共查询到20条相似文献,搜索用时 15 毫秒
1.
Immediate and short‐term effects of real‐time knee adduction moment feedback on the peak and cumulative knee load during walking 下载免费PDF全文
The peak external knee adduction moment (pKAM), KAM impulse, and peak knee flexion moment (pKFM) during gait are important loading variables in medial tibiofemoral osteoarthritis. We evaluated the effects of gait modification, using real‐time pKAM visual feedback, on pKAM, KAM impulse, and pKFM; and whether participants could maintain the KAM‐reducing gait after feedback removal. Eleven healthy individuals performed a series of walking trials on a split‐belt instrumented treadmill under four conditions of Baseline, Feedback, No Feedback Early, and No Feedback Late. Guided by real‐time feedback of pKAM, they modified their gait patterns to lower pKAM by 20%. Three‐dimensional joint kinematics/kinetics during each walking condition were recorded by a 12‐camera motion capture system and the instrumented treadmill. Change in each knee loading parameter from baseline across conditions was assessed using one‐way repeated‐measures analysis‐of‐variances. In the feedback limb, successful 20% reductions from baseline in pKAM and KAM impulse were achieved across all three conditions. There was a trend for concomitant pKFM increases, partially attenuating the beneficial effects of pKAM reduction. A carry‐over effect of KAM reduction in the non‐feedback limb was noted. The altered gait patterns were participant‐specific and multi‐modal; each participant reported a combination of two to three gait modification strategies used for pKAM reduction. Toe‐in and medial foot contact were the most reported strategies. The findings support the real‐time pKAM visual feedback as a tool for individualized gait modification to reduce knee load. Future studies to evaluate its effectiveness in persons with or at risk for medial knee osteoarthritis is warranted. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:397–404, 2018. 相似文献
2.
Effects of lateral‐offset sole shoes on knee adduction moment in women with medial compartment knee osteoarthritis 下载免费PDF全文
Woo Young Jang Hae Woon Jung Gi Won Choi Hyun Min Lee Hae Soo Park Soon Hyuck Lee 《Journal of orthopaedic research》2018,36(6):1694-1700
3.
Erhart-Hledik JC Elspas B Giori NJ Andriacchi TP 《Journal of orthopaedic research》2012,30(4):514-521
This study investigated the load‐modifying and clinical efficacy of variable‐stiffness shoes after 12 months in subjects with medial compartment knee osteoarthritis. Subjects who completed a prior 6‐month study were asked to wear their assigned constant‐stiffness control or variable‐stiffness intervention shoes during the remainder of the study. Changes in peak knee adduction moment, total Western Ontario and McMaster Universities (WOMAC), and WOMAC pain scores were assessed. Seventy‐nine subjects were enrolled, and 55 completed the trial. Using an intention‐to‐treat analysis, the variable‐stiffness shoes reduced the within‐day peak knee adduction moment (?5.5%, p < 0.001) in the intervention subjects, while the constant‐stiffness shoes increased the peak knee adduction moment in the control subjects (+3.1%, p = 0.015) at the 12‐month visit. WOMAC pain and total scores for the intervention group were significantly reduced from baseline to 12 months (?32%, p = 0.002 and ?35%, p = 0.007, respectively). The control group had a reduction of 27% in WOMAC pain score (p = 0.04) and no significant reduction in total WOMAC score. Reductions in WOMAC pain and total scores were similar between groups (p = 0.8 and p = 0.47, respectively). In the intervention group, reductions in adduction moment were related to improvements in pain and function (R2 = 0.11, p = 0.04). Analysis by disease severity revealed greater efficacy in adduction moment reduction in the less severe intervention group. While the long‐term effects of the intervention shoes on pain and function did not differ from control, the data suggest wearing the intervention shoe reduces the within‐day adduction moment after long‐term wear, and thus should reduce loading on the affected medial compartment of the knee. © 2011 Orthopaedic Research Society. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 30:514–521, 2012 相似文献
4.
