Article

Improvement in function after valgus bracing of the knee. An analysis of gait symmetry

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Abstract

The use of a valgus brace can effectively relieve the symptoms of unicompartmental osteoarthritis of the knee. This study provides an objective measurement of function by analysis of gait symmetry. This was measured in 30 patients on four separate occasions: immediately before and after initial fitting and then again at three months with the brace on and off. All patients reported immediate symptomatic improvement with less pain on walking. After fitting the brace, symmetry indices of stance and the swing phase of gait showed a consistent and immediate improvement at 0 and 3 months, respectively, of 3.92% (p = 0.030) and 3.40% (p = 0.025) in the stance phase and 11.78% (p = 0.020) and 9.58% (p = 0.005) in the swing phase. This was confirmed by a significant improvement at three months in the mean Hospital for Special Surgery (HSS) knee score from 69.9 to 82.0 (p < 0.001). Thus, wearing a valgus brace gives a significant and immediate improvement in the function of patients with unicompartmental osteoarthritis of the knee, as measured by analysis of gait symmetry.

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... Symétrie du pas. Une étude de niveau 4 selon l'Anaes a décrit une amélioration de la symétrie du pas pendant les phases d'appui et oscillante avec orthèses articulées valgisante, versus absence d'orthèse, chez 30 patients ayant une arthrose fémorotibiale [21]. Des variations dans le ratio phase d'appui sur phase oscillante ont suggéré un allongement de la phase d'appui alors que la phase oscillante est ralentie. ...
... 3 [9,[13][14][15][16]18,21] ont évalué l'effet d'orthèses articulées sur la douleur et l'incapacité chez les patients avec une arthrose fémorotibiale avec ou sans genu varum. Les résultats ont suggéré une efficacité de ces dispositifs en comparaison aux patients sans orthèses. ...
... Les orthèses articulées améliorent la force isocinétique du quadriceps [13], mais les résultats concernant la force du coup de pied sont inconstants [14,15,20]. Ce dispositif n'améliore pas la rapidité de la marche [14][15][16] mais améliore la force de propulsion verticale [20] et la symétrie du pas [21]. Cependant, l'effet n'est pas supérieur à celui d'une orthèse articulée en position neutre (pas de valgus) [20]. ...
Article
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Objectif Développer des recommandations de pratique clinique sur l’utilisation des orthèses de contention (de repos, souples non adhésives et articulées) dans la gonarthrose. Méthodes La méthodologie de la Société française de médecine physique et de réadaptation (Sofmer), qui associe une revue systématique de la littérature, un recueil des pratiques professionnelles et une validation par un panel d’experts multidisciplinaires, a été utilisée. Résultats Il existe peu d’études de niveau de preuve élevé sur les orthèses de contention dans la gonarthrose. L’efficacité des orthèses de repos n’a pas été démontrée. Les orthèses souples non adhésives ou genouillères élastiques diminuent la douleur dans la gonarthrose et leur utilisation s’accompagne d’une amélioration subjective. Ces actions ne semblent pas dépendre d’un effet thermique local. L’efficacité des orthèses souples n’est pas démontrée dans l’incapacité liée à la gonarthrose. Les orthèses articulées valgisantes diminuent la douleur et réduisent l’incapacité fonctionnelle dans la gonarthrose fémorotibiale interne à court et à moyen termes. Leur efficacité paraît supérieure à celle des orthèses souples, elles améliorent la qualité de vie, la proprioception du genou, la force du quadriceps, la symétrie du pas et, enfin, diminuent la charge compressive dans le compartiment fémorotibial interne. Cependant, l’efficacité des orthèses valgisantes est inconstante, il peut en résulter un inconfort et des effets indésirables. Des thrombophlébites des membres inférieurs secondaires à l’utilisation de telles contentions ont été rapportées. Les orthèses, quelles qu’elles soient, sont peu souvent prescrites en pratique clinique dans l’arthrose des membres inférieurs. Conclusion Seules des recommandations de faible niveau de preuve existent sur l’efficacité des orthèses (de repos, souples non adhésives et articulées de décharge) dans la gonarthrose. Celles-ci restent peu prescrites dans la pratique clinique française. Des essais randomisés sur l’utilisation des orthèses dans la gonarthrose restent nécessaires.
... OA of the lower extremity is mediated, at least in part, through aberrant dynamic loads (loads during ambulation) transmitted across the joints. Quantification and assessment of these knee loads through gait analysis has demonstrated that in knee OA, elevated joint loads are directly associated with radiographic severity (4,5), disease progression (6), and pain (7)(8)(9), and correspondingly, reduction of loading at the knee may yield significant symptomatic benefits (10,11). ...
... There has been interest in biomechanical interventions targeted at decreasing joint loading, with hopes of thereby improving pain and delaying disease progression. These interventions have included orthotic shoe inserts (12)(13)(14), knee braces (10,11,(15)(16)(17), and more recently, footwear (18)(19)(20)(21)(22). We have previously shown that walking barefoot (23), as well as walking in footwear designed to mimic barefoot mechanics (i.e., mobility shoes), is associated with reductions in knee loading when compared to walking in conventional footwear (19). ...
Article
Biomechanical interventions for knee osteoarthritis (OA) aim to improve pain and retard disease progression by decreasing knee loading. This study was undertaken to evaluate the effects of 6 months of use of flat, flexible footwear (the mobility shoe) on knee loading in OA. Subjects with knee OA underwent baseline gait analyses under conditions of walking in their own shoes, walking in mobility shoes, and walking barefoot. Thereafter, subjects wore the mobility shoes at least 6 hours per day for 6 days per week. Gait evaluations were repeated at 6, 12, and 24 weeks. An intent-to-treat analysis was performed to assess the longitudinal effects on knee loading with the shoe intervention. Compared to knee loading at baseline with the participants' own shoes, there was an 18% reduction in the knee adduction moment (KAM) by 24 weeks with the mobility shoes (P < 0.001) and no significant differences in the KAM by 24 weeks between mobility shoe and barefoot walking (P = 0.192). Over the 6 months of followup, participants also experienced an 11% reduction in the KAM when walking in their own shoes (P = 0.002) and a 10% reduction in the KAM when walking barefoot (P = 0.002 for the whole followup), as compared to these values at baseline under the same conditions. This study suggests that use of flat, flexible footwear results in significant reductions in knee loading in subjects with OA. By 24 weeks, there is evidence of a gait adaptation with sustained load reduction even when the mobility shoes are removed, suggesting that footwear may serve as a biomechanical training device to achieve beneficial alterations in gait mechanics for knee OA.
... According to the OARSI, conservative treatments, such as physical measures that allow improvement of biomechanical aspects and minimize intra-articular load, particularly KAM, produce the best evidence of efficacy. Braces for knee misalignments [7,8] and foot splints [9][10][11][12][13] are commonly used and frequently recommended as important interventions for the management of knee OA. ...
... It is important to emphasize that this type of footwear has been available in our country on a large scale since the 1980s, and it is widely used for the comfort it provides. Therefore, it is expected that adherence to this form of therapy will be greater and easier than the use of knee braces [7,8] and subtalar strapping splints [9]. ...
Article
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Recent studies have shown an important reduction of joint overload during locomotion in elderly women with knee osteoarthritis (OA) after short-term use of minimalist shoes. Our aim is to investigate the chronic effect of inexpensive and minimalist footwear on the clinical and functional aspects of OA and gait biomechanics of elderly women with knee OA. Fifty-six elderly women with knee OA grade 2 or 3 (Kellgren and Lawrence) are randomized into blocks and allocated to either the intervention group, which will use flexible, non-heeled shoes- Moleca®-for six months for at least six hours daily, or the control group, which could not use these shoes. Neither group is undergoing physical therapy treatment throughout the intervention period. Moleca® is a women's double canvas, flexible, flat walking shoe without heels, with a 5-mm anti-slip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. Both groups will be followed for six months and will be assessed at baseline condition, after three months, and after six months (end of intervention). All the assessments will be performed by a physiotherapist that is blind to the group allocation. The primary outcome is the pain Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. The secondary outcomes are global WOMAC score; joint stiffness and disability WOMAC scores; knee pain with a visual analogue scale; walking distance in the six-minute walk test; Lequesne score; amount and frequency (number of days) of paracetamol (500 mg) intake over six months; knee adduction moment during gait; global medical assessment score; and global patient auto-assessment score. At baseline, all patients receive a diary to record the hours of daily use of the footwear intervention; every two weeks, the same physiotherapist makes phone calls to all patients in order to verify adherence to treatment. The statistical analysis will be based on intention-to-treat analysis, as well as general linear models of analysis of variance for repeated measure to detect treatment-time interactions (α = 5%). This is the first randomized, clinical trial protocol to assess the chronic effect of minimalist footwear on the clinical and functional aspects and gait biomechanics of elderly women with knee osteoarthritis. We expect that the use of Moleca® shoes for six months will provide pain relief, reduction of the knee adduction moment when walking, and improve joint function in elderly women with knee OA, and that the treatment, thus, can be considered another inexpensive and easy-to-use option for conservative OA treatment. NCT01342458.
... 24,25 Knee osteoarthritis (KOA) is one of the most common musculoskeletal conditions that can have more pronounced effects on JPS accuracy and gait characteristics. Compared with matched healthy controls, individuals with KOA often have shown increased gait asymmetry [26][27][28][29] and variability [30][31][32] in one or more spatiotemporal parameters due to combined effects of pain and alignment impairments. 33 Altered gait patterns may lead to walking difficulties, 34 fear of falling, 35 and subsequently loss of functional independency, reducing quality of life 36,37 and increasing risk of death 37 in affected individuals. ...
