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.     

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.     

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.

     

Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis: a prospective randomized controlled study

OBJECTIVE: To compare the clinical effects of laterally wedged insoles and neutrally wedged insoles (used as control) in patients with medial femoro-tibial knee osteoarthritis (OA). DESIGN: 6-month prospective randomized controlled study. PATIENTS: outpatients with painful medial femoro-tibial knee OA. OUTCOME MEASURES: patient's overall assessment of disease activity (5 grade scale), WOMAC index subscales and concomitant treatments. STATISTICAL ANALYSIS: Performed as an intention-to-treat analysis. Main criterion: improvement in the patient's assessment of activity (defined as a reduction of 1 grade or more at month 6 compared to baseline, and no intraarticular injection or lavage during the study). Secondary criteria for assessment: (a) improvement in the patient's assessment of activity at months 1 and 3 compared to baseline, (b) improvement in the WOMAC subscales at months 1, 3 and 6, compared to baseline (defined as an improvement of at least 30%, and no intraarticular injection or lavage during the study) and (c) concomitant therapies (analgesics and NSAIDs). RESULTS: The baseline characteristics of the 156 recruited patients (41 males, 115 females, mean age 64.8 years) were not different in the two treatment groups. At months 1, 3 and 6 the percentages of patients with improvement in assessment of disease activity, in WOMAC pain, joint stiffness, and physical functioning subscales were similar in the two groups. The number of days with NSAIDs intake during the previous 3 months was decreased at month 6 compared with baseline in the group furnished with laterally wedged insoles (14.1 days+/-28 vs 9.9 days+/-27, P=0.04, Wilcoxon paired test), while it remained unchanged in the other group (15.5 days+/-24 vs 15+/-28, P=0.56). Compliance and tolerance were satisfactory. Compliance was different between the two groups at month 6, with a greater frequency of patients who wore insoles permanently in the laterally wedged insole group than in the other group (87.8% vs 74.3%;P=0.032). CONCLUSION: This study failed to demonstrate a relevant short-term symptomatic effect of laterally-wedged insoles in medial femoro-tibial OA. However, the decrease in NSAIDs consumption together with better compliance in the treated group are in favor of a beneficial effect of laterally-wedged insoles in medial femoro-tibial OA.     

Effects of harvesting the central third of the patella tendon on the kinetics of the knee joint and the retropatellar pressure

AIM: This biomechanical study was performed to evaluate the consequences of removing the central part of the patellar tendon on the kinematics and kinetics of the femoro-patellar joint. The tendonectomy was performed in the same manner as is frequently done during anterior cruciate ligament reconstructions. Of particular interest in this study was to identify potential factors of the patellar tendon resection which could result in anterior knee pain. METHOD: A simulated isokinetic knee extension from 120 degrees of flexion to full extension was performed on nine human knee cadaver specimens. Joint kinematics was evaluated with ultrasound sensors, and retropatellar contact pressure was measured using a thin-film resistive ink pressure measuring system. Data were taken before and after resection of the central third of the patellar tendon. RESULTS: Harvesting of the central third of the patellar tendon resulted in an elongation of the remaining patellar tendon by less then 0.5 mm. Furthermore, increases in patellar flexion lower than 1 degree were observed. Small changes in retropatellar pressure were also observed. CONCLUSION: The shortening of the patellar tendon due to tendon removal, as already suggested in several previous studies, is not attributed to the removal of the central portion of the tendon itself, but more likely due to secondary scarring contraction of the tissue. The changes of the patellarkinematics and the retropatellar pressure observed in this study are probably not of any clinical significance.     

Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis. A two-year prospective randomized controlled study

OBJECTIVE: To compare the clinical effects of laterally wedged insoles and neutrally wedged insoles (used as control) in patients with medial femoro-tibial knee osteoarthritis. METHODS: Study design: 24-month prospective randomized controlled study. Patients: Outpatients with painful medial femoro-tibial knee osteoarthritis. Outcome measures: Patient's overall assessment of disease activity (5 grade scale), WOMAC index subscales and concomitant treatments. Statistical analysis: Performed as an intention-to-treat analysis, with the last observation carried forward (LOCF). Main symptomatic criterion: Improvement in the patient's assessment of activity (defined as a reduction of one grade or more at the end of the study as compared to baseline, and no intra-articular injection or lavage during the 6 months previous to the last visit). Secondary criteria for assessment: (a) Changes in the WOMAC subscales at month 24, and (b) concomitant therapies (analgesics, NSAIDs and intra-articular injections or lavages). Structural criterion: Joint space width (JSW) at the narrowest point. Non-compliance was defined as intermittent or lack of insole fitting at two consecutive visits. Compliance within groups was compared by using a life table analysis technique (Log-Rank). RESULTS: The baseline characteristics of the 156 recruited patients (41 males, 115 females, mean age 64.8 years) were not different in the 2 treatment groups. At year 2, there was no statistically significant difference between the 2 groups concerning the percentages of patients with improvement in both global assessment of disease activity and in WOMAC subscales (pain, stiffness, function). The number of days with NSAIDs intake was lower in the group with laterally wedged insoles than in the neutrally wedged group (71+/-173 days vs. 127+/-193 days, P=0.003, Mann-Whitney test). The mean joint space narrowing rate did not differ between the two groups: 0.21+/-0.59 mm/year in the laterally wedged group vs 0.12+/-0.32 mm/year in the neutrally wedged group. Compliance and tolerance were satisfactory. Compliance was different between the 2 groups at month 24, with a greater frequency of patients who wore insoles permanently in the laterally wedged insole group than in the other group (85.8% vs 71.9%, P=0.023). CONCLUSION: This study failed to demonstrate a relevant symptomatic and/or structural effect of laterally-wedged insoles in medial femoro-tibial OA. However, the reduced NSAIDs intake and the better compliance in the treatment group are in favor of a beneficial effect of laterally-wedged insoles in medial femoro-tibial OA.     