General scheme to reduce the knee adduction moment by modifying a combination of gait variables 下载免费PDF全文
Julien Favre Jennifer C. Erhart‐Hledik Eric F. Chehab Thomas P. Andriacchi 《Journal of orthopaedic research》2016,34(9):1547-1556
Reducing the knee adduction moment (KAM) is a promising treatment for medial compartment knee osteoarthritis (OA). Although several gait modifications to lower the KAM have been identified, the potential to combine modifications and individual dose‐responses remain unknown. This study hypothesized that: (i) there is a general scheme consisting of modifications in trunk sway, step width, walking speed, and foot progression angle that reduces the KAM; (ii) gait modifications can be combined; and (iii) dose‐responses differ among individuals. Walking trials with simultaneous modifications in step width, walking speed, progression angle, and trunk sway were analyzed for 10 healthy subjects. Wider step width, slower speed, toeing‐in, and increased trunk sway resulted in reduced first KAM peak, whereas wider step width, faster speed, and increased trunk sway reduced the KAM angular impulse. Individual regressions accurately modeled the amplitude of the KAM variables relative to the amplitude of the gait modification variables, while the dose‐responses varied strongly among participants. In conclusion, increasing trunk sway, increasing step width, and toeing‐in are three gait modifications that could be combined to reduce KAM variables related to knee OA. Results also indicated that some gait modifications reducing the KAM induced changes in the knee flexion moment possibly indicative of an increase in knee loading. Taken together with the different dose‐responses among subjects, this study suggested that gait retraining programs should consider this general scheme of modifications with individualization of the modification amplitudes. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1547–1556, 2016. 相似文献
5.
Amir Haim Alon Wolf Guy Rubin Yulya Genis Mona Khoury Nimrod Rozen 《Journal of orthopaedic research》2011,29(11):1668-1674
The knee adduction moment (KAM) provides a major contribution to the elevated load in the medial compartment of the knee. An abnormally high KAM has been linked with the progression of knee osteoarthritis (OA). Footwear‐generated biomechanical manipulations reduce the magnitude of this moment by conveying a more laterally shifted trajectory of the foot's center of pressure (COP), reducing the distance between the ground reaction force and the center of the knee joint, thus lowering the magnitude of the torque. We sought to examine the outcome of a COP shift in a cohort of female patients suffering from medial knee OA. Twenty‐two female patients suffering from medial compartment knee OA underwent successive gait analysis testing and direct pedobarographic examination of the COP trajectory with a foot‐worn biomechanical device allowing controlled manipulation of the COP. Modulation of the COP coronal trajectory from medial to lateral offset resulted in a significant reduction of the KAM. This trend was demonstrated in subjects with mild‐to‐moderate OA and in patients suffering from severe stages of the disease. Our results indicate that controlled manipulation of knee coronal kinetics in individuals suffering from medial knee OA can be facilitated by customized COP modification. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29:1668–1674, 2011 相似文献
6.
Changes in the total knee joint moment in patients with medial compartment knee osteoarthritis over 5 years 下载免费PDF全文
Jessica L. Asay Jennifer C. Erhart‐Hledik Thomas P. Andriacchi 《Journal of orthopaedic research》2018,36(9):2373-2379
7.
8.
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 下载免费PDF全文
Richard K. Jones Graham J. Chapman Matthew J. Parkes Laura. Forsythe David T. Felson 《Journal of orthopaedic research》2015,33(11):1646-1654
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. 相似文献
9.
Dong Zhao Scott A Banks Kim H Mitchell Darryl D D'Lima Clifford W Colwell Benjamin J Fregly 《Journal of orthopaedic research》2007,25(6):789-797
The external knee adduction torque has been proposed as a surrogate measure for medial compartment load during gait. However, a direct link between these two quantities has not been demonstrated using in vivo measurement of medial compartment load. This study uses in vivo data collected from a single subject with an instrumented knee implant to evaluate this link. The subject performed five different overground gait motions (normal, fast, slow, wide, and toe-out) with simultaneous collection of instrumented implant, video motion, and ground reaction data. For each trial, the knee adduction torque was measured externally while the total axial force applied to the tibial insert was measured internally. Based on data collected from the same subject performing treadmill gait under fluoroscopic motion analysis, a regression equation was developed to calculate medial contact force from the implant load cell measurements. Correlation analyses were performed for the stance phase and entire gait cycle to quantify the relationship between the knee adduction torque and both the medial contact force and the medial to total contact force ratio. When the entire gait cycle was analyzed, R(2) for medial contact force was 0.77 when all gait trials were analyzed together and between 0.69 and 0.93 when each gait trial was analyzed separately (p < 0.001 in all cases). For medial to total force ratio, R(2) was 0.69 for all trials together and between 0.54 and 0.90 for each trial separately (p < 0.001 in all cases). When only the stance phase was analyzed, R(2) values were slightly lower. These results support the hypothesis that the knee adduction torque is highly correlated with medial compartment contact force and medial to total force ratio during gait. 相似文献
10.
