Evaluation of the Effect of Knee Unloader Orthoses, Lateral Wedge Insoles, and Ankle Foot Orthoses on Pain, Function, and Knee Adduction Moment in Subjects with Medial Compartment Knee Osteoarthritis: A Literature Review

Abstract

ABSTRACT Introduction Osteoarthritis (OA) is a destructive joint disease and a major cause of pain in the elderly. The use of supportive orthoses including valgus knee brace, lateral wedged insole, and ankle-foot orthosis (AFO) is a common treatment for these people. The purpose of this review of the literature is to evaluate the effect of orthoses on pain, function, and adduction moment (AM) of individuals with medial knee OA. Method The search was conducted among articles published from 2010 to 2021 in bibliographic online databases including ISI Web of Science, PubMed, Scopus, and Google Scholar. The potential titles and abstracts were reviewed based on the study inclusion criteria. All randomized controlled trial (RCT) studies on the effectiveness of valgus knee brace, AFO, and lateral wedged insoles in subjects with medial knee OA were reviewed. The search terms were OA, medial knee osteoarthritis, medial joint arthritis, unloader knee brace, valgus knee brace, knee sleeve, lateral wedge insole, AFO, ankle-foot orthosis, function, pain, alignment, kinetic, kinematic, and AM. Result Forty-two articles were reviewed to determine the current research process. Thirteen studies evaluated the effect of lateral wedge insole on pain, function, and AM in subjects with medial compartment knee OA. Ten studies evaluated unloader knee braces. Nine studies evaluated unloader knee brace compared with lateral wedge insole, three studies evaluated AFO, and seven studies examined the combination of knee braces and lateral wedge insoles on pain, function, and AM. Conclusion All three orthoses in short-term follow-up reduced the AM in subjects with medial knee OA. Lateral wedge insoles did not support pain reduction in studies. The results of this study showed that knee braces may have a more lasting effect on the knee joint in the long run than lateral wedge insoles. Although the number of studies that evaluated the effect of AFOs on outcomes of subjects with knee OA is low, this intervention was found to be effective in relieving pain and reducing AM. Clinical Relevance In clinical studies, clinical relevance in patients with medial knee OA, orthoses effectively reduced external knee AM and pain sensation during daily activities. Thus, use of orthoses effectively supports conservative treatment in medial knee OA.