Knee Adduction Moment In Patients Research Articles

Can exercise interventions reduce external knee adduction moment during gait? A systematic review and meta-analysis

BackgroundAn increased external knee adduction moment has been identified as a factor contributing to the progression of medial knee osteoarthritis. Interventions that reduce knee adduction moment may help prevent knee osteoarthritis onset and progression. While exercise interventions have been commonly used to treat knee osteoarthritis, whether exercises can modulate knee adduction moment in knee osteoarthritis patients remains unknown. This systematic review and meta-analysis aimed to determine if exercise interventions are effective in reducing knee adduction moment during gait. MethodsStudy reports published through May 2023 were screened for pre-specified inclusion/exclusion criteria. Nine studies met the eligibility criteria and yielded 24 effect sizes comparing the reduction in knee adduction moment of the exercise intervention groups to the control groups. Moderator/experimental variables concerning characteristics of the exercise interventions and included subjects (e.g., sex, BMI, type of exercise, muscle group targeted, training volume, physical therapist supervision) that may contribute to variation among studies were explored through subgroup analysis and meta-regression. FindingsThe effect of exercise intervention on modulating knee adduction moment during gait was no better than control (ES = -0.004, P = 0.946). Sub-group analysis revealed that the effect sizes of studies containing only females (positive exercise effect) were significantly greater than studies containing both males and females. InterpretationExercise may not be effective in reducing knee adduction moment during gait. Clinicians aiming to decrease knee adduction moment in patients with medial knee osteoarthritis should consider alternative treatment options. Exploring the underlying mechanism(s) regarding a more positive response to exercises in females may help design more effective exercise interventions.

The effect of gait modification on the response of medial meniscus extrusion during gait in patients with knee osteoarthritis

BackgroundAn increase in medial meniscus extrusion during weight-bearing conditions is associated with the progression of medial knee osteoarthritis (OA). Toe-out gait modification has been known to reduce the knee adduction moment (KAM); however, its effect on reducing the increase in medial meniscus extrusion in patients with knee OA remains unclear. Research questionTo (1) evaluate the effect of toe-out gait on the increase in medial meniscus extrusion and the KAM in patients with medial knee OA and (2) investigate the synergetic effect of lateral wedge insoles in combination with toe-out gait in determining the most effective intervention for reducing medial meniscus extrusion during gait. MethodsTwenty-five patients with medial knee OA were enrolled in this study. Participants walked under four conditions: normal gait, toe-out gait, normal gait with lateral wedge insoles, and toe-out gait with lateral wedge insoles. Medial meniscus extrusion and KAM peaks during gait were measured using ultrasound and a three-dimensional motion analysis system in each condition. These parameters were compared among the four conditions using repeated measures analysis of variance. ResultsThe increase in medial meniscus extrusion and the second KAM peak were significantly lower in all interventions compared with those observed during normal gait. However, there was no significant difference among the interventions. SignificanceThis study suggested that toe-out gait reduces the increase in medial meniscus extrusion and is associated with the reduction of the second KAM peak. However, no synergistic effect of lateral wedge insoles and toe-out gait was observed.

Effects of resistance training on gait velocity and knee adduction moment in knee osteoarthritis patients: a systematic review and meta-analysis

The systematic review aimed to analyze the effects of resistance training in knee osteoarthritis (OA) rehabilitation from a biomechanical perspective. A meta-analysis was performed to determine the potential benefits of resistance training on patients with knee OA. Relevant studies based on the inclusion and exclusion criteria were selected from CENTRAL, PubMed, Scopus, and Web of Science databases inception to August 2020. Outcome measures included gait velocity and knee adduction moment (KAM). The mean differences of the data with a 95% confidence interval were analyzed using STATA 15.1 software The search identified eight studies that satisfied all the inclusion criteria, in which 164 patients were involved in gait velocity studies and another 122 patients were part of KAM studies. Analysis of the pooled data showed that resistance training significantly improved the gait velocity in patients with knee OA (p < 0.01, z = 2.73), ES (95% CI) = 0.03 (0.01, 0.06) m/s. However, resistance training had no significant effect on improving KAM in patients with knee OA (p = 0.98, z = 0.03), ES (95% CI) = 0.00 (− 0.16, 0.16) percentage of body weight × height (%BW × Ht). Therefore, resistance training may enhance gait velocity but not KAM in knee OA patients. The protocol was registered at PROSPERO (registration number: CRD42020204897).

