Strategies to reduce joint load in the medial compartment of the knee during gait in individuals with osteoarthritis: a review of the literature

Claudio Marcos Bedran De Magalhães ,Renata Noce Kirkwood

doi:10.1590/1980-5918.029.004.ao20

Claudio Marcos Bedran De Magalhães , Renata Noce Kirkwood

Open Access

https://doi.org/10.1590/1980-5918.029.004.ao20

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Abstract

Abstract Introduction: Increased joint load on the medial compartment of the knee during gait is a mechanical factor responsible for pain and progression of medial knee osteoarthritis. The knee external adductor moment of force is a kinetic parameter that correlates with the joint load in the medial compartment. Objective: The aim of this study was to conduct a narrative review of the biomechanics strategies during gait of individuals with medial knee osteoarthritis that reduce external adductor moment of force of the knee. Methods: The review of the literature was conducted in the databases MEDLINE, PUBMED and PEDro and included articles published between 2000 and 2011. It was selected transversal, theoretical, correlational and longitudinal studies as well as controlled clinical trials. Results: Decreased gait velocity, increased external rotation of the foot, increased internal abductor moment force of the hip and lateral trunk inclination to the side of the support limb are compensatory strategies used to reduce the external adductor moment of force of the knee during gait of individuals with medial knee osteoarthritis. The lateral trunk inclination may be beneficial in a short term, however it decreases the activity of the abductors muscles of the hip during the support phase of the gait favoring compensation that could result in the progression of medial knee osteoarthritis. Conclusion: Strengthening of the abductors muscles of the hip reduces pain, improves the function and prevents compensations that in a long term could possibly accelerate the progression of the medial knee osteoarthritis.

Highlights

Increased joint load on the medial compartment of the knee during gait is a mechanical factor responsible for pain and progression of medial knee osteoarthritis
It was included studies that identi ied the correlation between biomechanical variables and reduced load on the medial knee compartment and on the external adductor at the knee, longitudinal studies examining the effect of strategies that reduced the knee external adductor moment, clinical trials that assessed the ef icacy of interventions focused on strategies that reduced load on the medial knee improving pain and function of the individuals
The results showed that the magnitude of the moments of the ankle and knee, the angular displacement of the hip in the sagittal plane and frontal of the knee and the vertical anteroposterior peak of the ground reaction forces (GRF) were dependent on speed

Summary

Introduction

Increased joint load on the medial compartment of the knee during gait is a mechanical factor responsible for pain and progression of medial knee osteoarthritis. The lateral trunk inclination may be bene icial in a short term, it decreases the activity of the abductors muscles of the hip during the support phase of the gait favoring compensation that could result in the progression of medial knee osteoarthritis. In the initial stage of OA occurs ibrillation of the articular cartilage surface with deep issures and calci ication of the cartilage layer and subchondral bone sclerosis and osteophyte formation develop with disease progression [1]. These structural changes of the articular cartilage and subchondral bone entail an in lammation of the synovial membrane. Studies in developed [6, 7] and emerging [8] countries show that the prevalence of symptomatic knee OA taken from radiography in the elderly, ranged from 5.6% to 8.7% in men and 11.4 to 15%, 4% in women

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