Article
Knee osteoarthritis (KOA) can have more pronounced effects on joint position sense (JPS) accuracy and gait characteristics. The aim of this study is to investigate the association between lower limb JPS and different aspects of gait pattern including gait asymmetry and variability and spatiotemporal coordination in individuals with bilateral KOA. In this cross-sectional study, lower limb JPS of 43 individuals with bilateral KOA (mild and moderate) were measured. Participants’ gait patterns during treadmill walking with self-selected comfortable speed were assessed. The correlations between JPS errors and gait parameters of limb with moderate KOA were analyzed. Positive relationships were found between stance time symmetry index and JPS errors of hip abduction ( r = .46, P = .003), ankle plantar flexion ( r = .33, P = .03), and ankle dorsiflexion ( r = .33, P = .03). Positive relationship was found between single limb support time symmetry index and hip abduction JPS error ( r = .41, P = .008). Significant negative associations were found between coefficient of variation of step length and JPS errors of knee extension ( r = .47, P = .002) and ankle plantar flexion ( r = .33, P = .003). Results did not show any significant relationship between lower limb JPS errors and walk ratio. It is likely that lower limb JPS deficits are partially responsible for some changes in gait patterns observed in individuals with bilateral KOA.
... Unloader knee orthoses used in valgus corrective bracing have shown great potential in improving the isokinetic strength of the quadriceps, as well as vertical propulsive force and gait symmetry, yet no improvements in gait velocity [13,51]. On the contrary, Toriyama et al. alleged that patients with unloader knee braces displayed higher walking speed and pace than those without bracing, which further highlights their inconsistencies [33]. ...
... Many studies have found significant asymmetry between hemiplegic limbs and nonhemiplegic limbs in stroke patients. The hemiplegic limbs have a slow gait rate, and their dysfunction leads to short standing durations, prolonged swinging durations, and reduced ground responses [36][37][38] , leading to insufficient power and poor progress. To adapt to this compensatory dysfunction, patients need to rely on the nonhemiplegic limb to maintain balance and push forwards, resulting in biomechanical changes of the nonhemiplegic limb, presenting with an erratic gait 39 . ...
Article
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Genu recurvatum in stroke patients with hemiplegia causes readily cumulative damage and degenerative changes in the knee cartilage. It is important to detect early cartilage lesions for appropriate treatment and rehabilitation. The purpose of this cross-sectional study was to provide a theoretical basis for the early rehabilitation of hemiplegia patients. We used a zero TE double-echo imaging sequence to analyse the water content in knee joint cartilage at 12 different sites of 39 stroke patients with genu recurvatum and 9 healthy volunteers using a metric similar to the porosity index. When comparing the hemiplegic limb vs. the nonhemiplegic limb in patients, the ratios of the deep/shallow free water content of the femur cartilages at the anterior horn (1.16 vs. 1.06) and posterior horn (1.13 vs. 1.25) of the lateral meniscus were significantly different. Genu recurvatum in stroke patients with hemiplegia can cause changes in the moisture content of knee cartilage, and the changes in knee cartilage are more obvious as the genu recurvatum increases. The "healthy limb" can no longer be considered truly healthy and should be considered simultaneously with the affected limb in the development of a rehabilitation treatment plan.
... Many studies have found significant asymmetry between hemiplegic limbs and nonhemiplegic limbs in stroke patients. The hemiplegic limbs have slow gait rate, and their dysfunction leads to short standing time, prolonged swinging time, and reduced ground response [36][37][38], leading to insufficient power and poor progress. In order to adapt to this compensatory dysfunction, patients need to rely on the non-hemiplegic limb to maintain balance and push forward, resulting in biomechanical changes of the non-hemiplegic limb, presenting spastic gait [39]. ...
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-BACKGROUND: Genu recurvatum in stroke patient hemiplegia causes readily cumulative damage and degenerative changes of knee cartilage. It is important to detect early lesions of cartilage for appropriate treatment and rehabilitation. -PURPOSE: The purpose is to provide theoretical basis for early rehabilitation of hemiplegia patients. -STUDY TYPE: Cross-sectional study. -POPULATION: 39 Stroke patients with genu recurvatum and 9 healthy volunteers. -SEQUENCE: We used zero TE double echo imaging sequence. -ASSESSMENT: Analyze the water content in knee joint cartilage at 12 different sites of stroke patients with genu recurvatum using a method similar to porosity index. -STATISTICAL TESTS: Statistical analysis was performed using SPSS 17.0 statistical software. The mean ± standard deviation was used to represent the mean. The independent sample t test was used for all mean comparisons. When the data did not conform to the normal distribution or variance heterogeneity, the non-parametric test was used. P< 0.05 was considered statistically significant. -RESULTS: When compared hemiplegia limb vs. non-hemiplegia limb in patients, the ratio of deep/shallow free water content of the cartilages at the junction of the femur and anterior horn (1.16 vs. 1.06) and posterior horn (1.13 vs. 1.25) of lateral meniscus were significant differences (P<0.05). -DATA CONCLUSION: Conclusion is that Genu recurvatum in stroke patients with hemiplegia can cause changes in moisture content of knee cartilage, and the changes of knee cartilage are more obvious with the increase of genu recurvatum. The so-called "healthy limb" is no longer the real meaning of healthy limb, and should be considered simultaneously with the affected limb in the development of rehabilitation treatment plan.
... In this research, though the HSS knee score improved in both groups after treatment, the amelioration of the HSS knee score in the fibulectomy group was better than that in the drug group at last follow-up with statistical differences. In our study, the HSS knee score in the partial fibulectomy group increased by 40.9% compared with increases of 30.7% [5], 29.4% [5], 17.3% [16], 28.5% [6], and 49.2% [17] reported for treatment with lateral wedge insoles, acupuncture, knee braces, toe-out gait modification, and opening wedge HTO, respectively. ...
Article
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Background: Upper partial fibulectomy has been preliminarily proved to have the efficacy for pain alleviation and improvement of function in patients with mild to moderate medial compartment knee osteoarthritis (KOA). However, the previous studies lack the control group with other treatments. The aim of this prospective, randomized controlled study is to compare the clinical and biomechanical effects between upper partial fibulectomy and drug conservative treatment on improvement of clinical pain, function, and gait for patients with mild to moderate medial knee osteoarthritis (KOA) and further discuss its biomechanical mechanism. Methods: From August 2016 to February 2017, 49 and 48 patients with mild to moderate medial KOA were allocated to fibulectomy and drug groups. We assessed the patients' visual analog scale (VAS) pain score, Hospital for Special Surgery (HSS) knee score, limb alignment, passive flexion/extension range of motion (ROM) of the knee, and 3D gait kinematics and kinetics parameters before and after intervention. Repeated-measures ANOVA with Dunnett's post hoc assessment and multivariate analysis of variance were applied for intragroup and intergroup comparisons, respectively. Results: The improvement in the fibulectomy group on the VAS pain score, HSS knee score, walking speed, and walking knee range of motion (ROM) was statistically better than that in the drug group. The decreased overall peak knee adduction moment (KAM) (decreased by 16.1%) and hip-knee-ankle (HKA) angle (decreased by 0.99° from a more varus alignment to a more neutral alignment) of the affected and operated side 1 year after surgery were observed in the fibulectomy group. Conclusion: This research demonstrated that as a biomechanical intervention, upper partial fibulectomy can be a better choice in pain relief and function and gait improvement than drug conservative treatment for patients with early-stage knee OA. The long-term clinical outcomes, indication, and rationale for the improvement in clinical symptoms should be investigated further.
... 55 Nonetheless, there is evidence that the global reduction in pain associated with consistent use of knee braces may facilitate correction of gait asymmetry and improvement in function. 56 Although promising data exist, the variability across these different trials suggests that more robust clinical trials are needed before an unequivocal recommendation can be made on behalf of knee braces for the treatment of OA. ...
Article
The goal of the practitioner managing a patient with knee osteoarthritis (OA) is to minimize pain and optimize their function. Several noninterventional (noninjectable) therapies are available for these individuals, each having varying levels of efficacy. An individualized approach to the patient is most beneficial in individuals with knee OA and the treatment plan the practitioner chooses should be based on this principle. The focus of this article is to provide an up-to-date overview of the treatment strategies available, evidence to support them, and in whom these treatments would be most appropriate. These include exercise (aerobic and resistance), weight loss, bracing and orthotics, topical and oral analgesic medications, therapeutic modalities, and oral supplements.
... The majority of included studies were of level 2 evidence (n = 14) (Table 1). 2,7,11,13,16,18,19,21,22,25,33,44,49,51 There were 3 studies of level 1 evidence, 27,39,45 7 studies of level 3 evidence, 12,14,17,26,47,48,52 and 5 studies of level 4 evidence. 20,23,29,30,32 The mean MINORS score was 12.3 ± 1.9, which indicates fair quality of evidence for nonrandomized studies. ...