The effects of knee pain on knee contact force and external knee adduction moment in patients with knee osteoarthritis

Knee osteoarthritis (OA) is a major cause of knee pain, leading to physical dysfunction. External knee adduction moment (KAM), a surrogate measure of knee contact force (KCF) in the medial compartment, is related to knee pain, but the association between KCF and pain severity remains unclear. This study aimed to reveal the differences in KCF due to pain severity. Twenty-eight patients with knee OA were evaluated knee symptoms including pain severity via the Knee Society Score. Based on the median symptom score, 17 points in this study, subjects were classified as having Mild symptomatic OA (n = 15) and Severe symptomatic OA (n = 13). Subjects walked three times at a comfortable speed along a six-meter walkway, and we calculated KAM during the stance phase. KCF magnitude and distribution were also computed using the subject-specific musculoskeletal model, considering physical characteristics such as the femorotibial angle measured by X-ray. No differences in physical characteristics such as femorotibial angle and gait speed were found by symptom severity, whereas KAM and medial KCF at minimum and second peak in Severe symptomatic OA patients were significantly greater than those in Mild symptomatic OA. A significant medial shift of KCF in Severe symptomatic OA was also seen at first peak and minimum. Severe symptomatic OA had a greater medial KCF and medial shift of KCF. Detailed evaluations of KCF magnitude and distribution in addition to KAM would provide crucial information on knee contact force in relation to symptom severity.

A neural network to predict the knee adduction moment in patients with osteoarthritis using anatomical landmarks obtainable from 2D video analysis

The knee adduction moment (KAM) can inform treatment of medial knee osteoarthritis; however, measuring the KAM requires an expensive gait analysis laboratory. We evaluated the feasibility of predicting the peak KAM during natural and modified walking patterns using the positions of anatomical landmarks that could be identified from video analysis. Using inverse dynamics, we calculated the KAM for 86 individuals (64 with knee osteoarthritis, 22 without) walking naturally and with foot progression angle modifications. We trained a neural network to predict the peak KAM using the 3-dimensional positions of 13 anatomical landmarks measured with motion capture (3D neural network). We also trained models to predict the peak KAM using 2-dimensional subsets of the dataset to simulate 2-dimensional video analysis (frontal and sagittal plane neural networks). Model performance was evaluated on a held-out, 8-person test set that included steps from all trials. The 3D neural network predicted the peak KAM for all test steps with r2( Murray etal., 2012) 2=0.78. This model predicted individuals' average peak KAM during natural walking with r2( Murray etal., 2012) 2=0.86 and classified which 15° foot progression angle modifications reduced the peak KAM with accuracy=0.85. The frontal plane neural network predicted peak KAM with similar accuracy (r2( Murray etal., 2012) 2=0.85) to the 3D neural network, but the sagittal plane neural network did not (r2( Murray etal., 2012) 2=0.14). Using the positions of anatomical landmarks from motion capture, a neural network accurately predicted the peak KAM during natural and modified walking. This study demonstrates the feasibility of measuring the peak KAM using positions obtainable from 2D video analysis.

The effects of two gait modifications for knee adduction moment in patients with knee osteoarthritis

Purpose: Purpose: Knee adduction moment (KAM) relates to medial knee osteoarthritis (OA). Several gait modifications have been reported to reduce KAM to ameliorate knee OA. Nanba style of walking (N walk) and walking with a continuous draw-in maneuver (DI walk) have biomechanical effects that reduce the KAM in healthy young individuals. It remains unknown, however, whether these biomechanical maneuvers reduce the KAM in patients with knee OA. The purpose of this study was to investigate the effects of the N walk and DI walk on KAM in patients with knee OA.

Effect of real-time biofeedback on peak knee adduction moment in patients with medial knee osteoarthritis: Is direct feedback effective?

