Background
The peak knee adduction moment is a valid proxy for medial knee joint loading. However as it only measures load at one instance of stance, knee adduction moment impulse, a measure that takes into account both the magnitude and duration of the stance phase, may provide more comprehensive information. This study directly compared the abilities of peak knee adduction moment and knee adduction moment impulse to distinguish between knee osteoarthritis severities.Methods
169 participants with medial knee osteoarthritis completed radiographic and magnetic resonance imaging, the Western Ontario and McMaster Universities Arthritis Index to assess pain and a three-dimensional gait analysis. Participants were classified using four dichotomous classifications: Kellgren–Lawrence grading, alignment, medial tibiofemoral bone marrow lesions, and pain.Findings
When using Kellgren–Lawrence grade and alignment classifications, the area under the receiver operator curves were significantly greater for knee adduction moment impulse than for peak knee adduction moment. Based on analysis of covariance, knee adduction moment impulse was significantly different between Kellgren–Lawrence grade and alignment groups while peak knee adduction moment was not significantly different. Both peak knee adduction moment and knee adduction moment impulse distinguished between bone marrow lesion severities while neither measure was significantly different between pain severity groups.Interpretations
Findings suggest knee adduction moment impulse is more sensitive at distinguishing between disease severities and may provide more comprehensive information on medial knee joint loading. Future studies investigating biomechanics of knee osteoarthritis should include knee adduction moment impulse in conjunction with peak knee adduction moment. 相似文献Background
Based on novel classification criteria using magnetic resonance imaging, a subpopulation of “early knee osteoarthritis patients” was clearly defined recently. This study assessed whether these early osteoarthritis patients already exhibit gait adaptations (knee joint loading in particular) and changes in muscle strength compared to control subjects and established knee osteoarthritis patients.Methods
Fourteen female patients with early knee joint degeneration, defined by magnetic resonance imaging (early osteoarthritis), 12 female patients with established osteoarthritis and 14 female control subjects participated. Specific gait parameters and lower limb muscle strength were analyzed and compared between groups. Within the osteoarthritis groups, association between muscle strength and dynamic knee joint loading was also evaluated.Findings
Early osteoarthritis patients presented no altered gait pattern, no significant increase in knee joint loading and no significant decrease in hamstring muscle strength compared to controls, while established osteoarthritis patients did. In contrast, early osteoarthritis patients experienced significant quadriceps weakness, comparable to established osteoarthritis patients. Within the osteoarthritis groups, muscle strength was not correlated with knee joint loading during gait.Interpretation
The results suggest that gait changes reflect mechanical overload and are most likely the consequence of structural degeneration in knee osteoarthritis. Quadriceps weakness might however contribute to the onset and progression of the disease. This study supports the relevance of classification of early osteoarthritis patients and assists in identifying their functional characteristics. This helps to understand the trajectory of disease onset and progression and further develop more targeted strategies for prevention and treatment of knee osteoarthritis. 相似文献Background
Hip abductor muscles generate moments of force that control lower extremity frontal plane motion. Strengthening these muscles has been a recent trend in therapeutic intervention studies for knee osteoarthritis. The current study investigated the relationship between hip abductor muscle function (strength and activation) and the net external knee adduction moment during gait in those with medial compartment knee osteoarthritis.Methods
54 individuals with moderate knee osteoarthritis walked at their self-selected velocity while gluteus medius electromyograms, segment motions and ground reaction forces were recorded. Net external knee adduction moment (KAM) and linear enveloped electromyographic profiles were calculated. Peak KAM was determined and then principal component analyses (PCA) were applied to KAM and electromyographic profiles. Isometric hip abductor strength, anthropometrics and gait velocity were measured. Multiple regression models evaluated the relationship between walking velocity, hip abductor strength, electromyographic variables recorded during gait and KAM waveform characteristics.Findings
Minimal peak KAM variance was explained by abductor strength (R2 = 9%, P = 0.027). PCA-based KAM waveform characteristics were not explained by abductor strength. Overall gluteus medius amplitude (PP1-scores) was related to a reduction in the bi-modal KAM (PP3-scores) pattern (R2 = 16%, P = 0.003).Interpretation
There was no clear relationship between hip abductor muscle strength and specific amplitude and temporal KAM characteristics. Higher overall gluteus medius activation amplitude was related to a sustained KAM during mid-stance. 84 to 90% of the variance in KAM waveform characteristics was not explained by hip abductor muscle function showing hip abductor muscle function has minimal association to KAM characteristics. 相似文献- Implications for Rehabilitation
Knee braces and foot orthoses are commonly used for improving knee adduction moment, pain and function in subjects with knee osteoarthritis (OA).