A 2-year follow-up of a study to compare the efficacy of lateral wedged insoles with subtalar strapping and in-shoe lateral wedged insoles in patients with varus deformity osteoarthritis of the knee

OBJECTIVE: This study was conducted in order to assess the effect of wearing a lateral wedged insole with a subtalar strap for 2 years in patients with osteoarthritis varus deformity of the knee (knee OA). DESIGN: The setting was an outpatient clinic. The efficacies of the strapped insole and a traditional shoe insert wedged insole (the inserted insole), as a positive control, were compared at the baseline and after 2 years of treatment. Randomization was performed according to birth date. The 61 female outpatients with knee OA who completed a prior 6-month study were asked to wear their respective insoles continuously as treatment during the course of the 2-year study. The femorotibial angle (FTA) was assessed by standing radiographs obtained while the subjects were barefoot and the Lequesne index of the knee OA at 2 years was compared with those at baseline in each insole group. RESULTS: There were 61 patients in the original study, but 13 patients (21.3%) did not want to wear the insole continuously and five (8.2%) withdrew for other reasons. The 42 patients who completed the 2-year study were evaluated. At the 2-year assessment, participants wearing the subtalar strapped insole (n=21) demonstrated significantly decreased FTA (P=0.015), and significantly improved Lequesne index (P=0.031) in comparison with their baseline assessments. These significant differences were not found in the group with the traditional shoe inserted wedged insole (n=21). CONCLUSION: Only those participants using the subtalar strapped insole demonstrated significant change in the FTA in comparison with the baseline assessments. If the insole with a subtalar strap maintains FTA for more than 2 years, it may restrict the progression of degenerative articular cartilage lesions of knee OA.     

Shoe insoles in the workplace

Ninety-six women participated in a crossover study to evaluate the effectiveness of viscoelastic polyurethane insoles in reducing back, leg, and foot pain among adults who spend the majority of each work day standing. Twenty-five of the subjects reported that the insoles made their shoes too tight to be comfortable. The remainder, however, found the insoles very comfortable (P less than .002, Wilcoxon, signed-rank test) and reported significant reductions in back pain (P less than .02), foot pain (P less than .03), and leg pain (P less than .007). When these subjects were asked whether they would prefer to wear their shoes alone or with insoles, the preference for insoles was overwhelming (P less than .007, back; P less than .03, leg; and P less than .009, foot pain). It is concluded that viscoelastic insoles can effectively improve comfort and reduce back, leg, and foot pain in individuals who must stand throughout the day.     

Effects of laterally wedged insoles on symptoms and disease progression in medial knee osteoarthritis: a protocol for a randomised,double-blind,placebo controlled trial

Background  

Whilst laterally wedged insoles, worn inside the shoes, are advocated as a simple, inexpensive, non-toxic self-administered intervention for knee osteoarthritis (OA), there is currently limited evidence to support their use. The aim of this randomised, double-blind controlled trial is to determine whether laterally wedges insoles lead to greater improvements in knee pain, physical function and health-related quality of life, and slower structural disease progression as well as being more cost-effective, than control flat insoles in people with medial knee OA.     

The effect of wedged insoles on the thrust of osteoarthritic knees

Summary. We describe a method of quantifying the lateral/medial thrust of the knee which occurs in the early phase of walking. We have used this method to evaluate the effects of wedged insoles on the lateral and medial thrust for normal knees and knees with unicompartment osteoarthritis (OA). A laterally elevated (valgus) insole decreased the lateral thrust of both normal and osteoarthritic knees. A medially elevated (varus) insole increased the lateral thrust. In 50 symptomatic knees with medial compartment OA, decreasing the lateral thrust with a valgus insole reduced pain on walking in 27. Patients whose pain was reduced by valgus insoles tended to have earlier OA and to have a significantly greater reduction in the lateral thrust than in the 23 remaining unaffected knees. A varus insole was effective in decreasing the medial thrust and reducing pain in all ten knees with lateral compartment OA. We recommend the use of valgus insoles for patients with painful early medial compartment OA and the use of varus insoles for lateral compartment OA.