BackgroundGait modifications can reduce the knee adduction moment, a representation of knee loading. Reduced loading may help to slow progression of medial knee osteoarthritis. We aimed to investigate the response of patients with medial knee osteoarthritis to direct feedback on the knee adduction moment as a method for modifying the gait pattern, before and after training with specific gait modifications. MethodsForty patients with medial knee osteoarthritis underwent 3D gait analysis on an instrumented-treadmill, while receiving real-time feedback on the peak knee adduction moment. Patients were trained with three different modifications; toe-in, wider steps and medial thrust gait. The response to real-time feedback on the knee adduction moment was measured before and after training. To evaluate the short term retention effect, we measured the changes without feedback. We also evaluated the effects on the knee flexion moment and at the hip and ankle joints. FindingsWith direct feedback on the knee adduction moment, patients were initially unable to reduce the knee adduction moment. After training with specific modifications, peak knee adduction moment was reduced by 14% in response to direct feedback. Without feedback a 9% reduction in peak knee adduction moment was maintained. Hip moments were not increased with modified gait, but small increases in ankle adduction moment and knee flexion moment were observed. InterpretationReal-time biofeedback directly on the knee adduction moment is a promising option for encouraging gait modifications to reduce knee loading, however only when combined with specific instructions on how to modify the gait.

Combined effect of toe out gait and high tibial osteotomy on knee adduction moment in patients with varus knee deformity

BackgroundGait adaptations, including toe out gait, have been proposed as treatments for knee osteoarthritis. The clinical application of toe out gait, however, is unclear.This study aims to identify the changes in Knee adduction moment in varus knee deformity assessing toe out gait as an alternative to high tibial osteotomy, and if any change in dynamic loading persists post operatively, when anatomical alignment is restored. MethodsThree-dimensional motion analysis was performed on 17 patients with medial compartment knee osteoarthritis and varus deformity prior to undergoing high tibial osteotomy, 13 patients were assessed post-operatively, and results compared to 13 healthy controls. FindingsPre-operatively, there was no significant difference between natural and toe out gait for measures of knee adduction moment. Post high tibial osteotomy, first (2.70 to 1.51% BW·h) and second peak (2.28 to 1.21% BW·h) knee adduction moment were significantly reduced, as was knee adduction angular impulse (1.00 to 0.52% BW·h·s), to a healthy level. Adopting toe out gait post-operatively reduced the second peak further to a level below that of healthy controls. InterpretationIncreasing the foot progression angle from 20° (natural) to 30° in isolation did not significantly alter the knee adduction moment or angular impulse. This suggests that adopting a toe out gait, in isolation, in an already high natural foot progression angle, is not of benefit. Adopting toe out gait post-operatively, however, resulted in a further reduction in the second peak to below that of the healthy control cohort, however, this may increase lateral compartment load.

Effects of active feedback gait retraining to produce a medial weight transfer at the foot in subjects with symptomatic medial knee osteoarthritis.

This study aimed to determine if active feedback gait retraining to produce a medial weight transfer at the foot significantly reduces the knee adduction moment in subjects with medial compartment knee osteoarthritis. Secondarily, changes in peak knee flexion moment, frontal plane knee and ankle kinematics, and center of pressure were investigated. Ten individuals with medial compartment knee osteoarthritis (9 males; age: 65.3 ± 9.8 years; BMI: 27.8 ± 3.0 kg/m2 ) were tested at self-selected normal and fast speeds in two conditions: Intervention, with an active feedback device attached to the shoe of their more affected leg, and control, with the device de-activated. Kinematics and kinetics were assessed using a motion capture system and force plate. The first peak, second peak, and impulse of the knee adduction moment were significantly reduced by 6.0%, 13.9%, and 9.2%, respectively, at normal speed, with reductions of 10.7% and 8.6% in first peak and impulse at fast speed, respectively, with the active feedback system, with no significant effect on the peak knee flexion moment. Significant reductions in peak varus knee angle and medialized center of pressure in the first half of stance were observed, with reductions in peak varus knee angle associated with reductions in the knee adduction moment. This study demonstrated that active feedback to produce a medial weight-bearing shift at the foot reduces the peaks and impulse of the knee adduction moment in patients with medial compartment knee osteoarthritis. Future research should determine the long-term effect of the active feedback intervention on joint loading, pain, and function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2251-2259, 2017.