Orthotic devices can reduce knee adduction moment, pain and improve function in knee OA.
The combined use of a knee braces and foot orthoses can provide more improvement in knee adduction moment, reduced pain and increased function.
Background
Laterally wedged insoles are one of the gait modifications potentially slowing down progression of medial knee osteoarthritis. Clinical studies have, however, found large individual differences in the biomechanical effect and an insufficient pain reduction. To clarify if and how pain mediates mechanical changes during gait the current study investigated how acute experimental knee pain changes the mechanical effect of laterally wedged insoles in healthy subjects during walking.Methods
3D gait analysis was carried out for twelve healthy individuals. The study followed a cross-over design and data were collected with both a neutral and a 10-degree laterally wedged insole with experimental pain induced by hypertonic and isotonic saline injections into the infrapatellar fat pad. Peak knee adduction moment was the primary outcome. A repeated ANOVA (analysis of variance) was used to evaluate the relationship between the factors wedge, condition and test number.Findings
Wedges significantly reduced peak knee adduction moment but experimental knee pain did only marginally affect its magnitude in either condition. While frontal plane mechanics were relatively unaffected by pain, the sagittal plane knee extension moment increased with laterally wedging (P = 0.008), whereas late knee flexion moment was reduced by experimental knee pain (P = 0.04).Interpretation
The effect of laterally wedged insoles in attenuating knee adduction moment during walking is independent of experimental knee pain. The present study provides evidence that subjects with experimental knee pain reduce knee loading by reducing extension moment, whereas lateral wedges have the opposite effect and increase the extension moment. 相似文献Background
The progression of medial knee osteoarthritis seems closely related to a high external knee adduction moment, which could be reduced through gait retraining. We aimed to determine the retraining strategy that reduces this knee moment most effective during gait, and to determine if the same strategy is the most effective for everyone.Methods
Thirty-seven healthy participants underwent 3D gait analysis. After normal walking was recorded, participants received verbal instructions on four gait strategies (Trunk Lean, Medial Thrust, Reduced Vertical Acceleration, Toe Out). Knee adduction moment and strategy-specific kinematics were calculated for all conditions.Findings
The overall knee adduction moment peak was reduced by Medial Thrust (− 0.08 Nm/Bw·Ht) and Trunk Lean (− 0.07 Nm/Bw·Ht), while impulse was reduced by 0.03 Nms/Bw·Ht in both conditions. Toeing out reduced late stance peak and impulse significantly but overall peak was not affected. Reducing vertical acceleration at initial contact did not reduce the overall peak. Strategy-specific kinematics (trunk lean angle, knee adduction angle, first peak of the vertical ground reaction force, foot progression angle) showed that multiple parameters were affected by all conditions. Medial Thrust was the most effective strategy in 43% of the participants, while Trunk Lean reduced external knee adduction moment most in 49%. With similar kinematics, the reduction of the knee adduction moment peak and impulse was significantly different between these groups.Interpretation
Although Trunk Lean and Medial Thrust reduced the external knee adduction moment overall, individual selection of gait retraining strategy seems vital to optimally reduce dynamic knee load during gait. 相似文献Background
Given the complexity of the gait of patients with knee osteoarthritis, a multiple correspondence analysis may be helpful to optimise the extraction of relevant gait and clinical information. Therefore, the aims of this study are to identify the main associations with clinical and gait biomechanical parameters and to evaluate whether there are more specific knee osteoarthritis groups with different gait profiles.Methods
Ninety patients with severe knee osteoarthritis and twenty-six healthy individuals participated in this study. Pain and function were assessed with the WOMAC Index; knee joint deformity was assessed by the hip-knee-ankle angle on full-limb radiography; and full body gait analysis was performed with a motion analysis system and force plates.Findings
Using multiple correspondence analysis, two categories of gait parameters that best explain the gait variance of patients with knee osteoarthritis were highlighted. The forward displacement category is composed of the parameters speed, stride length, hip flexion and knee flexion. The frontal category is composed of the parameters thorax obliquity and knee adductor moments. Moreover, based on these parameters, four distinct gait profiles were identified: two gait profiles were associated with knee varus deformities, increased thorax obliquity and different forward displacements, while two gait profiles were associated with valgus deformities and different forward displacements.Interpretation