Article
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Context: Knee osteoarthritis affects 9.3 million adults over age 45 years in the United States. There is significant disability associated with this condition. Given the potential complications and the significant cost to the health care system with the dramatic increase in total knee arthroplasties performed for this condition, assessment of the efficacy of nonoperative modalities, such as offloading knee braces, is essential as part of optimizing nonoperative treatment for this condition. Objective: To determine the effectiveness of valgus offloader braces in improving clinical outcomes for patients with medial compartment knee osteoarthritis. Data Sources: Three databases (PubMed, MEDLINE, and EMBASE) were searched from data base inception through July 28, 2017. Study Selection: Studies reporting outcomes of valgus offloader knee braces in the treatment of medial compartment knee osteoarthritis were included. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Data pertaining to demographics, descriptive statistics, and clinical outcomes were extracted from the included studies. The methodological quality of included studies was evaluated. Results: A total of 31 studies were included, with a total of 619 patients. The majority of studies reported improved pain outcomes using valgus offloader braces. However, variable results were reported as to whether valgus offloader braces significantly improved functional outcomes and stiffness. Offloader bracing was more effective at reducing pain when compared with neutral braces or neoprene sleeves. Conclusion: Valgus offloader bracing is an effective treatment for improving pain secondary to medial compartment knee osteoarthritis. The literature remains unclear on the effectiveness of valgus offloader braces with regard to functional outcomes and stiffness. Larger prospective randomized trials with consistent outcome assessment tools and consideration of patient compliance would be beneficial to more accurately determine treatment effects of valgus offloader bracing.
... 1-All Correspondences to: Fatemeh Zare Zadeh; Email:< natelnoory@yahoo.com> 2-PhD Student One cross-sectional study suggested that valgus braces immediately improved the function of the patient with unicompartmental osteoarthritis of the knee (13). A randomized clinical trial by Kirkley et al also showed that unloader knee orthoses were effective in improving quality of life and function in knee OA patients (7). ...
Article
Full-text available
Objectives: Patients suffering from mild to moderate knee osteoarthritis may be treated with unloader knee orthoses or laterally wedged insoles. The aim of this study was to identify and compare the effects of two orthoses in these patients. Methods: 56 patients with medial compartment knee OA were evaluated when wearing an unloader knee orthosis and insoles with a 6° lateral wedge which were randomly assigned. Testing was performed at baseline and after 6 months of use with the two types of orthoses. The KOOS score was used to assess outcomes in this study. A paired T test was used for comparing base line and the 6th month post interventions KOOS sub scale score. An independent T test was used for analyzing the efficacy between the two orthoses. Results: Each of the interventions improved all parameters compared to the baseline condition (P=0.000). However, in comparing the effect between these orthoses, we did not find significant differences in activities of daily living (P=0.871), or sports and recreational activities (P=0.351). The pain and symptoms (P=0.000) were, however, significantly different between the two interventions. Discussion: The unloader knee orthoses were more effective than lateral wedge insoles in reducing pain and symptoms.
... The primary aim of this thesis was to explore the use of an instrumented treadmill as a tool to assess higher gait performance. Specifically our goal was to test patients with different types of joint replacement and knee osteoarthritis at higher speeds than that which has been previously reported in case differences existed which may have been undetectable at slower Analysis of gait asymmetry has already been described in clinical practice especially with regards to performance(55), injury (36) and medical technology (111). However, most studies have assessed knee osteoarthritis patients at slower speeds (40) and with conventional methods (112). ...
... 4,12 The symmetry index has been used along with the assessment of functional asymmetry in gait kinematic and kinetic parameters, ground reaction force of gait and running. [13][14][15][16][17] This index defined by Robinson et al. has been widely used to quantify symmetry and it has been found to be cheap, useful, and easily applicable and results are presented clearly. 18 Since preferred and non-preferred leg could be different from each other in nature, it might be acceptable to think that plantar pressure distribution data of preferred foot can be distinct from non-preferred foot. ...
... The restoration of symmetry during gait is therefore often a primary target set for patient rehabilitation [43,44]. The analysis of gait symmetry during the rehabilitation process can aid in monitoring and assessing the effects of treatments or interventions, with improvements in the measured symmetry being used as indications of clinically effective treatment [45]. ...
Article
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Foot pathologies can negatively influence foot function, consequently impairing gait during daily activity, and severely impacting an individual's quality of life. These pathologies are often painful and correspond with high or abnormal plantar pressure, which can result in asymmetry in the pressure distribution between the two feet. There is currently no general consensus on the presence of asymmetry in able-bodied gait, and plantar pressure analysis during gait is in dire need of a standardized method to quantify asymmetry. This paper investigates the use of plantar pressure asymmetry for pathological gait diagnosis. The results of this study involving plantar pressure analysis in fifty one participants (31 healthy and 20 with foot pathologies) support the presence of plantar pressure asymmetry in normal gait. A higher level of asymmetry was detected at the majority of the regions in the feet of the pathological population, including statistically significant differences in the plantar pressure asymmetry in two regions of the foot, metatarsophalangeal joint 3 (MPJ3) and the lateral heel. Quantification of plantar pressure asymmetry may prove to be useful for the identification and diagnosis of various foot pathologies.
... This has spurred research efforts to reduce pain, preserve joints, delay replacement, and where possible restore joint function. High loads across the medial compartment of the OA knee in particular have been linked to both disease severity 1,2 and progression, 3 and so reduction of the loads at the knee is the basis for a number of potentially successful OA treatments, such as wedge insoles, braces, [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] and high tibial osteotomy. [24][25][26][27] A novel approach to reduce loads across the medial knee compartment is offered by the KineSpring system (Moximed, Hayward, CA, USA), which has been in clinical use for unicompartmental knee OA patients since mid-2008. ...
Article
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Introduction The KineSpring implant system has been shown to provide load reductions at the medial compartment of the knee, and has demonstrated clinical success in reducing pain and increasing function in patients with medial knee osteoarthritis. These results depend on the ability of the KineSpring to rotate, lengthen, and shorten to accommodate knee motions, and in response to knee position and loading. Purpose The present study was undertaken to determine length changes of the implanted KineSpring in response to a range of knee positions, external knee loads, and placements by different orthopedic surgeons. Materials and methods KineSpring system components were implanted in ten cadaver leg specimens by ten orthopedic surgeons, and absorber-length changes were measured under combined loading and in different positions of the knee. Results and conclusion Spring compression consistent with knee-load reduction, and device lengthening and shortening to accommodate knee loads and motions were seen. These confirm the functionality of the KineSpring when implanted medially to the knee.
... These results demonstrate that conservative treatments for medial knee OA, such as muscle-strengthening exercises, the insole, and knee brace, effectively improved gait ability and decreased resting and walking pain when applied to patients according to their OA grades. This study shows that the symptoms in patients with severe OA also improved after treatment with the valgus brace.The evidence presented in previous studies regarding whether foot orthoses or knee braces improved pain and function in patients with medial knee OA has been controversial[15,22,23]. Lateral-wedge insoles that did not cover the subtalar joint were used in many of these previous studies. ...
... Entlastende Kniegelenkorthesen werden in der Literatur als sichere und kostengünstige Behandlungsmöglichkeit zur Schmerzreduktion und Funktionsverbesserung bei Patienten mit medialer Gonarthrose beschrieben [8, 11, 15, 20]. Ihre Wirksamkeit wird auf der anderen Seite in Frage gestellt [22]. ...
Article
Hintergrund Valgisierende Orthesen stellen eine kostengünstige Alternative in der Behandlung der medialen Gonarthrose dar. Sie helfen zum einen in der präoperativen Diagnostik als Entscheidungshilfe, ob ein Patient aller Voraussicht nach von einer valgisierenden Osteotomie des Tibiakopfes profitiert. Darüber hinaus ist ein direkter klinischer Nutzen in Form einer Schmerzlinderung und Besserung der Kniegelenkfunktion in einigen Arbeiten gezeigt worden. Diskussion Die genauen Wirkungsmechanismen werden kontrovers diskutiert. Es wird eine Verringerung der mechanischen Last im medialen Kompartiment des Kniegelenks durch Verringerung des Varus, sowie eine Reduktion des gesteigerten Muskeltonus angenommen. Schlussfolgerung Ein langfristiger Nutzen der entlastenden Kniegelenkorthesen ist jedoch umstritten, da zum einen der degenerative Gelenkverschleiß fortschreitet, zum anderen aufgrund des oft fehlenden Tragekomforts der Orthesen die Bereitschaft zum Tragen der Orthese mit der Zeit abnimmt.
... The ratio index (RI) is a common method of analyzing gait symmetry, and has been used to compare peak velocity of below-knee amputees [17], to reflect the degree of asymmetry in each of the support phases of the gait cycle for 25 patients with residual stroke symptoms [18], and to assess subjects with osteoarthritis of the knee [19]. The greatest limitations of this index are its low sensitivity, relatively low asymmetry, and failure to provide information regarding the location of the asymmetry [8]. ...
Article
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Although gait symmetry is being evaluated and reported in the literature with increasing frequency, there is still no generally accepted standard for assessing symmetry, making it difficult to compare studies and establish criteria to guide clinical decision-making. The purpose of this study was to ascertain whether gait symmetry in healthy subjects is consistent when assessed using various coefficients (RI, SI, GA, and SA), and if possible to identify a gait symmetry coefficient with the highest diagnostic utility. The study involved a group of 58 healthy university-level students of physical education and secondary school students aged 20.03 ± 0.97. Measurements of spatial-temporal gait parameters were conducted using the ZEBRIS platform. Our analysis supports existing recommendations that the symmetry index (SI) should be used as the most sensitive assessment of gait symmetry on the basis of spatial-temporal parameters in healthy subjects. Moreover, we developed normative values of individual features for diagnostic purposes.
... In an 18-month follow-up study, varus or valgus malalignment were associated with a four to fivefold increase in medial or lateral progression and joint space narrowing. 26 In addition, recent studies suggest that bracing of OA knees through patella taping can reduce the symptoms and progression associated with advanced or severe knee OA. [27][28][29] Ambulatory aids such as heel and sole wedges are also an interesting option. While there have not been any RCTs reported, longitudinal studies of heel wedges suggest that they may reduce pain, especially for people with early or milder medial OA of the knee. ...