Effects of foot orthoses with medial arch support and lateral wedge on knee adduction moment in patients with medial knee osteoarthritis.

There is contradictory evidence regarding whether the addition of medial arch supports to laterally wedged insoles reduces knee adduction moment, improves comfort, and reduces knee pain during the late stance phase of gait. To verify if such effects occur in participants with medial knee osteoarthritis. Randomized single-blinded study. Gait analysis was performed on 18 patients affected by medial knee osteoarthritis. Pain and comfort scores, frontal plane kinematics and kinetics of ankle, knee, and hip were compared in four conditions: without foot orthosis, with foot orthoses, with medial arch support, and with foot orthoses with medial arch support and lateral wedge insoles with 6° and 10° inclination. Lower-extremity gait kinetics were characterized by a significant decrease, greater than 6%, in second peak knee adduction moment in laterally wedged insole conditions compared to the other conditions ( p < 0.001; effect size = 0.6). No significant difference in knee adduction moment was observed between laterally wedged insole conditions. In contrast, a significant increase of 7% in knee adduction moment during the loading response was observed in the customized foot orthoses without lateral inclination condition ( p < 0.001; effect size = 0.3). No difference was found in comfort or pain ratings between conditions. Our study suggests that customized foot orthoses with a medial arch support may only be suitable for the management of medial knee osteoarthritis when a lateral wedge is included. Clinical relevance Our data suggest that customized foot orthoses with medial arch support and a lateral wedge reduce knee loading in patients with medial knee osteoarthritis (KOA). We also found evidence that medial arch support may increase knee loading, which could potentially be detrimental in KOA patients.

Use of Two-Piece Foot Orthoses to Adjust Lateral Inclination Angle in Medial Knee Osteoarthritis Treatment

ABSTRACT Introduction Individualization of lateral inclination of foot orthoses (FO) is necessary to optimize the reduction of knee adduction moment (KAM) in medial knee osteoarthritis patients. The trial-and-error (or iterative) method is generally used for this purpose. Two kinds of orthoses can be used: several one-piece lateral FO (each with a different inclination height) for each patient or a two-piece lateral FO, that is, FO plus several laterally wedged insoles with different heights. The aim of this study was to determine whether comfort and mechanical impact on the knee and ankle are similar with the use of one-piece versus two-piece lateral FO during gait. Material and Methods Gait analysis was performed on 17 patients affected by medial knee osteoarthritis (grade II–III). Discomfort, frontal plane kinematics, and kinetics of the ankle and knee joints were compared in three conditions: without orthosis, with lateral customized FO, and with a combination of lateral wedge insoles and customized FO without lateral inclination. Lateral inclination was customized according to the orthotist's experience. Results One- and two-piece lateral customized FO had the same effect on the knee loading (p &gt; 0.05). However, both conditions with FO led to similar significant differences in knee adduction and ankle eversion moment compared with the without-orthosis condition (p &lt; 0.05; effect size from 0.05 to 0.40). Conclusions These results will be valuable for orthotists who make customized orthoses (with arch support) to reduce KAM in patients with medial knee osteoarthritis. Manufacturing two-piece orthoses is practical and economical: the customized FO can be kept and the wedge insole repeatedly replaced until the patient's pain is relieved.

Relationships among foot position, lower limb alignment, and knee adduction moment in patients with degenerative knee osteoarthritis.

[Purpose] The aim of this study was to determine the relationships among the foot progression angle, foot rotation angle, lower limb alignment, and knee adduction moments in patients with degenerative knee osteoarthritis (OA). [Subjects] Forty-eight patients diagnosed with degenerative knee OA (Kellgren-Lawrence grades 2 and 3) were included. [Methods] To assess the lower extremity alignment and weight-bearing ratio, static radiographic measurement was used. Foot progression angle, foot rotation angle, and knee adduction moments were measured by using a three-dimensional motion analysis system. [Results] The results of this study were as follows: the foot progression angle in the early and late stance phase was significantly correlated with the first and second peak knee adduction moments; the weight-bearing ratio was significantly correlated with the first and second peak knee adduction moments; and the tibiofemoral angle was significantly correlated with the first and second peak knee adduction moments. [Conclusion] The results of the present study indicated that as the foot progression angle and the foot lateral rotation angle increased, the knee adduction moment decreased. The weight-bearing ratio and tibiofemoral angle assessment with mechanical axis alignment were correlated with the knee adduction moments. These parameters may be helpful for selecting therapeutic options for patients with degenerative knee OA.

