten patients with medial knee osteoarthritis (OA). The knee orthosis was tested in two valgus adjustments (4° and 8°), and the laterally wedged insole was fabricated with an inclination of 4°. A motion capture system and force platforms were used for data collection and joint moments were calculated using inverse dynamics. The valgus moment applied by the orthosis was also measured using a strain gauge implemented in the orthosis' rotational axis. For the second peak knee adduction moment, decreases of 18%, 21%, and 7% were observed between baseline and test conditions for the orthosis in 4° valgus, in 8° valgus, and insole, respectively. Similar decreases were observed for knee lever arm in the frontal plane. Knee adduction angular impulse decreased 14%, 18%, and 7% from baseline to conditions for the orthosis in 4° valgus, in 8° valgus, and insole, respectively. Knee angle in the frontal plane reached a more valgus position during gait using the valgus knee brace. The valgus moment applied by the orthosis with 8° valgus adjustment was 30% higher than with 4° valgus adjustment. The valgus knee orthosis was more effective than the laterally wedged insole in reducing knee adduction moment in patients with medial knee OA.     

Knee and ankle biomechanics with lateral wedges with and without a custom arch support in those with medial knee osteoarthritis and flat feet

This study compared immediate changes in knee and ankle/subtalar biomechanics with lateral wedge orthotics with and without custom arch support in people with knee osteoarthritis and flat feet. Twenty‐six participants with radiographic evidence of medial knee osteoarthritis (22 females; age 64.0 years [SD 8.0 years], BMI 27.2 kg/m² [4.2]) and flat feet (median foot posture index = + 5) underwent three‐dimensional gait analysis for three conditions: Control (no orthotic), lateral wedge, and lateral wedge plus arch support. Condition order was randomized. Outcomes included frontal plane knee and ankle/subtalar biomechanics, and comfort. Compared to the control, lateral wedge and lateral wedge with arch support reduced the knee adduction moment impulse by 8% and 6%, respectively (p < 0.05). However, the lateral wedge resulted in a more everted foot position (4.3 degrees) than lateral wedge plus arch support (3.2 degrees) (p < 0.05). In contrast, lateral wedge plus arch support reduced foot frontal plane excursion compared to other conditions (p < 0.05). Participants self‐reported significantly more immediate comfort with lateral wedge plus arch support compared to the control, whereas there was no difference in self‐reported comfort between lateral wedge and control. No immediate changes in knee pain were observed in any condition. Clinical significance: Rather than prescribing lateral wedges to all patients with knee osteoarthritis, those who have medial knee osteoarthritis and flat feet may prefer to use the combined orthotic to reduce loads across the knee, and to minimize the risk of foot and ankle symptoms as a consequence of orthotic treatment. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1597–1605, 2016.     

The effect of different types of insoles or shoe modifications on medial loading of the knee in persons with medial knee osteoarthritis: a randomised trial

Many conservative treatments exist for medial knee osteoarthritis (OA) which aims to reduce the external knee adduction moment (EKAM). The objective of this study was to determine the difference between different shoes and lateral wedge insoles on EKAM, knee adduction angular impulse (KAAI), external knee flexion moment, pain, and comfort when walking in individuals with medial knee OA. Seventy individuals with medial knee OA underwent three‐dimensional walking gait analysis in five conditions (barefoot, control shoe, typical wedge, supported wedge, and mobility shoe) with pain and comfort recorded concurrently. The change in EKAM, KAAI, external knee flexion moment, pain, and comfort were assessed using multiple linear regressions and pairwise comparisons. Compared with the control shoe, lateral wedge insoles and barefoot walking significantly reduced early stance EKAM and KAAI. The mobility shoe showed no effect. A significant reduction in latter stance EKAM was seen in the lateral wedge insoles compared to the other conditions, with only the barefoot condition reducing the external knee flexion moment. However, the mobility shoe showed significant immediate knee pain reduction and improved comfort scores. Different lateral wedge insoles show comparable reductions in medial knee loading and in our study, the mobility shoe did not affect medial loading. © 2015 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. J Orthop Res 33:1646–1654, 2015.     