Article
Osteoarthritis is a common cause of disability in the elderly. Management involves pharmacological and non-pharma- cological therapies, often in combination. Paracetamol is regarded as the drug of first choice in the management of pain, however anti-inflammatory drugs or other analgesics should be considered if regular paracetamol fails. If conventional non- steroidal anti-inflammatory drugs or cyclo-oxygena se-2 specific inhibitors are prescribed, attention should be paid to gastrointestinal, hepatic, cardiac and renal risk factors. Recent research indicates that some complementary and alternative medicines (e.g. glucosamine) are effective and should be considered, particularly given their low side effect profile. The evidence around surgical procedures mostly supports arthro- plasty (joint replacement) for severe, refractory knee osteoar- thritis; however arthroscopy has generally been found to be ineffective. Physical therapies, weight loss and joint protec- tion also have a place in management and given that osteoar- thritis contributes to psychological morbidity, supportive programs such as the Arthritis Self-Management Course should also be routinely recommended. J Pharm Pract Res 2002; 32: 276-281.
... [17][18][19][20][21][22][23][24][25][26][27][28][29][30] They have also been shown to improve confidence, function, stiffness and varus rotation during walking. 31 Draper et al. 32 demonstrated that valgus braces immediately improved the function of patients with unicompartmental OA of the knee. Kirkley et al. 33 also demonstrated that such orthoses were effective in improving quality of life, function and pain in knee OA patients. ...
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Background: Patients with medial compartment osteoarthritis of the knee suffer from pain and stiffness. However, current unloader braces are not being used for extended periods by knee osteoarthritis patients due to interface problems, so compliance is an issue. The aim of this study was to design a new bespoke orthosis that could be comfortable to wear while also providing the required correction to reduce medial compartment loading. Case description and methods: A new knee orthosis design was initially tested for its frontal plane correction of knee varus using a surrogate knee model. It was then assessed by a volunteer subject with grade 2 medial compartment knee osteoarthritis using a static standing radiograph. Findings and outcomes: When fitted to the surrogate knee model, the brace corrected the knee from 10° of varus to neutral alignment in the frontal plane. When worn in situ during static stance on the affected leg of the volunteer patient, it corrected the knee by 6° to a less varus position. Conclusion: The orthosis provided frontal plane correction of the knee during static standing. It could therefore prove to be suitable for use by knee osteoarthritis patients.
... 54 In an attempt to identify the efficacy of bracing for relatively younger persons with unicompartmental knee OA, studies in which the participants' mean age was close to 55 years or younger are summarized (Table 2). Overall, partic- ipants' self-report scores significantly improved, 15,32,43,46,[55][56][57][58][59] as did functional performance. 58 Although static alignment may not be affected, 55 knee adduction angles, excursions, and moments show favorable changes with respect to medial compartment loading. ...
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Regular exercise and weight reduction are not only important for maintaining general health, they are also strongly recommended conservative modalities for managing knee osteoarthritis (OA). The objective of this paper is to discuss the mechanics of knee joint loading and to review the most recent literature with respect to the functionality and efficacy of unloader braces for managing knee OA, specifically from the perspective of the middle-aged athlete. Evidence suggests valgus braces for medial compartment knee OA significantly reduce knee adduction angle measures and improve measures relating to medial knee joint loading, as well as gait symmetry and speed. Benefits were demonstrated during walking and during more demanding functional measures such as running and negotiating stairs. No studies have investigated the efficacy of bracing for relatively young athletic OA patients and, thus, the role of bracing for this population during sports remains unclear.
... Among the conservative treatments for OA, use of knee braces has been recognised as effective in reducing pain, improving function , and decreasing joint moments, which could indicate a decrease in joint loading (Draper et al., 2000; Hewett et al., 1998; Kirkley et al., 1999; Brouwer et al., 2006; Lindenfeld et al., 1997; Pollo et al., 2002; Self et al., 2000; Fantini Pagani et al., 2010a, 2010b). Some authors postulated that pain reduction in patients with medial knee OA using an unloader knee brace could be mediated by a decrease in muscle co-contraction, which would reduce internal joint loading, rather than by mechanically unloading of the joint induced by the brace (Ramsey et al., 2007). ...
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The purpose of this study was to analyse the effect of a valgus knee orthosis designed for patients with knee osteoarthritis on the electromyographic activity (EMG) of seven muscles of the lower limb during gait. Twelve patients with medial knee osteoarthritis walked on a treadmill in three different conditions: without orthosis, with a knee orthosis in 4° valgus adjustment and with an orthosis in a neutral flexible adjustment. Root-mean-square (RMS) was analysed in each condition during a 150ms pre-activation phase and during the stance phase of gait, which was divided in four sub-phases. In addition, co-contraction ratios (CCRs) were calculated between extensor/flexor, medial/lateral muscles and between agonist and antagonist muscle pairs. Significant decreases in muscle activity and CCRs were observed with the use of the knee orthosis in both adjustments compared to the condition without orthosis. Using the valgus brace, medial/lateral CCR decreased significantly during the late stance and the flexor/extensor CCR decreased significantly during the loading phase and late stance. Decreases of muscle pairs CCRs were observed with the neutral flexible adjustment. The results support the theory of a possible beneficial effect of knee braces in reducing knee loading by decreasing muscle activation and co-contraction levels, which could contribute to decelerate disease progression in patients with knee osteoarthritis.
... The ratio index (RI) is a common method of analyzing gait symmetry, and has been used to compare peak velocity of below-knee amputees [17], to reflect the degree of asymmetry in each of the support phases of the gait cycle for 25 patients with residual stroke symptoms [18], and to assess subjects with osteoarthritis of the knee [19]. The greatest limitations of this index are its low sensitivity, relatively low asymmetry, and failure to provide information regarding the location of the asymmetry [8]. ...
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Gait recordings exhibit intra-subject, inter-subject, within-trial and between-trial variability as well as data analysis methods. In medicine, comparison of different measuring method results or quantifying changes due to specific treatment is required. The aim of this study was to compare a group homogeneity with respect to dispersion around the reference curve and to compare waveforms of normal and pathological gait data based on joint angle curves. Data files were tracked using APAS system. Our own model of lower limb was used to calculate the trajectories of joint angles for 5 groups: healthy men, women, children, persons with drop foot and Trendelenburg's sign. Waveform parameterizations, RMS, IAE and correlation coefficients were used to compare joint angles with reference curve. The sample scores obtained in this work provide an important information about closeness in the shape of two curves. Using multiple techniques of data analysis will benefit and give more accurate information.
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Abstract: Objectives: Knee Osteoarthritis (OA) is a leading cause of disability in older adults. In current study, the effects of three types of orthoses on pain reduction were evaluated in OA patients in Iran. Methods & Materials: In this prospective clinical trial, thirty-six patients consisting of 11 men and 25 women with age (Mean±SD) of 54.56±2.82 years and diagnosis of mild to moderate knee OA included. Patients were assigned to three groups of neoprene sleeve, unloader knee brace, and insole with lateral heel wedge each with twelve members. Their pain evaluated using visual analog scale before orthotic treatment and again six months after orthotic treatment. The results of each group compared together using paired t statistics. Results: There was a significant difference in knee pain in all three groups before and after orthotic treatment (P<0.05). Percent of pain reduction was 40.909%, 40.186% and 32.493% in neoprene sleeve, unloader knee brace, and insole with lateral heel wedge, respectively. Conclusion: It seems that neoprene sleeve by keeping the knee joint temperature, decreases pain. In group with unloader knee brace, probably the brace alters thigh and calf alignments during walking and causes pain reduction. In insole with lateral heel wedge group, it seems that insole by altering the orientation of calcaneus to valgus, reduces pain. Future studies with more participants and with consideration of longer follow-up in addition to measure knee and calcaneus displacements are recommended. Keywords: Orthoses, Pain, Knee Osteoarthritis, Knee Alignment
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Background Knee orthoses have been extensively used as a nonsurgical approach to improving knee deficiencies. Currently, arthritic knee conditions remain the leading cause of disability, and this number is expected to increase. As the use of knee orthoses varies widely, so has their effectiveness which is still largely debatable. Here, we present the functions and effectiveness of the three most prominent knee orthotic models dedicated to supporting knee osteoarthritis—unloader, patellofemoral, and knee sleeves.Purpose/Research QuestionConsidering the depth and diversity of the many clinical studies and documented laboratory reports published to date, this literature review was created to educate the clinician, patient, and researcher on common knee orthoses used for the management of arthritic knee conditions. In doing so, we discuss their design, biomechanical effects, and clinical efficacy, as well as broader outcomes, limitations, and recommendations for use.Results/SynthesisThe knee orthoses discussed within the scope of this paper are dedicated to protecting the knee against strenuous compressive loads that may affect the patellofemoral and tibiofemoral joints of the knee. Since the knee has multiple axes of motion and articulating surfaces that experience different loads during functional activities, it can be implied that, to a large extent, knee brace designs can differ drastically. Unloader knee orthoses are designed to decrease tibiofemoral and patellofemoral joint pressures. Patellofemoral knee orthoses are designed to decrease strain on the patellofemoral and quadriceps tendons while stabilizing the patella. Knee sleeves are designed to stabilize movements, reduce pain in joints, and improve proprioception across the knee joint.Conclusion Although patients often report benefits from wearing braces, these benefits have not been confirmed by clinicians and scientific investigators. Results from these three orthosis types show that clinical efficacy is still elusive due to the different methodologies used by researchers.Layman SummaryKnee orthoses also referred to as knee brace are commonly used for support and stability of the knee. Unloader knee braces are designed to relieve and support those suffering from knee osteoarthritis by improving physical impairment and reducing pain. Patellofemoral knee braces aim to help patients manage patellofemoral pain syndrome. Rehabilitative compression sleeves, also known as knee sleeves, are often used to assist patients suffering from knee pain and laxity. Important findings on the three knee braces discussed show discrepancies in results. Their effectiveness and validity are yet to be understood.