Effect of proprioceptive training on foot posture, lower limb alignment, and knee adduction moment in patients with degenerative knee osteoarthritis: a randomized controlled trial.

[Purpose] The purpose of this study was to determine the effect of proprioceptive training on foot progression angle, weight-bearing ratio, and knee adduction moment in patients with degenerative osteoarthritis of the knee. [Subjects] The subjects were 37 patients diagnosed with Kellgren-Lawrence grade 2 or 3 degenerative knee osteoarthritis. They were randomly allocated to three groups: a proprioceptive training group (PT group), quadriceps strengthening group (QS group), and control group. [Methods] The study parameters of the three groups were compared before and after a 12-week training period. Therapeutic exercises were performed twice per week for 12 weeks. Outcomes included the foot progression angle, weight-bearing ratio, and knee adduction moment. [Results] First, a significant difference in the foot progression angle was observed among the groups, significantly increasing in the PTG compared with the CG. Second, a significant difference in the weight-bearing ratio was observed among the groups, significantly increasing in the PTG compared with the CG. Third, a significant difference in the first peak knee adduction moment was observed among the groups, significantly decreasing in the PTG compared with the CG. [Conclusion] The results of the present study indicate that proprioceptive training increased the foot progression angle and weight-bearing ratio and decreased the first peak knee adduction moment. Moreover, incorporating proprioceptive training into a physical therapy exercise program could improve functional ability and delay the progression of degenerative osteoarthritis.

Gait neuromechanics in women with and without joint hypermobility

s / Gait & Posture 39S (2014) S1–S141 S7 legs, dependent on affected side, and three trials of participants were considered. Linear MixedModels were used to determine the main effects within retained principal components (PCs). Results: PatientsmeanAntetorsionwas38.6◦(SD6.1◦), basedon CT-scans. There were no significant group differences in sex, age, BMI and walking speed, but patients showed significant less hip external rotation in clinical examination. Group effects based on LinearMixedModels revealed that patientswalkedwith significant more internal foot progression angle (FPA) andmore external ankle rotation (ARA) than controls. There were no alterations observed in knee kinematics. Patients walked with significant more anterior pelvic tilt (SPA) and at hip joint level with more internally rotated (THA) and flexed (SHA) hips. Group effects in kinetics revealed that patients showed a significant lower knee adductionmoment (FKM) andhip adductionmoment (FHM).Differentiation into primary and secondary passive effects was derived from clinical considerations. Discussion and conclusions: Deviations in FPA and THA were stated as primary deviations. Due to the reduced hip external rotation patientswere not able to counterbalance for primary deviations. Passive secondary effects were detected in ARA, SHA, SPA, FKM and FHM. In order to achieve normal gait, patients walked with external ankle rotation, flexed hips and more anterior pelvic tilt. During gait internal hip rotation induced anterior pelvic tilt andmore hip flexion by straining iliofemoral ligaments. Moreover, anterior pelvic tilt may have wide-ranging consequences as it may induce increased lordosis of the lumbar spine and extension of the thoracic spine. Although in the current study FKM mean gait waveform indicated a tendency for an increased knee adduction moment in patients, the application of Linear Mixed Models on PC-scores of retained PCs showed a significant group effect in PC3 (explaining 16.74% of total variance), representing a lower knee adduction moment in patients. In hip the only significant group effect corresponded to a lower hip adduction moment in patients (PC2, explaining 15.32% of total variance), whereas mean gait waveform indicated a higher hip adduction moment. In summary coxa antetorta is not mainly a cosmetic problem in general. Modifications in kinematics and kinetics may cause physical complaints and osteoarthritis in future. Therefore, conducting 3DGA is recommended for individual clinical decision-making and planning surgical corrections in patients with coxa antetorta.