High tibial closing wedge osteotomy for medial compartment osteoarthrosis of knee

Background:

Most patients of symptomatic osteoarthrosis of knee are associated with varus malalignment that is causative or contributory to painful arthrosis. It is rational to correct the malalignment to transfer the functional load to the unaffected or less affected compartment of the knee to relieve symptoms. We report the outcome of a simple technique of high tibial osteotomy in the medial compartment osteoarthrosis of the knee.

Materials and Methods:

Between 1996 and 2004 we performed closing wedge osteotomy in 78 knees in 65 patients. The patients selected for osteotomy were symptomatic essentially due to medial compartment osteoarthrosis associated with moderate genu varum. Of the 19 patients who had bilateral symptomatic disease 11 opted for high tibial osteotomy of their second knee 1-3 years after the first operation. Preoperative grading of osteoarthrosis and postoperative function was assessed using Japanese Orthopaedic Association (JOA) rating scale.

Results:

At a minimum follow-up of 2 years (range 2-9 years) 6-10° of valgus correction at the site of osteotomy was maintained, there was significant relief of pain while walking, negotiating stairs, squatting and sitting cross-legged. Walking distance in all patients improved by two to four times their preoperative distance of 200-400 m. No patient lost any preoperative knee function. The mean JOA scoring improved from preoperative 54 (40-65) to 77 (55-85) at final follow-up.

Conclusion:

Closing wedge high tibial osteotomy performed by our technique can be undertaken in any setup with moderate facilities. Operation related complications are minimal and avoidable. Kirschner wire fixation is least likely to interfere with replacement surgery if it becomes necessary.     

胫骨高位截骨术与单髁置换术治疗膝内侧间室骨关节炎的疗效

目的 探讨胫骨高位截骨术(HTO)与单髁置换术(UKA)治疗膝内侧间室骨关节炎的疗效.方法 将60例膝内侧间室骨关节炎患者按治疗方法的不同分为HTO组和UKA组,每组30例.比较术中出血量、手术时间、术后引流量、并发症发生情况.记录两组术前及末次随访时疼痛VAS评分、Tegner膝关节运动评分、HSS评分.结果 患者均...     

The relationship between reductions in knee loading and immediate pain response whilst wearing lateral wedged insoles in knee osteoarthritis

Studies of lateral wedge insoles (LWIs) in medial knee osteoarthritis (OA) have shown reductions in the average external knee adduction moment (EKAM) but no lessening of knee pain. Some treated patients actually experience increases in the EKAM which could explain the overall absence of pain response. We examined whether, in patients with painful medial OA, reductions in the EKAM were associated with lessening of knee pain. Each patient underwent gait analysis whilst walking in a control shoe and two LWI's. We evaluated the relationship between change in EKAM and change in knee pain using Spearman Rank Correlation coefficients and tested whether dichotomizing patients into biomechanical responders (decreased EKAM) and non‐responders (increased EKAM) would identify those with reductions in knee pain. In 70 patients studied, the EKAM was reduced in both LWIs versus control shoe (?5.21% and ?6.29% for typical and supported wedges, respectively). The change in EKAM using LWIs was not significantly associated with the direction of knee pain change. Further, 54% were biomechanical responders, but these persons did not have more knee pain reduction than non‐responders. Whilst LWIs reduce EKAM, there is no clearcut relationship between change in medial load when wearing LWIs and corresponding change in knee pain. © 2014 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. J Orthop Res 32:1147–1154, 2014.

     

Effects of the amount of valgus correction for medial compartment knee osteoarthritis on clinical outcome, knee kinetics and muscle co-contraction after opening wedge high tibial osteotomy.