Chapter
Injuries to various structures of the knee joint, including the ligaments, menisci, and patellofemoral components, compose a significant portion of sports-related injuries seen by health care providers and compromise a patient's knee joint function and stability. Knee orthoses have been used in each step of the sport performance process, such as injury minimization, ligament rehabilitation after reconstruction, and treatment of functional instability of the knee joint. The knee joint allows for flexion and extension with some degree of translation and axial rotation. Shear forces act upon the knee during gait and in weight-bearing tasks. Proper functioning of knee braces must take into account these biomechanical factors. Both prefabricated (“off-the-shelf”) and custom-made knee brace designs have proven effective, and each has benefits with cost, fit, weight, and material components. More recently, braces have been manufactured with composite lightweight materials, such as carbon fiber and aluminum. Athletes have used knee orthoses both to prevent medial collateral ligament (MCL) and anterior cruciate ligament (ACL) injury and to protect ACL-deficient knees or an ACL-reconstructed graft while returning to full activity. Knee braces have become an important component in functional rehabilitation programs for treatment of MCL sprains. Acute grade I and II posterior cruciate ligament (PCL) tears have been shown to heal with bracing, protected weight bearing, and quadriceps muscle rehabilitation. Braces are now used in osteoarthritis to enhance function and reduce pain.
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Objective To investigate the effect of residual varus and valgus deformity on the stress distribution of the knee joint after tibial fracture malunion. Methods Fourteen adult cadaver specimens were selected to establish the models of tibial fractures, which were fixed subsequently at neutral position (anatomical reduction) and malunion positions (at 5°, 10°, and 15° valgus positions, and 5°, 10°, and 15° varus positions). The stress distribution on the medial and lateral plateau of the tibia was quantitatively measured using ultra‐low‐pressure sensitive film technology. The changes in the stress distribution of the knee joint after tibial fracture malunion and the relationship between the stress values and the residual varus or valgus deformity were analyzed. Results Under 400 N vertical load, the stress values on the medial and lateral plateau of the tibia at the neutral position were 1.137 ± 0.139 MPa and 1.041 ± 0.117 MPa, respectively. When compared with the stress values measured at the neutral position, the stress on the medial plateau of the tibia was significantly higher at varus deformities and lower at valgus deformities, and the stress on the lateral plateau was significantly higher at valgus deformities and lower at varus deformities (all P < 0.05). The stress values on the medial plateau of the tibia were significantly higher than the corresponding data on the lateral plateau at neutral and 5°, 10°, and 15° varus deformities, respectively (all P < 0.05), and significantly lower than the corresponding data on the lateral plateau at 5°, 10°, and 15° valgus deformities, respectively (all P < 0.05). Conclusion Residual varus and valgus deformity after tibial fracture malunion can lead to obvious changes of the stress distribution of the knee joint. Therefore, tibial fractures should be reduced anatomically and fixed rigidly to avoid residual varus–valgus deformity and malalignment of lower limbs.
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Die mediale Kniegelenkarthrose ist eine der häufigsten Erkrankungen bei Personen über 55 Jahren. Die eingeschränkte Mobilität und Schmerzsituation beeinträchtigen das tägliche Leben. Neben den operativen gibt es auch konservative Maßnahmen, die zu einer Schmerzreduktion und Belastungsnormalisierung führen können. Dazu zählen aktive Maßnahmen wie die Modifikation des Gangbilds und Muskelkräftigung. Durch die Modifikation des Gangbilds lässt sich die Belastungssituation im Gehen reduzieren. Nachgewiesen wird diese Belastungsreduktion mithilfe einer dreidimensionalen Ganganalyse. Der primäre Zielparameter ist dabei das externe Adduktionsmoment. Modifikationen, die die Belastungssituation positiv beeinflussen sind vermehrte Seitneigung zur Standbeinseite, vermehrte Fußaußenrotation oder vermehrte Oberschenkelinnenrotation. Passive Maßnahmen, wie Kniegelenksorthesen oder Schuhranderhöhungen, können ebenfalls zu einer Reduktion des externen Adduktionsmoments führen. In Studien wurde nachgewiesen, dass die Maßnahmen nicht nur das Adduktionsmoment, sondern auch subjektiv das Schmerzempfinden verringern. Konservative Maßnahmen können eine Belastungsreduktion im Kniegelenk bewirken und somit die Lebensqualität insgesamt etwas steigern.
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Background: Evidence that knee braces used for the treatment of osteoarthritis mediate pain relief and improve function by unloading the joint (increasing the joint separation) remains inconclusive. Alternatively, valgus-producing braces may mediate pain relief by mechanically stabilizing the joint and reducing muscle cocontractions and joint compression. In this study, therefore, we sought to examine the degree to which so-called unloader braces control knee instability and influence muscle cocontractions during gait. Methods: Sixteen subjects with radiographic evidence of knee malalignment and medial compartment osteoarthritis were recruited and fitted with a custom Generation II Unloader brace. Gait analysis was performed without use of the brace and with the brace in neutral alignment and in 4 degrees of valgus alignment. A two-week washout period separated the brace conditions. Muscle cocontraction indices were derived for agonist and antagonist muscle pairings. Pain, instability, and functional status were obtained with use of self-reported questionnaires, and the results were compared. Results: The scores for pain, function, and stability were worst when the knee was unsupported (the baseline and washout conditions). At baseline, nine of the sixteen patients reported knee instability and five of the nine complained that it affected their activities of daily living. Poor knee stability was found to be correlated with low ratings for the activities of daily living, quality of life, and global knee function and with increased pain and symptoms. Knee function and stability scored best with the brace in the neutral setting compared with the brace in the valgus setting. The cocontraction of the vastus lateralis-lateral hamstrings was significantly reduced from baseline in both the neutral (p = 0.014) and valgus conditions (p = 0.023), and the cocontraction of the vastus medialis-medial hamstrings was significantly reduced with the valgus setting (p = 0.068), as a result of bracing. Patients with greater varus alignment had greater decreases in vastus lateralis-lateral hamstring muscle cocontraction. Conclusions: When knees with medial compartment osteoarthritis are braced, neutral alignment performs as well as or better than valgus alignment in reducing pain, disability, muscle cocontraction, and knee adduction excursions. Pain relief may result from diminished muscle cocontractions rather than from so-called medial compartment unloading.
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Introduction: Unloader braces are non-surgical treatment options for patients with unicompartmental knee osteoarthritis (OA). However, many patients do not adhere to brace treatment because of complications related to discomfort and poor fit. An alternative to knee bracing is an ankle-foot orthosis (AFO) with a lever arm that presses the lower leg into valgus or varus. The aim of this study is to evaluate the clinical benefits of this AFO for patients with unicompartmental knee OA. Materials and methods: Twenty-three patients with knee OA were enrolled in this observational study. The primary clinical outcome measure was the Western Ontario and McMasters Universities Arthritis Index (WOMAC) total score. Secondary outcome measures included WOMAC subscores, visual analogue pain scale, activity restriction and complication rate. Clinical scores were collected at start and 3, 6, 9, and 12 months after enrollment. Statistical evaluation was performed using the Student's t test. Results: Of the patients enrolled, 83 % suffered from medial compartment OA. Most patients had Grade II OA according to the Kellgren and Lawrence classification. WOMAC total score, both subscores and visual analogue pain scale were significantly improved over time. Patients also noted a reduction in restrictions to activities of daily living and sport-related activities while using the AFO. No patients discontinued orthosis use because of adverse effects. Two types of complications were noted: discomfort or light pressure sores around the ankle (7 patients), and wear and tear of the shoe in which the AFO was worn (14 patients). Conclusions: This observational study suggests that this AFO is effective at significantly reducing pain and stiffness as well as improving the physical function of patients with mild to moderate unicompartmental osteoarthritis of the knee.
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The effect of joint pathologies, such as unilateral knee osteoarthritis (UKOA) or low back pain (LBP), on bilateral gait symmetry has gained increased attention during the past decade. This study is the first to compare gait patterns between patients with UKOA and LBP in combination and with UKOA only. Temporal, kinematic, and kinetic variables were measured bilaterally during gait stance phase in 31 subjects with UKOA and LBP (Group I) and 11 subjects with only UKOA (Group II). Group I patients exhibited less hip rotation in the affected limb (A) than in the nonaffected (NA) limb during walking in contrast to Group II patients. Group I patients had minimal bilateral differences in hip abduction and flexion, but Group II patients displayed significantly larger values in the NA limb compared to the A limb for both parameters. Hip flexion patterns were significantly different between Groups I and II. Subjects in both groups adapted gait patterns that minimized vertical ground reaction force, knee flexion motion, and stance time on the UKOA affected limb. The distinct kinematic gait patterns that were revealed in this study may provide clinical value for assessment of patients with UKOA in conjunction with LBP.