Gait deviations and compensations in adolescents with coxa antetorta

s / Gait & Posture 39S (2014) S1–S141 S7 legs, dependent on affected side, and three trials of participants were considered. Linear MixedModels were used to determine the main effects within retained principal components (PCs). Results: PatientsmeanAntetorsionwas38.6◦(SD6.1◦), basedon CT-scans. There were no significant group differences in sex, age, BMI and walking speed, but patients showed significant less hip external rotation in clinical examination. Group effects based on LinearMixedModels revealed that patientswalkedwith significant more internal foot progression angle (FPA) andmore external ankle rotation (ARA) than controls. There were no alterations observed in knee kinematics. Patients walked with significant more anterior pelvic tilt (SPA) and at hip joint level with more internally rotated (THA) and flexed (SHA) hips. Group effects in kinetics revealed that patients showed a significant lower knee adductionmoment (FKM) andhip adductionmoment (FHM).Differentiation into primary and secondary passive effects was derived from clinical considerations. Discussion and conclusions: Deviations in FPA and THA were stated as primary deviations. Due to the reduced hip external rotation patientswere not able to counterbalance for primary deviations. Passive secondary effects were detected in ARA, SHA, SPA, FKM and FHM. In order to achieve normal gait, patients walked with external ankle rotation, flexed hips and more anterior pelvic tilt. During gait internal hip rotation induced anterior pelvic tilt andmore hip flexion by straining iliofemoral ligaments. Moreover, anterior pelvic tilt may have wide-ranging consequences as it may induce increased lordosis of the lumbar spine and extension of the thoracic spine. Although in the current study FKM mean gait waveform indicated a tendency for an increased knee adduction moment in patients, the application of Linear Mixed Models on PC-scores of retained PCs showed a significant group effect in PC3 (explaining 16.74% of total variance), representing a lower knee adduction moment in patients. In hip the only significant group effect corresponded to a lower hip adduction moment in patients (PC2, explaining 15.32% of total variance), whereas mean gait waveform indicated a higher hip adduction moment. In summary coxa antetorta is not mainly a cosmetic problem in general. Modifications in kinematics and kinetics may cause physical complaints and osteoarthritis in future. Therefore, conducting 3DGA is recommended for individual clinical decision-making and planning surgical corrections in patients with coxa antetorta.

Real-time tracking of knee adduction moment in patients with knee osteoarthritis.

The external knee adduction moment (EKAM) is closely associated with the presence, progression, and severity of knee osteoarthritis (OA). However, there is a lack of convenient and practical method to estimate and track in real-time the EKAM of patients with knee OA for clinical evaluation and gait training, especially outside of gait laboratories. A real-time EKAM estimation method was developed and applied to track and investigate the EKAM and other knee moments during stepping on an elliptical trainer in both healthy subjects and a patient with knee OA. Substantial changes were observed in the EKAM and other knee moments during stepping in the patient with knee OA. This is the first study to develop and test feasibility of real-time tracking method of the EKAM on patients with knee OA using 3-D inverse dynamics. The study provides us an accurate and practical method to evaluate in real-time the critical EKAM associated with knee OA, which is expected to help us to diagnose and evaluate patients with knee OA and provide the patients with real-time EKAM feedback rehabilitation training.

The position of the center of the mass from the knee center correlates closely with the knee adduction moment in patients with knee osteoarthritis

The position of the center of the mass from the knee center correlates closely with the knee adduction moment in patients with knee osteoarthritis

Toe-in gait reduces the first peak knee adduction moment in patients with medial compartment knee osteoarthritis