The goal of opening wedge high tibial osteotomy (HTO) is to reduce excessive loading on the medial compartment of the knee by correcting varus deformity, thereby reducing pain and improving function. Although surgical outcome is reportedly poor in cases of under- or overcorrection, the recommended alignment varies. The aim of this study was to investigate the effect of the degree of frontal plane knee alignment following open wedge HTO surgery on muscle co-contraction, joint moments, and self-reported functional outcome. Sixteen patients with medial compartment osteoarthritis (OA), who were scheduled for an opening wedge osteotomy, were recruited for participation in the study. Data were collected using an optoeletric motion analysis system and varus and valgus angulations of the knee were measured, using standing, long cassette, radiographs of the lower extremities. Results showed that physical function improved significantly overall (p < 0.001). However, those subjects whose knee alignment was further away from the group's postoperative mean tended to improve less in their Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) scores than those closer to the mean (p = 0.07). They also had higher medial and lateral co-contractions and higher adduction moments one year after surgery (p 相似文献   

应用Oxford单髁置换术治疗年轻膝内侧单间室骨关节炎患者的早期疗效

目的探讨应用Oxford单髁置换术治疗55岁及以下膝内侧单间室骨关节炎患者的早期疗效。方法回顾性分析2014年1月至2016年12月在北京积水潭医院矫形骨科行Oxford活动平台单髁置换术治疗的47例(56膝)55岁及以下膝内侧单间室骨关节炎患者的病历资料。术前及末次随访记录患者的牛津大学膝关节评分(OKS)、视觉模拟评分(VAS)、膝关节活动度(ROM)及机械轴股骨胫骨角(mFTA),并分析患者术后并发症发生率及假体生存率。结果手术年龄为(52.77±2.28)岁。随访时间为(42.16±9.60)个月。ROM由术前的(114.02±5.75)°提高至术后的(120.35±8.63)°,差异有统计学意义(P<0.05)。VAS评分由术前的(6.14±0.86)分降低至术后的(1.18±1.38)分,差异有统计学意义(P<0.05)。mFTA角由术前的(7.14±2.66)°改善至术后的(4.10±2.39)°,差异有统计学意义(P<0.001),且无膝关节内翻过度矫正。OKS评分由术前的(20.04±3.88)分提高至术后的(42.07±4.58)分,差异有统计学意义(P<0.001),优良率为91.1%。5例患者术后残留持续疼痛。随访期间,未发生其他严重并发症,假体生存率为100%。结论Oxford单髁置换术可显著改善年轻膝内侧单间室骨关节炎患者的临床症状和膝关节功能,早期疗效满意。残留疼痛是Oxford单髁置换术后最常见的并发症。     

Hip and knee joint rotations differ between patients with medial and lateral knee osteoarthritis: gait analysis of 30 patients and 15 controls.

The motions and moments in the hip and knee in female patients on the waiting list for knee prosthesis surgery with medial (n = 15) or lateral (n = 15) osteoarthritis (OA) were compared with a control group (n = 15). We hypothesized that not only the kinematics and kinetics of the knee but also of the hip would differ between patients the medial and lateral groups. At midstance, patients with lateral OA showed slightly (2 degrees) more maximal (peak) adduction (p = 0.015) of the hip joint and patients with medial OA had 7 degrees more abduction (p < 0.001) than did controls. In patients with lateral OA, the femur was positioned in about 7 degrees more maximum external rotation (p = 0.001), but femur position did not differ between medial OA and controls (p > or = 0.8). There was a tendency to higher internal hip rotation moment in lateral OA compared to controls (p = 0.021). The maximum values of the internal knee abduction moments were 52% higher in medial OA (p = 0.005) and 63% lower in lateral OA (p < 0.001) compared to controls. Cases with medial OA had 9 degrees more, whereas those with lateral OA had 6 degrees less external tibial rotation than controls (medial vs. lateral OA, p = 0.001). We found an association between presence of lateral OA of the knee and the biomechanics of the hip joint. It remains to be evaluated if the changed biomechanics of the hip joint is a reason for development of lateral OA or an observation that is a result of this disease.     