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Résumé. Les auteurs présentent une méthode d’évaluation quantitative, avec mesure par un accéléromètre, des écarts internes ou externes qui se font au niveau du genou dans la première phase du pas. Ils ont étudié les effets dynamiques et l’utilité clinique des semelles à coin valgisant ou varisant pour les genous atteints d’arthrose unicompartimentale. Une semelle à coin externe (valgisante) diminue l’écart externe ou augmente l’écart interne que subit le genou normal ou arthrosique. L’effet est inverse pour une semelle à coin interne. Sur 50 genoux atteints d’arthrose interne avec écart externe, la semelle à coin valgisant diminue les douleurs à la marche dans 27 cas et est inefficace dans 23 cas. Les genoux pour lesquels les semelles valgisantes sont efficaces ont une réduction significative de l’écart externe par rapport à ceux pour lesquels ces semelles sont inefficaces. La semelle valgisante est plus efficace en cas d’arthrose du genou débutante qu’en cas d’arthrose évoluée. La semelle varisante est active pour les 10 genoux avec arthrose compartimentale externe et écart interne.

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Accepted: 28 February 1996     

Effects of knee flexion angle at graft fixation on the outcome of anterior cruciate ligament reconstruction

Clinical outcome in 44 patients who underwent anterior cruciate ligament (ACL) reconstruction with hamstring tendons augmented by the ligament augmentation device for chronic ACL deficiency was studied; average follow-up was 38 months (range, 24 to 52 months). In 19 patients, grafts were fixed with the knees at full extension (group 1), whereas in 25 patients, the grafts were fixed with the knees at 30° of flexion (group 2). The results of subjective testing (Lysholm score), the Lachman test, the pivot-shift test, muscle strength testing, angle of extension loss, and follow-up arthroscopy were compared to assess the effects of flexion angle at fixation on stability and function. The range of motion in group 1 was significantly better than that in group 2. The stability of the knees and the arthroscopic appearance of the grafts in group 1 were, however, significantly worse than those in Group 2.     

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   

大蒜素对兔膝骨关节炎作用的实验研究

[目的]探讨大蒜素对兔膝骨关节炎的作用。[方法]将30只家兔随机分为空白对照组、模型对照组和大蒜素组,每组10只;除空白对照组外其余2组按改良Hulth法建立模型,术后开始灌服药物,大蒜素组(大蒜素,128 mg/kg/d)、空白对照组和模型对照组(等量生理盐水20 ml),连用8周。术后8周处死所有家兔取右膝股骨髁大体观察;苏木精-伊红(HE)和番红O(SA-O)染色对股骨髁关节软骨行Mankin评分;采用q RTPCR法检测股骨内侧髁负重区软骨组织interleukin-1β(白细胞介素-1β,IL-1β)、matrix metalloproteinase-3(基质金属蛋白酶-3,MMP-3)和tissue inhibitor of metalloproteases-1(基质金属蛋白酶组织抑制因子-1,TIMP-1)的m RNA相对表达量。[结果]三组之间比较,空白对照组的Mankin评分最低,IL-1β、MMP-3和TIMP-1 m RNA表达量最低,模型对照组和大蒜素组,分别与空白对照组比较,上述指标差异均有统计学意义(P<0.05);与模型对照组比较,大蒜素组Mankin评分降低,IL-1β、MMP-3、TIMP-1 m RNA表达量降低,差异有统计学意义(P<0.05)。[结论]大蒜素能够改善兔膝骨关节炎Mankin评分并能够下调股骨髁关节软骨中IL-1βm RNA、MMP-3m RNA表达,上调TIMP-1 m RNA表达量。     

Immediate effect of insoles on balance in older adults

BackgroundIn recent years, fall prevention in older adults has received considerable attention in healthcare. Among many interventions, insoles are considered cost-effective and easily adopted tools to improve balance in older people. Numerous studies have verified the immediate effects of insoles on balance in older adults. However, there is still lack of consensus regarding the immediate benefits of using insoles on balance improvement.Research questionGiven this, a meta-analysis was conducted to provide more conclusive evidence about the immediate effect of insoles on balance in older adults and answer the question: “Do insoles influence balance in older people?”MethodsPubMed, NDSL, Medline, Google Scholar, and Web of Science were searched from March to August 2018. The key terms were “insole”, “elderly”, “gait”, “balance”, “shoe”, “foot”, and “postural”. Finally, seven primary studies were selected for this meta-analysis. The balance related outcomes were coded to compute effect sizes and the overall effect size of the standardized mean differences was analyzed. Moderating variables included kinematic variables of balance, static and dynamic balance, and type of insole.ResultsThe overall effect size of insoles was medium (d = 0.618), which suggests that insoles are beneficial for older adults for improving balance. More specifically, this study revealed that textured and vibration insoles were the most effective types of insoles.SignificanceThis finding supports the idea that augmented tactile and mechanical sensory input from insoles can enhance the postural control mechanisms in older adults with age-related deterioration of sensory mechanisms. The use of insoles may lead to a reduction in the rate of falls which are related to decreased quality of life in older adults.     