Roda RD Wilson JL Wilson DA Richardson G Dunbar MJ 《The Journal of arthroplasty》2012,27(6):1244-1250
Computer-assisted surgery can be used to measure 3-dimensional knee function during arthroplasty surgery; however, it is unknown if the movement of the knee measured during surgery is related to the in vitro, dynamic state of the knee joint, specifically the knee adduction moment during gait, which has been related to implant migration. The purpose of this study was to determine if the preoperative adduction moment is correlated with the knee abduction/adduction angle measured intraoperatively. A statistically significant correlation was found between the mean (r(2) = 0.59; P = .001) and peak (r(2) = 0.53; P = .003) preoperative knee adduction moment and the mean abduction/adduction angle measured intraoperatively. The association found in this study suggests the potential for incorporating functional information that relates to surgical outcome into surgical decision making using computer-assisted surgery. 相似文献
11.
Evidence and mechanism by which upper partial fibulectomy improves knee biomechanics and decreases knee pain of osteoarthritis 下载免费PDF全文
Yong Nie ZeYu Huang Bin Xu Bin Shen Virginia B. Kraus FuXing Pei 《Journal of orthopaedic research》2018,36(8):2099-2108
12.
13.
Pete B. Shull Amy Silder Rebecca Shultz Jason L. Dragoo Thor F. Besier Scott L. Delp Mark R. Cutkosky 《Journal of orthopaedic research》2013,31(7):1020-1025
This study examined the influence of a 6‐week gait retraining program on the knee adduction moment (KAM) and knee pain and function. Ten subjects with medial compartment knee osteoarthritis and self‐reported knee pain participated in weekly gait retraining sessions over 6 weeks. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and a 10‐point visual‐analog pain scale score were measured at baseline, post‐training (end of 6 weeks), and 1 month after training ended. Gait retraining reduced the first peak KAM by 20% (p < 0.01) post‐training as a result of a 7° decrease in foot progression angle (i.e., increased internal foot rotation), compared to baseline (p < 0.01). WOMAC pain and function scores were improved at post‐training by 29% and 32%, respectively (p < 0.05) and visual‐analog pain scale scores improved by two points (p < 0.05). Changes in WOMAC pain and function were approximately 75% larger than the expected placebo effect (p < 0.05). Changes in KAM, foot progression angle, WOMAC pain and function, and visual‐analog pain score were retained 1 month after the end of the 6‐week training period (p < 0.05). These results show that a 6‐week gait retraining program can reduce the KAM and improve symptoms for individuals with medial compartment knee osteoarthritis and knee pain. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:1020–1025, 2013 相似文献
14.
Xavier Robert-Lachaine Yoann Dessery Étienne L. Belzile Sylvie Turmel Philippe Corbeil 《Journal of orthopaedic research》2020,38(10):2262-2271
Immediate biomechanical and functional effects of knee braces are often reported, however, the duration and type of knee brace treatment for knee osteoarthritis (KOA) remain unclear. The objective was to evaluate usage, comfort, pain, and knee adduction moment (KAM) of three knee braces each worn 3 months by patients. Twenty-four patients with KOA were assigned in a randomized crossover trial a valgus three-point bending system brace (V3P-brace), an unloader brace with valgus and external rotation functions (VER-brace) and a stabilizing brace used after ligament injuries (ACL-brace). Functional questionnaires and gait assessment were carried out before and after each brace wear period of 3 months. A Friedman test was applied between brace wear diary recordings. Repeated measures analyses of variance contrasted the factors brace type (ACL, V3P, and VER), time (pre and post) and wear (without and with) on comfort, pain, function, and KAM. Brace usage was similar, but the V3P-brace was slightly less worn. Discomfort was significantly lowered with the VER-brace. All knee braces relieved pain and symptoms from 10% to 40%. KAM angular impulse was reduced with the three braces, but the VER-brace obtained the lowest relative reduction of 9%. The interaction between time and wear indicated that part of the KAM reduction with brace wear was maintained post treatment. All three knee braces have great benefits for pain and function among the medial KOA population. The VER-brace offers additional advantages on daily use, comfort and KAM, which could improve compliance to brace treatment. 相似文献
15.