Muscle stabilization strategies in people with medial knee osteoarthritis: The effect of instability

The sensation of knee instability (shifting, buckling. and giving way) is common in people with medial knee osteoarthritis (OA). Its influence on knee stabilization strategies is unknown. This study investigated the influence of knee instability on muscle activation during walking when knee stability was challenged. Twenty people with medial knee OA participated and were grouped as OA Stable (OAS) (n = 10) and OA Unstable (OAU) (n = 10) based on self‐reported knee instability during daily activities. Quadriceps strength, passive knee laxity, and varus alignment were assessed and related to knee instability and muscle cocontraction during walking when the support surface translated laterally. Few differences in knee joint kinematics between the groups were seen; however, there were pronounced differences in muscle activation. The OAU group used greater medial muscle cocontraction before, during, and following the lateral translation. Self‐reported knee instability predicted medial muscle cocontraction, but medial laxity and limb alignment did not. The higher muscle cocontraction used by the OAU subjects appears to be an ineffective strategy to stabilize the knee. Instability and high cocontraction can be detrimental to joint integrity, and should be the focus of future research. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:1180–1185, 2008     

膝关节骨关节炎内侧半月板突出的临床意义

目的 探讨膝关节骨关节炎患者内侧半月板突出的病因及影响.方法 选取2011年1月至2012年3月诊断为膝关节退行性骨关节炎并经MRI确认有内侧半月板突出的60例患者为半月板突出组,无突出的60例为对照组.在MRI上测量内侧半月板突出距离、胫股角,分析突出组胫股角与突出距离的相关性,比较两组膝内翻、内侧半月板及胫股关节软骨损伤的发生率,分析内侧半月板突出对半月板损伤、膝内翻对半月板突出的影响.结果 突出组:半月板突出距离平均(8.30±1.79) mm;60例有膝内翻,胫股角平均179.0°±2.2°;内侧半月板损伤发生率:前角50.0％ (30/60),体部93.3％ (56/60),后角93.3％ (56/60);内侧半月板后角根部撕裂14例,发生率23.3％(14/60);胫股内侧关节软骨退变发生率:胫骨内侧平台100％(60/60),股骨内髁100％(60/60);胫股角与内侧半月板突出距离呈负相关.对照组:内侧半月板超出胫骨内侧平台边缘的距离平均(0.57±0.80) mm;4例膝内翻;内侧半月板损伤发生率:前角0,体部16.7％(10/60),后角70.0％ (42/60);无内侧半月板后角根部撕裂;胫股内侧关节软骨退变发生率:胫骨内侧平台26.7％(16/60),股骨内髁30.0％ (18/60).半月板突出组与对照组半月板损伤比值比为6.0、膝内翻例数比值比为15.0.半月板突出组内侧半月板各部位及胫股内侧关节软骨损伤的发生率和严重程度高于对照组.结论 膝内翻可能是内侧半月板突出的原因之一,内侧半月板突出显著增加半月板损伤的发生率,其对膝胫股内侧关节骨关节炎的发生、发展有重要影响.     

胫骨高位截骨术与单髁置换术的早期疗效及费用比较

目的比较胫骨内侧撑开楔形高位双平面截骨术(OWHTO)与Oxford Ⅲ代单髁置换治疗膝关节内侧间室骨关节炎的早期疗效及治疗费用。 方法回顾性分析2014年1月至2018年1月内蒙古自治区人民医院收治的内侧胫股关节炎患者共48例(48膝)，除外感染性关节炎及外侧骨关节炎患者，按照手术方式不同分为胫骨内侧撑开楔形高位双平面截骨术组(截骨组)和单髁置换组(单髁组)。A组12例(12膝)，男4例，女8例，年龄平均(58.3±3.5)岁；B组36例(36膝)，男14例，女22例，平均年龄(59.4±4.5)岁。分别于术前、术后6个月对两组患者进行疼痛模拟评分(VAS)、美国特种外科医院(HSS)膝关节评分，并拍摄膝关节正侧位X线片，测量膝内翻角度。使用两独立样本t检验及卡方检验比较两组患者手术前后VAS、HSS评分，以及患者住院和术后康复费用。 结果所有患者均获得满意随访，随访时间平均(8.5±1.8)个月。截骨组患者VAS评分术前(7.62±0.51)分，术后(2.15±0.26)分，术后与术前相比，差异有统计学意义(t＝1.61，P<0.05)；单髁组VAS评分术前(7.73±0.64)分，术后(2.31±0.14)分，术后与术前相比，差异有统计学意义(t＝2.09，P<0.05)。截骨组患者HSS评分术前(56± 5)分，术后(88±3)分，评分改善(t＝24.11，P<0.05)；单髁组HSS评分术前(57±6)分，术后(91±4)分，评分改善(t＝26.75，P<0.05)。两组患者VAS、HSS评分无明显差异，而截骨组住院费用显著低于单髁组(t＝3.59，P<0.05)。 结论两组患者均获得良好的早期疗效，但胫骨内侧撑开楔形高位双平面截骨术住院费用及术后康复治疗费用更少，同时又达到了"保膝"的目的，所以，对于两种术式均合适的患者，可以优先考虑胫骨内侧撑开楔形高位双平面截骨术。     