Pressure distribution at the knee joint

Traumata or repetitive microtraumata, malalignment with varus or valgus deviation, or chronic joint instability are discussed in the aetiology of osteoarthritis and osteochondritis dissecans of the knee. Biomechanical factors influencing the patterns of pressure distribution at the articular surface and the subchondral bone are suggested to be most important in the pathogenesis. Consequently, the patterns of pressure distribution at the femoral condyles of weight-bearing knee joints were investigated in a cadaveric biostatic model. The pressure in the articular joint space was evaluated with pressure-sensitive films of the knee in different joint positions in the coronal plane (10° varus, 10° valgus, and neutral position) without and with medial collateral ligament (MCL), lateral CL (LCL), MCL + anterior cruciate ligament (ACL) or LCL + ACL ligament division. Results demonstrated that the location of the contact area and the peak pressure depended on the joint position and stage of ligamentous division. Without ligament division, a maximum peak pressure was observed at the medial condyle in the neutral and varus positions. Only in the valgus position did the lateral condyle show a higher peak of pressure than the medial condyle. Ligament division of the LCL and LCL + ACL resulted in an increase of peak pressure at the medial condyle, particularly in the varus position. Division of the MCL and MCL + ACL ligament complex reduced the differences between the medial and lateral condyle. In the valgus position, the peak pressure was significantly higher at the lateral condyle. The absolute maximum peak pressure was measured in the varus position at the medial condyle after division of the LCL and ACL. The absolute minimum was found in the valgus position at the medial condyle after division of the MCL and ACL. No significant change of the location of the centre of peak pressure area was observed due to the different joint positions.Presented in part at the 21st Congress of the Austrian Society of Orthopaedic Surgery, 5 May–1 June 1991, Linz, Austria     

Arthroscopic surgery at the knee joint

384 patients were subjected to arthroscopy in 1980 and 1981. Pathological findings were obtained in 361 patients, mainly lesions of the meniscus. In 51 patients (approx. 14% of the cases) arthrotomy became necessary for various reasons. 310 patients were subjected to surgery, using the arthroscope. Follow-up examinations showed that the postoperative healing phase and hence also the postoperative inpatient period were significantly reduced compared with those patients who had been subjected to arthrotomy with the same therapeutic effect. Patients who have undergone arthroscopy re-attain their full knee-joint function much earlier than those on whom arthrotomy was performed. Hence, their ability to work is restored more quickly, and they are much sooner able to resume their sports activities.     

半月板不同切除术对膝关节胫骨旋转角度的影响

目的 探讨半月板不同部位及不同程度切除后对膝关节胫骨旋转角度的影响.方法 取6具新鲜尸体共12个膝关节标本,分为对照组(完整膝关节标本)和实验组,实验组又分为半月板部分切除组(内侧半月板前角切除组、内侧半月板后角切除组、外侧半月板前角切除组)和半月板全切除组(内侧半月板全切除组、外侧半月板全切除组),每组测量4个标本,标本重复使用.应用Staubli机器人模拟生理状态下膝关节站立至下蹲屈膝过程,采用日本Nenicon角度测量仪测量各组标本在膝关节屈曲0～90°过程中胫骨旋转角度的变化. 结果 对照组(完整膝关节标本)在膝关节屈曲0、10°、20°、30°、60°、90°时胫骨旋转角度平均分别为4.9°±0.8°、9.2°±0.8°、11.4°±0.8°、12.1°±0.5°、12.4°±0.5°.在膝关节屈曲0～ 90°过程中,半月板部分切除组与对照组、半月板部分切除组之间胫骨旋转角度比较差异均无统计学意义(P＞0.05)；半月板全切除组与半月板部分切除组及半月板全切除组之间胫骨旋转角度比较差异均有统计学意义(P＜0.05).半月板全切除组与对照组在膝关节屈曲0～30°时胫骨旋转角度比较差异有统计学意义(P＜0.05),而在膝关节屈曲30°～90°时比较差异无统计学意义(P＞0.05). 结论 半月板部分切除对伴随屈曲运动的胫骨旋转运动形式无明显影响.在膝关节屈曲0～30°过程中,半月板全切除对胫骨旋转角度有明显影响.