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The most common cause of disability in the United States is knee osteoarthritis (OA). This disease affects more than 27 million Americans commonly older than -40 years (Centers for Disease Control and Prevention [CDC], 2012). Osteoarthritis develops gradually over a period of years and results in the gradual deterioration of the hyaline cartilage that covers the articulating surfaces of the knee joint. In most people, the disease is idiopathic but can also be hereditary or the result of trauma, which causes pain, stiffness, limited range of motion, and localized swelling in the knee (Brandt and Slemenda. Osteoarthritis epidemiology, pathology and pathogenesis. In: Primer on the Rheumatic Diseases. 10th Ed. Atlanta, GA: Arthritis Foundation; 1993, p 18408). Knee OA cannot be cured, but there are interventions available to help manage the symptoms. An unloading knee orthosis is one course of action. The principle of the unloader knee brace is to create a varus or a valgus moment at the knee, creating additional space in the joint space, thus relieving pain caused by bone-on-bone contact and improving function within the knee for activities of daily living (ADLs) (Kirkley et al. J Bone Joint Surg 1999;81[4]:539-547. Sharma et al. JAMA 2001;286[2]:188-195). After extensive research, 42 custom and off-the-shelf OA knee braces are currently available within the United States for patients with varus and valgus gonarthrosis secondary to OA. Upon further examination, it was noted that only 15 of the 42 have evidence-based information to support their effectiveness in relieving symptoms common within the knee for an individual with a diagnosis of OA. The 15 braces are SofTec OA brace (Bauerfeind), Thruster 2/Dynamic Unloading Osteoarthritis (DUO) (Bledsoe), Legacy Thruster OA (Bledsoe), Fusion OA (Breg), Defiance OA (Donjoy), OA Adjuster (Donjoy), OA Nano (Donjoy), OAsys (Ossur), Unloader ADJ (Ossur), Unloader Express (Ossur), Unloader One (Ossur), Unloader Select (Ossur), Unloader Spirit (Ossur), Genu Arthro-Model 28K29/21 (Ottobock), and Bionicare Knee System (VQ OrthoCare). The purpose of this article was twofold. The first was to examine the pros and cons indicated within the evidence-based articles for each of the 15 OA knee braces currently on the market, and the second was to provide an updated picture for each of the 15 braces, as well as the manufacturer, description, indication(s), features, warranty, and approximate price list.
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The aim of this study was to evaluate the effectiveness of the OAdjuster® (dj Orthopedics, Vista, CA, USA) brace on lateral compartment osteoarthritis (OA). The OAdjuster knee brace will effectively control joint angles in the frontal plane throughout the stance phase of the gait cycle. Two patients with valgus knee deformity diagnosed with lateral compartment OA in the right knee were included in this study. Both patients have been fitted with the OAdjuster knee brace in the treatment of OA. A subjective history was taken of each patient through a personal interview. Objective tests and measures were taken to rule out any other joint pathology. Each patient ambulated with and without the unloading brace and was filmed with two digital cameras. Analysis of joint angles and gait parameters was performed with the Ariel Performance Analysis System® (APAS) (Ariel Dynamics, Inc, San Diego, CA, USA). In case 1, the knee valgus angle at midstance decreased from 4.4° of valgus to 1.7° of valgus with the use of the brace. The hyperextension angle in the sagittal plane also decreased during single-limb stance on the braced limb from 12.1° to a neutral alignment. Other gait parameters in case 1 showed very little change with the use of the OAdjuster brace. Case 2 exhibited a decrease in valgus angle during midstance from 8.4° to 7.0°. The hyperextension angle during single-limb stance also decreased from 11.2° to 4.4°. Gait parameters also showed an improvement in case 2 with the use of the unloading brace. The OAdjuster brace may become a viable option for patients with lateral compartment OA and who are unable to undergo surgical procedures because of other comorbidities. The OAdjuster brace effectively controlled joint angles in the frontal and the sagittal plane throughout the stance phase of the gait cycle.
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Purpose: Unicompartmental knee osteoarthritis (OA) is often treated with the prescription of an unloading knee brace to decrease pain and stiffness. Braces have been shown to improve the quality of life by applying an external moment to offset increased compressive tibiofemoral contact loads, but evidence regarding mechanical efficacy at the joint is controversial. Thus, the purpose of this study was to review the current state of unloading braces on knee mechanics, clinical impact, and long-term disease progression. Methods: A literature search was performed through the PubMed MEDLINE database for the search terms "osteoarthritis," "knee," "brace," and derivatives of the keyword "unload." Articles published since January 1, 1980 were reviewed for their relevance. Evidence for the effectiveness of unloading braces for disease management both biomechanically and clinically was considered. Results: While significant research has been done to show improvement in OA symptoms with the use of an unloading brace, current literature suggests a debate regarding the effectiveness of these braces for biomechanical change. Clinical findings reveal overall improvements in parameters such as pain, instability, and quality of life. Conclusion: Although clinical evidence supports brace use to improve pain and functional ability, current biomechanical evidence suggests that unloading of the affected knee compartment does not significantly hinder disease progression. LEVEL OF EVIDENCE: III.
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Objective and accurate evaluation of patients who underwent lower limb operation is important in determining a proper rehabilitation process according to the patient's recovery status. Gait symmetry analysis is a common protocol that is used to evaluate lower limb function; however, most studies have focused only on the terminal symmetry of lower limb during gait motion and were unable to provide information about detailed motions of the whole leg. To more accurately analyze mutual symmetry of the left and right leg during gait motion, measurement of motions of the whole left and right leg including the pelvis, hip, knee, and ankle is required. Eight patients (mean [standard deviation]: age = 22.87 [6.05] years; height = 167.81 [5.86] cm; weight = 629.52 [133.63] Newtons) who underwent limbsalvage surgery and eight normal volunteers (age = 28.87 [3.79] years; height = 167 [8.36] cm; weight = 657.46 [157.02] Newtons) participated in this study. Using motion capture cameras arranged around each subject, real-time gait motion of each participant was recorded and moving trajectories of 12 submotion elements were extracted. Mutual symmetry of the motion between the left and right leg was then calculated using a Pearson correlation method, while a nonparametric Mann-Whitney test was performed for group comparison. Experimental results showed that the moving trajectories of the left and right leg were similar in the normal group (r = 0.8114[0.22]) but were critically different in the patient group (r = 0.624286[0.15]). In addition, there was statistically significant difference (p = 0.0162) in gait symmetry between the normal group and the patient group (95% confidence level). We conclude that the proposed protocol can provide a useful evaluation tool for patient recovery condition and that it could be helpful in establishing an effective postoperative treatment protocol for lower limb patients.
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Background: Patients suffering from mild-to-moderate medial compartment knee osteoarthritis may be treated with an unloader knee orthosis. However, compliance has been shown to be an issue with such devices. Objectives: The aim of this study was to identify the effects of a new design of knee unloader orthosis on specific gait parameters in patients with mild-to-moderate medial knee osteoarthritis. Methods: The gait of seven patients was assessed in two conditions: without an orthosis and when wearing a new design of unloader knee orthosis. Gait analysis was performed to determine alterations to the adduction moment, speed of walking, step length, cadence and knee sagittal plane range of motion during ambulation for the two test conditions. Results: The knee adduction moment was significantly reduced (p = 0.001), and the speed of walking significantly increased (p < 0.001) when wearing the orthosis. However, a reduction in knee range of motion (p = 0.002) and an increase in step length (p < 0.001) were observed with the orthosis donned. Cadence was not significantly altered (p = 0.504). Conclusion: The use of a new design of unloader knee orthosis as a conservative treatment approach for patients with mild-to-moderate medial compartment osteoarthritis appears warranted. Clinical relevance: Various conservative modalities have been used to reduce pain and improve function in medial compartment osteoarthritis. A new design of an unloader knee orthosis has been developed and is shown to have immediate benefits in patients with mild medial knee osteoarthritis.
Article
The purpose of the study was to test the biomechanical differences between a lateral wedge and a valgus knee bracing on the knee joint moment during walking in patients with early stage of medial compartment knee osteoarthritis (OA). We conducted a crossover randomized design to compare gait parameters of 32 patients (with early stage medial compartment knee OA) in three different conditions during walking: with a custom-made lateral wedge of 5° (in standard shoes), with a valgus knee bracing (in standard shoes), and with control condition (in standard shoes). Both two-orthose conditions showed decreased loading patterns (knee adduction moment and knee adduction angular impulse) on the knee joint in dynamic condition (statistic probability P < 0.05). The decreased loading on OA knee in wedge condition was associated with a laterally shifted location of centre of pressure and increased ankle valgus degree and moment at the same foot (P < 0.05). It was not found significant differences in loading of the knee between these two-orthose conditions. These results indicated that, under dynamic condition, patients wearing lateral wedge and valgus knee bracing showed changes of moments on knee joints. Lateral wedge was as effective as valgus knee bracing in the treatment of early stage of knee OA.
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Respecto a la artrosis, es el momento de olvidar la resignación (tanto de los enfermos como de los médicos) y pasar a la estimulación (de los médicos y de los pacientes). La artrosis es la enfermedad articular más frecuente y tiene una etiología múltiple, aspectos clínicos variados y evolución variable; sin tratamientos radicales, es una enfermedad degenerativa crónica. Dentro de un contexto multidisciplinario, su tratamiento es complejo y supone el empleo de medios farmacológicos y no farmacológicos.