膝关节单髁置换术治疗严重内侧间室骨性关节炎

[目的]探讨膝关节单髁置换术治疗严重内侧间室骨性关节炎的疗效与手术技术。[方法]回顾性分析2008年5月～2009年6月采用膝关节单髁置换术治疗18例(18膝)严重内侧间室骨性关节炎患者的资料,对患者术前、术后膝关节疼痛及关节活动度进行评估(HSS评分法),并测量术后膝关节力线与术前测量结果比较,分析术前病例的选择及手术技术。[结果]术后平均随访18个月(12～24个月),所有病例术后随访时关节内侧间室负重和静息性疼痛症状明显减轻或消失,膝关节活动度达到平均100°(0°～120°);术后力线为平均内翻2°(0°～内翻5°)。HSS评分由术前68分(60～76分)增至85分(78～90分),优良率达89%。[结论]膝关节单髁置换术治疗严重内侧间室骨性关节炎具有较好的疗效,术前病例选择和术中在C型臂机监视下手术操作至关重要。     

Changes in the total knee joint moment in patients with medial compartment knee osteoarthritis over 5 years

Progression of medial compartment knee osteoarthritis (OA) has been associated with repetitive mechanical loading during walking, often characterized by the peak knee adduction (KAM) and knee flexion moments (KFM). However, the relative contributions of these components to the knee total joint moment (TJM) can change as the disease progresses since KAM and KFM are influenced by different factors that change over time. This study tested the hypothesis that the relative contributions of KAM, KFM, and the rotational moment (KRM) to the TJM change over time in subjects with medial compartment knee OA. Patients with medial compartment knee OA (n = 19) were tested walking at their self‐selected speed at baseline and a 5‐year follow‐up. For each frame during stance, the TJM was calculated using the KAM, KFM, and KRM. The peaks of the TJM and the relative contributions of the moment components at the time of the peaks of the TJM were tested for changes between baseline and follow‐up. The percent contribution of KFM to the first peak of the TJM (TJM1) significantly decreased (p < 0.001) and the percent contribution of KAM to TJM1 significantly increased (p < 0.001), while the magnitude of the TJM1 did not significantly change over the 5‐year follow‐up. These gait changes with disease progression appear to maintain a constant TJM1, but the transition from a KFM to a KAM dominance appears to reflect gait changes associated with progressing OA and pain. Thus, the TJM and its component analysis captures a comprehensive metric for total loading on the knee over time. Published 2018. This article is a U.S. Government work and is in the public domain in the USA. 36:2373–2379, 2018.

     

Localization of the full‐thickness cartilage lesions in medial and lateral unicompartmental knee osteoarthritis