These gait parameters can be used to simplify the characterisation of the gait of the knee osteoarthritis population. Patients in varus profiles increase thorax obliquity on the stance limb and may reduce forward displacement. Patients in valgus profiles, however, only reduce forward displacement. 相似文献Background
Patients with osteoarthritis of the knee have unique spatiotemporal gait alterations. These gait changes have not yet been differentiated according to the location of knee pain. The purpose of this study was to compare the gait patterns of patients with symptomatic knee osteoarthritis that exhibit either anterior or medial joint pain.Methods
240 Patients with knee osteoarthritis were evaluated at one therapy center. Patients were divided into two groups according to the location of greatest pain in their worse knee. Patients underwent a computerized spatiotemporal gait analysis. Differences in gait patterns between the two knee pain locations were also examined within each gender.Findings
Compared with patients with pain in the anterior knee compartment, those with pain in the medial knee compartment exhibited a significantly slower walking speed (P < 0.01), shorter step length (P < 0.01), lower single-limb-support phase (P < 0.01). These differences are witnessed mainly between the females in each group, whereas males differed only in single-limb-support.Interpretation
The results of this study suggested underlying gait differences in the nature of medial and anterior knee pain. Furthermore, gender differences in gait may exist between patients with medial knee pain compared to patients with anterior knee pain. 相似文献Background
Stair climbing is a challenging task to the elderly being the task with the first complaint in patients with mild to moderate knee osteoarthritis. Stair climbing results in around six times more compressive load transmitted through the knee joint than walking on level ground. The purpose of this study was to assess whether lateral wedge insoles would reduce medial compartment knee loading when ascending and descending stairs in patients with medial knee osteoarthritis.Methods
Eight patients with medial knee osteoarthritis were tested in random order with and without a pair of 5° off-the-shelf lateral wedge insoles for two separate activities (stair ascent and stair descent). Kinematic and kinetic data were collected for the lower extremity using a sixteen camera motion capture system and two force plates. Primary outcome measures were the external knee adduction moment and the knee adduction angular impulse.Findings
During stair ascent and descent, lateral wedge insoles significantly (P < 0.05) reduced the 1st peak external knee adduction moment in early stance (ascent 6.8%, descent 8.4%), the trough in mid stance (ascent 13%, descent 10.7%), 2nd peak in the late stance (ascent 15%, descent 8.3%) and the knee adduction angular impulse compared to the control (standard shoe) with large effect sizes (0.75–0.95).Interpretation
In this first study on stairs, lateral wedge insoles consistently reduced the overall magnitude of medial compartment loading during stair ascent and descent. Further research is needed to determine the relationship of this with clinical results when ascending and descending stairs with lateral wedge insoles. 相似文献Objective
To analyze knee joint loading, subjective pain relief, and improvements in function in patients with osteoarthritis (OA) with the use of 2 orthosis adjustments.Design
Patients were tested under 3 different conditions (without orthosis, orthosis at 4° valgus, and a neutral very flexible adjustment) in a crossover trial.Setting
University gait analysis laboratory with 3-dimensional motion analysis and force platforms.Participants
Patients (N=11) with a clinical and radiographic diagnosis of unilateral OA in the medial knee compartment.Interventions
Patients wore a knee orthosis designed to unload the medial knee compartment for 4 weeks in 2 different adjustments (2 weeks in each adjustment).Main Outcome Measures
Net knee adduction moment and net knee adduction angular impulse during the stance phase were analyzed by using inverse dynamics. Subjective pain relief, stiffness, and function improvement were evaluated using a questionnaire (Western Ontario and McMaster Universities Osteoarthritis Index). A 6-minute walk test and stair-climbing test also were performed.Results
Both orthosis adjustments induced subjective pain relief and improvement in function compared with the condition without orthosis. Knee adduction moment was significantly decreased with both adjustments, whereas the decrease observed with the 4° valgus adjustment was significantly greater than the flexible adjustment (25% vs 12.5%). Compared with the condition without orthosis, changes in knee adduction angular impulse of 29% and 15% were found with 4° valgus and the neutral flexible orthosis, respectively. Time required for the stair-climbing activity was significantly decreased using the orthosis in 4° valgus adjustment compared with the condition without orthosis. No significant differences were observed among conditions during the 6-minute walk test.Conclusions
Both orthosis adjustments were effective in decreasing symptoms; however, a decrease in knee loading was more effective using the 4° valgus adjustment, which could contribute to avoidance of disease progression. 相似文献Background