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SUMMARY In 2005, 9.6% of the Taiwan population were 65 years of age or older. Osteoarthritis (OA) is the most common form of chronic arthritis, which is a common cause of functional limitation and dependency in the elderly in Taiwan. The age-related changes in muscle strength and knee OA increase susceptibility to falls, which are asso- ciated with significant morbidity and mortality in the elderly. The plan for management should be tailored to the individual elderly patient and should be a multidisciplinary approach that includes nonpharmacologic modalities combined with pharmacologic measures. Our understanding of the etiopathogenesis of knee OA has grown significantly in recent decades, which has led to targeted and more effective approaches to disease management. Therapeutic advances include the introduction of safer agents for symptomatic relief, as well as agents with potential for disease or structure modification. (International Journal of Gerontology 2007; 1(1): 31-39)
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Since activities of daily living do not exist in isolation this prospective study examined biomechanical function during level walking and sit-to-stand activities over two months of brace use by subjects with varying grades of knee osteoarthritis. Kinematic and kinetic data were collected using infrared cameras and force platforms; clinical scores compared perceived and measured functional effects. There was no significant change in pain for any grades of OA but activity levels were significantly higher at one month in the moderate OA grades and at two months for the low OA grades. Mechanical constraints and changes in movement strategies were consistent across tasks and OA grade. This study provides valuable data for further studies aimed at refining the use and optimization of valgus bracing efficacy.
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Medial knee osteoarthritis (OA) is a common disorder often associated with pathologic joint loading. Insoles, braces, and high tibial osteotomy are OA treatments aimed at reducing medial joint loads, but their use and effectiveness are limited. The KineSpring System implant also intends to reduce knee loads in OA patients while overcoming those limitations. The present study was undertaken to test the implant's effect on loads at the knee. Six cadaver knees with Outerbridge Grade I-II medial OA were subjected to simulated gait using a kinematic test system. Knees were tested with and without the medial knee implant while thin film sensors measured medial and lateral femoro-tibial contact pressures. Significant medial compartment load reductions (134 ± 53 N (P = .002)) were found throughout the stance phase of gait in the treated knee. Significant total joint load decreases ((91 ± 40 N) (P = .002)) were also observed without substantial changes in lateral compartment loads. These significant reductions of medial and total intra-articular loads are also within clinically effective ranges of other unloading systems. This suggests that the KineSpring System could be a viable treatment for medial knee OA.
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The purpose of this study was to determine if short form (SF)-12 physical component would increase with unloader brace use. Patient expectations and predictors of significant improvement were determined. Our hypothesis was that patients with unloader braces will have increases in general physical health (SF-12) and function (Western Ontario and McMaster Universities Arthritis Index [WOMAC]). Patients were enrolled in institutional review board-approved prospective cohort study. They completed a self-administered questionnaire (SF-12; WOMAC, Tegner activity scale, expectations) at enrollment, 3 weeks, 6 weeks, and 6 months. In this study, 39 patients, 23 males and 16 females (average age = 61 years [range 44 to 87]), were prescribed an unloader brace. Patients had significant improvement in quality of life (SF-12) (p < 0.05). There was significant improvement in pain, stiffness, and function (WOMAC) (p < 0.05). Patients who reported Tegner of 3 or greater at final follow-up had significantly higher SF-12 physical component (48 vs. 37; p = 0.023). Return to recreational sports was very important in 83% and somewhat important in 17%. Improving ability to walk was very important in 89%. Pain relief was very important in 69%, somewhat important in 17%. Of these, 39% expected most pain to be relieved and 57% expected all pain to be relieved. The most important expectations were to have confidence in knee (97% very important), avoid future knee degeneration (90% very important), and improve ability to maintain general health (93% very important). Patients demonstrated a significant decrease in pain and disability. Patients saw improvement in SF-12 physical component. Braces specifically designed to unload the degenerative compartment of the knee can be an effective treatment to decrease pain and maintain activity level to increase overall physical health.
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Background: For persons with unicompartment knee osteoarthritis (OA), off-unloader braces are a mechanical intervention designed to reduce pain, improve physical function, and possibly slow disease progression. Pain relief is thought to be mediated by distracting the involved compartment via external varus or valgus forces applied to the knee. In so doing, tibiofemoral alignment is improved, and load is shifted off the degenerative compartment, where exposure to potentially damaging and provocative mechanical stresses are reduced. Objectives: To provide a synopsis of the evidence documented in the scientific literature concerning the efficacy of off-loader knee braces for improving symptomatology associated with painful disabling medial compartment knee OA. Search strategy: Relevant peer-reviewed publications were retrieved from a MEDLINE search using the terms with the reference terms osteoarthritis, knee, and braces (per Medical Subject Headings), plus a manual search of bibliographies from original and review articles and appropriate Internet resources. Results: For persons with combined unicompartment knee OA and mild to moderate instability, the strength of recommendation reported by the Osteoarthritis Research Society International in the ability of off-loader knee braces to reduce pain, improve stability, and diminish the risk of falling was 76% (95% confidence interval, 69%-83%). The more evidence the treatment is effective, the higher the percentage. Conclusions: Given the encouraging evidence that off-loader braces are effective in mediating pain relief in conjunction with knee OA and malalignment, bracing should be fully used before joint realignment or replacement surgery is considered. With the number of patients with varus deformities and knee pain predicted to increase as the population ages, a reduction of patient morbidity for this widespread chronic condition in combination with this treatment modality could have a positive impact on health care costs and the economic productivity and quality of life of the affected individuals.
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The pathogenesis of osteoarthritis (OA) appears to be the result of a complex interplay between mechanical, cellular, and biochemical forces. Obesity is the strongest risk factor for disease onset and mechanical factors dominate the risk for disease progression. This narrative review focuses on the influence of biomechanics and obesity on the etiology of OA and its symptomatic presentation. We need to revisit the way we currently manage the disease and focus on the modifiable, primarily through nonpharmacologic intervention. Greater therapeutic attention to the important role of mechanical factors and obesity in OA etiopathogenesis is required if we are to find ways of reducing the public health impact of this condition.
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The objective of this 30-week randomised crossover trial was to determine whether a multi-modal realignment treatmentwould be successful in relieving pain and improving function among persons with medial tibiofemoral osteoarthritis (OA). The authors conducted a double-blind randomised crossover trial of a multi-modal realignment treatment for medial tibiofemoral OA. Trial participants met American College of Rheumatology criteria for OA, with knee pain, aching or stiffness on most days of the past month and radiographic evidence of a definite osteophyte with predominant medial tibiofemoral OA. The authors tested two different treatments: (A) control treatment consisting of a neutral knee brace (no valgus angulation), flat unsupportive foot orthoses and shoes with a flexible mid-sole; and (B) active treatment consisting of a valgus knee brace, customised neutral foot orthoses and shoes designed for motion control. For each subject, the trial lasted 30 weeks, including 12 weeks each of active treatment and control treatment separated by a 6-week washout period. The primary outcome of the linear regression model was change in knee pain and function, as assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). 80 participants with medial tibiofemoral OA were randomised. Their mean age was 62 years, their mean body mass index was 34 kg/m(2) and their mean WOMAC Pain score was 9.2 (0-20 scale). There was no evidence of a carryover effect. The regression model demonstrated that the mean difference in pain between the active treatment and the control treatment was -1.82 units (95% CI -3.05 to -0.60; p=0.004) on the WOMAC Pain scale, indicating a small but statistically significant decrease in pain with the multi-modal active treatment. For WOMAC Function, the realignment intervention had a non-significant effect on function, with a -2.90 unit decrease (95% CI -6.60 to 0.79) compared with the control condition (p=0.12). Multi-modal realignment treatment decreases pain in persons with medial tibiofemoral OA.
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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.
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We assessed short-term treatment results of younger patients with varus malalignment and chronic anterior cruciate ligament deficiency. Forty-one patients (mean, 32 years; range, 16 to 47) underwent a high tibial osteotomy. Because of giving way symptoms, 14 also had a lateral iliotibial band extraarticular procedure at the time of the osteotomy and 16 had an intraarticular anterior cruciate ligament allograft reconstruction after the osteotomy. All returned for followup (mean, 58 months; range, 23 to 86), which included KT-1000 arthrometer testing and evaluation by our knee rating system. Statistically significant ( P < 0.05) improvements were found in the mean overall rating scores for pain, swell ing, and giving way. Preoperatively, 30 (73%) had pain with activities of daily living or with any sports activity; 11 (27%) could perform only light sports activities with out pain. At followup, 32 patients (78%) had no pain with activities of daily living or light sports. Ten of 15 patients with advanced medial tibiofemoral arthrosis (subchondral bone exposure) had significant improvements in symptoms. Patient satisfaction was high: 88% stated they would undergo the procedure again and 78% felt their knee condition was improved. Patients who had the allograft reconstruction had significantly lower ( P < 0.05) anterior-posterior dis placements at followup than those who had the extraar ticular procedure. We concluded that osteotomy should be performed early in the disease process for younger athletes who experience symptoms with activity. It may be unrealis tic, however, to expect continuation of sports beyond light recreational, given the joint arthrosis that is usually present and the high in vivo joint loadings with athletes. Anterior cruciate ligament reconstruction should be considered when giving way previously occurred and the patient plans to resume athletics. However, patients with advanced arthrosis can avoid anterior cruciate ligament surgery by reducing athletic activities.