This study's aim was to determine the patterns of osteoarthritis (OA) in both unicompartmental medial and lateral OA of the knee. Forty patients with medial and 20 with lateral unicompartmental knee osteoarthritis were studied to determine the location of full‐thickness cartilage lesions. Intraoperatively, the distance between margins of the lesion and reference lines were measured. The femoral measurements were transposed onto lateral radiographs to determine the relationship between the lesion site and knee flexion angles. Both tibial and femoral lesions were significantly (p < 0.01) more posterior in lateral OA than medial OA. In medial OA, the lesion center was, on average, at 11° (SD 3°) of flexion, whereas in lateral OA, it was at 40° (SD 3°). The smallest medial femoral lesions were near full extension and, as they enlarged, they extended posteriorly. The smallest lateral femoral lesions extended from 20° to 60° flexion. As these lesions enlarged, they extended both anteriorly and posteriorly. There was a well‐defined relationship between the site of the lesions and their size, suggesting that they develop and progress in a predictable manner. The relationship was different for medial and lateral OA, suggesting that different mechanical factors are important in initiating the different types of OA. The lesions in medial OA occur in extension, perhaps initiated by events occurring at heel strike. The lesions in lateral OA begin at flexion angles above those occurring during the single leg stance phase of the gait cycle, so activities other than gait are likely to induce lateral OA. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:1339–1346, 2009     

胫骨高位截骨术联合关节镜治疗老年内侧间室膝骨关节炎

目的:探讨胫骨高位截骨术联合关节镜治疗老年内侧间室膝骨关节炎患者的近期临床疗效。方法 :回顾性分析2017年8月至2018年10月行胫骨高位截骨术联合关节镜治疗的老年内侧间室膝骨关节炎患者61例,其中男17例,女44例;年龄60～83(67.87±6.45)岁。术前及术后12个月采用下肢力线比率(weight bearing line,WBL),股胫角(femora-tibial angle,FTA)评估下肢力线情况;术前及术后1、3、12个月采用视觉模拟疼痛(visual analogue scale,VAS)评分,美国特种外科医院(Hospital for Special Surgery,HSS)评分评估膝关节功能恢复情况。结果:61例患者均获得随访,时间12～19(14.27±4.69)个月;下肢力线比率由术前的(14.79±5.61)%提高至术后12个月的(59.33±7.82)%,差异有统计学意义(t=2.294,P0.05);股胫角由术前的(182.14±2.19)°提高至术后12个月的(171.54±3.16)°,差异有统计学意义(t=1.827,P0.05)。VAS评分由术前的6.14±2.21分别降至术后1、3、12个月的3.64±0.92、2.02±0.63、0.93±0.61,差异有统计学意义(F=458.24,P0.001);HSS评分由术前的49.66±13.79分别提高至术后1、3、12个月的58.39±9.26、71.82±6.06、82.71±6.97,差异有统计学意义(F=266.45,P0.001)。3例患者术中出现对侧骨皮质断裂,调整力线后固定,术后12个月截骨区愈合良好;4例手术切口愈合缓慢,分别在术后3～4周愈合。结论:胫骨高位截骨术联合关节镜可以有效调整老年内侧间室膝骨关节炎患者的下肢力线,改善膝关节疼痛及功能障碍。     

Identification of good candidates for valgus bracing as a treatment for medial knee osteoarthritis

Valgus unloader braces are a conservative treatment option for medial compartment knee osteoarthritis that aim to unload the damaged medial compartment through application of an external abduction moment. Patient response to bracing is highly variable, however. While some experience improvements in pain, function, and joint loading, others receive little to no benefit. The objective of this work was to analyze clinical measures and biomechanical characteristics of unbraced walking to identify variables that are associated with the mechanical effectiveness of valgus unloader bracing. Seventeen patients with medial knee osteoarthritis walked overground with and without a valgus unloader brace. A musculoskeletal model was used to estimate the contact forces in the medial compartment of the tibiofemoral joint and brace effectiveness was defined as the decrease in peak medial contact force between unbraced and braced conditions. Stepwise linear regression was used to identify clinical and biomechanical measures that predicted brace effectiveness. The final regression model explained 77% of the variance in brace effectiveness using two variables. Bracing was more effective for those with greater peak external hip adduction moments and for those with higher Kellgren–Lawrence grades, indicating more severe radiographic osteoarthritis. The hip adduction moment was the best predictor of brace effectiveness and was well correlated with several other measures indicating that it may be functioning as a “biomarker” for good bracing candidates. Clinical Significance: The ability to predict good candidates for valgus bracing may improve issues of patient compliance and could enable the ability to train patients to respond better to bracing. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:351–356, 2018.