The first peak of the knee adduction moment has been linked to the presence, severity, and progression of medial compartment knee osteoarthritis. The objective of this study was to evaluate toe-in gait (decreased foot progression angle from baseline through internal foot rotation) as a means to reduce the first peak of the knee adduction moment in subjects with medial compartment knee osteoarthritis. Additionally, we examined whether the first peak in the knee adduction moment would cause a concomitant increase in the peak external knee flexion moment, which can eliminate reductions in the medial compartment force that result from lowering the knee adduction moment. We tested the following hypotheses: (a) toe-in gait reduces the first peak of the knee adduction moment, and (b) toe-in gait does not increase the peak external knee flexion moment. Twelve patients with medial compartment knee osteoarthritis first performed baseline walking trials and then toe-in gait trials at their self-selected speed on an instrumented treadmill in a motion capture laboratory. Subjects altered their foot progression angle from baseline to toe-in gait by an average of 5° (p<0.01), which reduced the first peak of the knee adduction moment by an average of 13% (p<0.01). Toe-in gait did not increase the peak external knee flexion moment (p=0.85). The reduced knee adduction moment was accompanied by a medially-shifted knee joint center and a laterally-shifted center of pressure during early stance. These results suggest that toe-in gait may be a promising non-surgical treatment for patients with medial compartment knee osteoarthritis.

Ambulatory measurement of the knee adduction moment in patients with osteoarthritis of the knee

High knee joint-loading increases the risk and progression of knee osteoarthritis (OA). Mechanical loading on the knee is reflected in the external knee adduction moment (KAdM) that can be measured during gait with laboratory-based measurement systems. However, clinical application of these systems is limited. Ambulatory movement analysis systems, including instrumented force shoes (IFS) and an inertial and magnetic measurement system (IMMS), could potentially be used to determine the KAdM in a laboratory-free setting. Promising results have been reported concerning the use of the IFS in KAdM measurements; however its application in combination with IMMS has not been studied.The objective of this study was to compare the KAdM measured with an ambulatory movement analysis system with a laboratory-based system in patients with knee OA. Gait analyses of 14 knee OA patients were performed in a gait laboratory. The KAdM was concurrently determined with two the systems: (i) Ambulatory: IFS and IMMS in combination with a linked-segment model (to obtain joint positions); (ii) Laboratory: force plate and optoelectronic marker system.Mean differences in KAdM between the ambulatory and laboratory system were not significant (maximal difference 0.20%BW⁎H in late stance, i.e. 5.6% of KAdM range, P>0.05) and below clinical relevant and hypothesized differences, showing no systematic differences at group level. Absolute differences were on average 24% of KAdM range, i.e. 0.83%BW⁎H, particularly in early and late stance. To achieve greater accuracy for clinical use, estimation of joint position via a more advanced calibrated linked-segment model should be investigated.

Combined Effects of a Valgus Knee Brace and Lateral Wedge Foot Orthotic on the External Knee Adduction Moment in Patients With Varus Gonarthrosis

ObjectiveTo test the hypothesis that a custom-fit valgus knee brace and custom-made lateral wedge foot orthotic will have greatest effects on decreasing the external knee adduction moment during gait when used concurrently. DesignProof-of-concept, single test session, crossover trial. SettingBiomechanics laboratory within a tertiary care center. ParticipantsPatients (n=16) with varus alignment and knee osteoarthritis (OA) primarily affecting the medial compartment of the tibiofemoral joint (varus gonarthrosis). InterventionsCustom-fit valgus knee brace and custom-made full-length lateral wedge foot orthotic. Amounts of valgus angulation and wedge height were tailored to each patient to ensure comfort. Main Outcome MeasuresThe external knee adduction moment (% body weight [BW]*height [Ht]), frontal plane lever arm (cm), and ground reaction force (N/kg), determined from 3-dimensional gait analysis completed under 4 randomized conditions: (1) control (no knee brace, no foot orthotic), (2) knee brace, (3) foot orthotic, and (4) knee brace and foot orthotic. ResultsThe reduction in knee adduction moment was greatest when concurrently using the knee brace and foot orthotic (effect sizes ranged from 0.3 to 0.4). The mean decrease in first peak knee adduction moment compared with control was .36% BW*Ht (95% confidence interval [CI], –.66 to –.07). This was accompanied by a mean decrease in frontal plane lever arm of .59cm (95% CI, –.94 to –.25). ConclusionsThese findings suggest that using a custom-fit knee brace and custom-made foot orthotic concurrently can produce a greater overall reduction in the knee adduction moment, through combined effects in decreasing the frontal plane lever arm.