The purpose of the study was to investigate the changes in gait patterns and clinical measurements following treatment with a novel biomechanical device on patients with knee osteoarthritis.Methods
Forty six patients with bilateral knee osteoarthritis were analyzed. Patients completed a gait test, Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire and SF-36 Health Survey at baseline and after 12 weeks. The biomechanical device was individually calibrated to each patient at baseline to allow training under reduced pain.Findings
Gait velocity, step length and single limb support improved significantly and toe out angle decreased significantly (10%, 6%, 1% and 2%, respectively). WOMAC-Pain and WOMAC-Function significantly decreased (26% and 34%, respectively), and SF-36 score significantly increased following the 12 weeks of treatment.Interpretation
Our results suggest an overall improvement in the gait patterns, level of pain and level of function of patients with knee osteoarthritis following 12 weeks of treatment with the novel biomechanical device.The study is registered at clinicaltrials.gov, identifier NCT00767780, http://www.clinicaltrials.gov/ct/show/NCT00767780. 相似文献Background
Individuals with medial knee osteoarthritis often present with varus knee alignment and ambulate with increased knee adduction moments. Understanding the factors that relate to the knee adduction moment in healthy individuals may provide insight into the development of this disease. Thus, this study aimed to examine the relationships of both static and dynamic lower extremity measures with the knee adduction moment. We hypothesized that the dynamic measures would be more closely related to this moment.Methods
Arch height index, hip abduction strength and two static measures of knee alignment were recorded for 37 young asymptomatic knees that varied from normal to varus-aligned. Overground gait analyses were also performed. Correlation coefficients were used to assess the relationships between the static and dynamic variables to the knee adduction moment. Hierarchical regression analyses were then conducted using the static measures, the dynamic measures, and the static and dynamic measures together.Results
Among the static measures, the tibial mechanical axis and the distance between the medial knee joint lines were correlated with the knee adduction moment. The best predictive static model (R2 = 0.53) included only the tibial mechanical axis. Among the dynamic variables, knee adduction and rearfoot eversion angles were correlated with the knee adduction moment. Knee adduction and rearfoot eversion, together, were the best dynamic model (R2 = 0.53). The static and dynamic measures together created the strongest of the three models (R2 = 0.59).Conclusions
These results suggest that dynamic measures slightly enhance the predictive strength of static measures when explaining variation in the knee adduction moment. 相似文献Background
Interpreting gait data is challenging due to intersubject variability observed in the gait pattern of both normal and pathological populations. The objective of this study was to investigate the impact of using principal component analysis for grouping knee osteoarthritis (OA) patients' gait data in more homogeneous groups when studying the effect of a physiotherapy treatment.Methods
Three-dimensional (3D) knee kinematic and kinetic data were recorded during the gait of 29 participants diagnosed with knee OA before and after they received 12 weeks of physiotherapy treatment. Principal component analysis was applied to extract groups of knee flexion/extension, adduction/abduction and internal/external rotation angle and moment data. The treatment's effect on parameters of interest was assessed using paired t-tests performed before and after grouping the knee kinematic data.Findings
Increased quadriceps and hamstring strength was observed following treatment (P < 0.05). Except for the knee flexion/extension angle, two different groups (G1 and G2) were extracted from the angle and moment data. When pre- and post-treatment analyses were performed considering the groups, participants exhibiting a G2 knee moment pattern demonstrated a greater first peak flexion moment, lower adduction moment impulse and smaller rotation angle range post-treatment (P < 0.05). When pre- and post-treatment comparisons were performed without grouping, the data showed no treatment effect.Interpretation
The results of the present study suggest that the effect of physiotherapy on gait mechanics of knee osteoarthritis patients may be masked or underestimated if kinematic data are not separated into more homogeneous groups when performing pre- and post-treatment comparisons. 相似文献- Implications for Rehabilitation
Osteoarthritis is a progressive joint disabling condition that restricts physical function and participation in daily activities, particularity in elderly individuals.
Obesity is a comorbidity commonly associated with osteoarthritis and it appears to increase self-reported disability in those diagnosed with osteoarthritis of the knee.
In a relatively small sample, this study recommends that rehabilitation professionals obtain self-report questionnaires of disability after performance-based tests in obese individuals with osteoarthritis of the knee as they are more likely to give an accurate representation of their level of ability at this time.