Benjamin J. Fregly Darryl D. D'Lima Clifford W. Colwell Jr. 《Journal of orthopaedic research》2009,27(8):1016-1021
Gait modification offers a noninvasive option for offloading the medial compartment of the knee in patients with knee osteoarthritis. While gait modifications have been proposed based on their ability to reduce the external knee adduction moment, no gait pattern has been proven to reduce medial compartment contact force directly. This study used in vivo contact force data collected from a single subject with a force‐measuring knee replacement to evaluate the effectiveness of two gait patterns at achieving this goal. The first was a “medial thrust” gait pattern that involved medializing the knee during stance phase, while the second was a “walking pole” gait pattern that involved using bilateral walking poles commonly used for hiking. Compared to the subject's normal gait pattern, medial thrust gait produced a 16% reduction and walking pole gait a 27% reduction in medial contact force over stance phase, both of which were statistically significant based on a two‐tailed Mann–Whitney U‐test. While medial thrust gait produced little change in lateral and total contact force over the stance phase, walking pole gait produced significant 11% and 21% reductions, respectively. Medial thrust gait may allow patients with knee osteoarthritis to reduce medial contact force using a normal‐looking walking motion requiring no external equipment, while walking pole gait may allow patients with knee osteoarthritis or a knee replacement to reduce medial, lateral, and total contact force in situations where the use of walking poles is possible. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 1016–1021, 2009 相似文献
16.
Jonas Weidow Roy Tranberg Tuuli Saari Johan Krrholm 《Journal of orthopaedic research》2006,24(9):1890-1899
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. 相似文献
17.
《Journal of orthopaedic research》2017,35(8):1661-1670
18.
Janie L. Astephen Kevin J. Deluzio Graham E. Caldwell Michael J. Dunbar 《Journal of orthopaedic research》2008,26(3):332-341
Mechanical factors have been implicated in the progression of knee osteoarthritis (OA). Understanding how these factors change as the condition progresses would elucidate their role and help in developing interventions that could delay the progress of knee OA. In this cross‐sectional study, we identified kinematic and kinetic variables at the hip, knee, and ankle joints that change between three clinically distinct levels of knee OA disease severity: asymptomatic, moderate OA, and severe OA. The severity level was based on a combined radiographic/symptomatic clinical decision for treatment with (severe) or without (moderate) total knee replacement surgery. Gait variables that changed between groups were categorized as: those that differed between the asymptomatic group and both OA groups, those that differed between the asymptomatic group and the severe OA group only, or those that changed progressively, that is, the asymptomatic differed from the moderate OA, and the moderate OA differed from the severe OA group. Changes seen in both OA subject groups compared to asymptomatic included increased mid‐stance knee adduction moments, decreased peak knee flexion moments, decreased peak hip adduction moments, and decreased peak hip extension moments. Changes found only in the severe knee OA group included multiple kinematic and kinetic differences at the hip, knee, and ankle joints. Gait differences that progressed with OA severity included decreased stance phase knee flexion angles, decreased early stance knee extension moments, decreased peak stance phase hip internal rotation moments, and decreased peak ankle dorsiflexion moments. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:332–341, 2008 相似文献
19.
Hicks-Little CA Peindl RD Fehring TK Odum SM Hubbard TJ Cordova ML 《The Journal of arthroplasty》2012,27(6):1183-1189
Knee osteoarthritis (OA) accounts for more functional disability of the lower extremity than any other disease. We recruited 18 patients with knee OA and 18 healthy age-, height-, mass-, and gender-matched control subjects to investigate the effects knee OA has on select spatial and temporal gait variables during a stair climbing task. No group-by-direction interaction was observed; however, significant effects did occur for group and direction. Specifically, patients with knee OA demonstrated less time in single support, greater time in double support, decreased step length, greater step width, less stride length, decreased total gait velocity, greater total time in support, and less total time in swing, compared with controls. Early-stage knee OA directly influences specific temporal and spatial gait characteristics during stair climbing. 相似文献
20.
Knee and ankle biomechanics with lateral wedges with and without a custom arch support in those with medial knee osteoarthritis and flat feet 下载免费PDF全文
Gillian L. Hatfield Christopher K. Cochrane Judit Takacs Natasha M. Krowchuk Ryan Chang Rana S. Hinman Michael A. Hunt 《Journal of orthopaedic research》2016,34(9):1597-1605
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. 相似文献