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A double crossover study was designed and carried out on 39 patients to test the efficacy of valgus bracing using a GII brace in patients with medial gonarthrosis. Two brace designs were studied-one with a medial and one with a lateral hinge. The double crossover technique involved evaluating each patient under conditions of no brace, brace in neutral, and brace in valgus, each for a period of 6 weeks. Pain and function were recorded by subjects on diary forms daily and at the end of each week. Standing posterior-anterior radiographs were done on all patients under conditions of weight bearing, nonweight bearing, without brace, and with brace in valgus. Statistical analysis using repeated measures analysis of variance showed statistically significant pain relief compared to baseline with both a lateral hinge in valgus (p = 0.02) and a medial hinge in valgus (p < 0.0001). No significant change in function was found and no significant radiographic evidence of change in femoral-tibial angle or joint space alteration was demonstrated. Seventy-four percent of patients purchased their brace at the end of the study. Follow-up at an average 20 months after the study showed 58% of the patients with a lateral hinge and 93% of the patients with a medial hinge were still using their braces as the principal form of therapy. Valgus bracing using a GII brace, especially with a medial hinge, can be a useful treatment modality for reducing pain in the patient with medial gonarthrosis to replace or delay surgery. (C) Lippincott-Raven Publishers.
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From this study of 213 knees it appears that 61.8% of the patients rated themselves as having less pain than before osteotomy even after 10 years from the time of surgery. Functionally, 64.7% were better. Rarely did a patient believe that his pain was worse than it was preoperatively, even up to 10 years after the surgery; nor did any patient believe that his functional status was compromised further by the operation. The conclusions drawn from the most recent study are the following. Upper tibial osteotomy for gonarthrosis and varus deformity relieves pain and restores function in more than 60% of the patients, even 10 years after the operation. The major complication is recurrence of deformity, in part, at least, the cause of recurring pain. It can be minimized by achieving at least 7 degrees of valgus axial alignment (up to 10 degrees is allowable), and by excluding from operation knees with bicompartmental involvement.
Article
We evaluated the results in eighty-three patients (ninety-five knees) who had had a high tibial osteotomy for either unicompartmental osteoarthritis or osteonecrosis. The operations were performed between 1965 and 1976. The mean length of follow-up was 8.9 years (range, five to fifteen years). The early results were promising: at two years 97 per cent and at five years 85 per cent of the knees had either an excellent or a good result. At subsequent follow-up, however, only sixty knees (63 per cent) had an excellent or good result, and in the remainder recurrent pain had developed. Twenty-two knees (23 per cent) had been revised to a total knee arthroplasty because of pain. The alignment obtained by the osteotomy was not as important in determining the long-term result as we had previously believed. Although recurrent varus deformity was observed in more than one-quarter of the knees, it was not necessarily associated with an unsatisfactory result. The passage of time was the most important factor in determining the result, as only fifteen (37 per cent) of the knees that had been followed for more than nine years were pain-free. We now believe that total knee arthroplasty is a more suitable operation for patients who are more than sixty years old and that high tibial osteotomy should be reserved for patients who have a strenuous occupation or who wish to continue to participate in sports activities.
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A stylized wedge-shaped defect was created in the medial plateau of autopsy specimens of the tibia to evaluate methods for fixation in total knee arthroplasty. A series of tibial components was inserted by five different methods. With each method loading of up to 1780 N axially and a varus load of 1340 N at 28 Newton-meters were assessed. The vertical deflections of the medial and lateral sides of the tray relative to the bone were measured while bending of the stem was recorded with strain gauges. The greatest deflections occurred when cement alone filled the defect; only slight improvement resulted from the addition of two cancellous screws to buttress the metal tray. Further improvement occurred when solid spacers of Plexiglas or metal were used. Finally, the most secure support was obtained with an integral custom-made tibial component. A central stem 70 mm long carried 23%-38% of the axial load, considered useful in the situation of deficient proximal bone. A metal wedge was considered an acceptable alternative to a custom-made component and may prove useful in the reconstruction of tibial bone stock defects.
Article
The purpose of this study was to determine whether a brace designed to unload varus degenerative knees actually alters medial compartment loads by decreasing the adduction moment. Eleven patients who had arthrosis confined to the medial compartment were fitted with a valgus brace and tested before and after brace wear with pain and function scoring instruments and by automated gait analysis. The biomechanical data from these patients were compared with those from 11 healthy control subjects. Scores from an analog pain scale decreased 48% with brace wear, and function with activities of daily living increased 79%. Mean adduction moment without the brace measured 4.0 +/- 0.8% body weight times height versus 3.6 +/- 0.8% body weight times height when wearing the brace (10% decrease). The mean adduction moment for control subjects was 3.5 +/- 0.6% body weight times height. Thus, the mean adduction moment decreased from approximately one standard deviation from the normal mean to a value that is similar to the control value. Nine of 11 patients had a decrease in the adduction moment with the brace, five of 11 patients had a reduction higher than 10%, and decreases in this moment were as high as 32%. This study shows that pain, function, and biomechanical knee loading can be altered by a brace designed to unload the medial compartment of the knee.
Article
The purpose of this study was to compare a custom-made valgus-producing functional knee (unloader) brace, a neoprene sleeve, and medical treatment only (control group) with regard to their ability to improve the disease-specific quality of life and the functional status of patients who had osteoarthritis in association with a varus deformity of the knee (varus gonarthrosis). The study design was a prospective, parallel-group, randomized clinical trial. Patients who had varus gonarthrosis were screened for eligibility. The criteria for exclusion included arthritides other than osteoarthritis; an operation on the knee within the previous six months; symptomatic disease of the hip, ankle, or foot; a previous fracture of the tibia or femur; morbid obesity (a body-mass index of more than thirty-five kilograms per square meter); skin disease; peripheral vascular disease or varicose veins that would preclude use of a brace; a severe cardiovascular deficit; blindness; poor English-language skills; and an inability to apply a brace because of physical limitations such as arthritis in the hand or an inability to bend over. Treatment was assigned on the basis of a computer-generated block method of randomization with use of sealed envelopes. The patients were stratified according to age (less than fifty years or at least fifty years), deformity (the mechanical axis in less than 5 degrees of varus or in at least 5 degrees of varus), and the status of the anterior cruciate ligament (torn or intact). The patients were randomly assigned to one of three treatment groups: medical treatment only (control group), medical treatment and use of a neoprene sleeve, or medical treatment and use of an unloader brace. The disease-specific quality of life was measured with use of the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the McMaster-Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR), and function was assessed with use of the six-minute walking and thirty-second stair-climbing tests. The primary outcome measure consisted of an analysis of covariance of the change in scores between the baseline and six-month evaluations. One hundred and nineteen patients were randomized. The control group consisted of forty patients (thirty-one men and nine women; mean age, 60.9 years); the neoprene-sleeve group, of thirty-eight patients (twenty-seven men and eleven women; mean age, 58.2 years); and the unloader-brace group, of forty-one patients (twenty-eight men and thirteen women; mean age, 59.5 years). Nine patients withdrew from the study. At the six-month follow-up evaluation, there was a significant improvement in the disease-specific quality of life (p = 0.001) and in function (p< or =0.001) in both the neoprene-sleeve group and the unloader-brace group compared with the control group. There was a significant difference between the unloader-brace group and the neoprene-sleeve group with regard to pain after both the six-minute walking test (p = 0.021) and the thirty-second stair-climbing test (p = 0.016). There was a strong trend toward a significant difference between the unloader-brace group and the neoprene-sleeve group with regard to the change in the WOMAC aggregate (p = 0.062) and WOMAC physical function scores (p = 0.081). The results indicate that patients who have varus gonarthrosis may benefit significantly from use of a knee brace in addition to standard medical treatment. The unloader brace was, on the average, more effective than the neoprene sleeve. The ideal candidates for each of these bracing options remain to be identified.
Article
It has been recognised for centuries that various conditions will lead to asymmetries in gait and several researchers have analysed symmetry of gait. However, in general such analyses are based on five steps or fewer. A new system has been designed and manufactured that is based on a motorised treadmill with forceplates (errors +3. 2% and -4.3%) that quickly gathers information on larger numbers of steps. It automatically records the data and then performs a semi automatic analysis to calculate various parameters from each of the measured steps, including: heel strike, toe off, stance phase, swing phase, peak forces and loading and unloading rates. Other parameters can also be easily incorporated into the analysis such as double support time. Student's t tests are performed comparing the means of these parameters. The ratios of the parameters, left to right (or uninvolved to involved limbs), are then quoted as Symmetry Indices. It has been found to be quick and easy to use and produces results that are both readily understood and clinically relevant.
Bracing and heel wedging for unicompartmental osteoarthritis of the knee Joint loading with valgus bracing in patients with varus gonarthrosis
  • Fe Pollo
  • Lindenfeld Tn
  • Te Hewett
  • Andriacchi
Pollo FE. Bracing and heel wedging for unicompartmental osteoarthritis of the knee. Am J Knee Surg 1998;11:47-50. 3. Lindenfeld TN, Hewett TE, Andriacchi TP. Joint loading with valgus bracing in patients with varus gonarthrosis. Clin Orthop 1997;344:290-7.
The role of high tibial osteotomy in the anterior cruciate ligament-deficient knee with varus alignment. In: Orthopedic sports medicine. principles and practice
  • Noyes Fr
  • Simon
Noyes FR, Simon R. The role of high tibial osteotomy in the anterior cruciate ligament-deficient knee with varus alignment. In: Orthopedic sports medicine. principles and practice. Philadelphia: WB Saunders, 1993:1401-43.
3 Validation of symmetry indices by comparison with HSS score (mean ±SD)
  • Fig
Fig. 3 Validation of symmetry indices by comparison with HSS score (mean ±SD).
The role of high tibial osteotomy in the anterior cruciate ligament-deficient knee with varus alignment
  • F R Noyes
  • R Simon
Noyes FR, Simon R. The role of high tibial osteotomy in the anterior cruciate ligament-deficient knee with varus alignment. In: Orthopedic sports medicine. principles and practice. Philadelphia: WB Saunders, 1993:1401-43.