Reduce Knee Pain Research Articles

Neuromuscular electrical stimulation (NMES) for patellofemoral pain syndrome.

Neuromuscular electrical stimulation (NMES) for patellofemoral pain syndrome.

Novel aquatic physiotherapy programme for elderly Chinese adults with osteoarthritis of the knee: a randomised controlled trial

BackgroundOsteoarthritis of the knee is a chronic degenerative disease with a prevalence of 21·5–42·8% in China. Aquatic exercise has been used in rehabilitating patients with osteoarthritis of the knee, but its efficacy has been questioned with the outcomes of a recent meta-analysis. We aimed to assess the efficacy of a physiotherapist-designed aquatic exercise programme in reducing knee pain and physical impairments and improving functional mobility in a Chinese population with osteoarthritis of the knee. MethodsThis randomised, single-blinded, controlled trial was done at the Centre of Health and Wellness in Hong Kong and approved by the EdUHK Human Research Ethics Committee. After written informed consent was obtained, 83 eligible elderly participants (20 men and 63 women) were randomly assigned to either the aquatic exercise or control groups. The aquatic exercise group received aquatic exercise training for 1 h per week for 10 weeks along with advice on self-care. The control group received self-care advice only. Measurements were taken before and after the intervention. The primary outcome was knee pain as measured on a visual analogue scale. Secondary outcomes included passive flexion and extension ranges of motion (goniometry) and isometric muscle strength (hand-held dynamometry) of the affected knee and total distance covered in a 6 min walk test. We used two-way repeated-measures analysis of covariance to analyse the data. FindingsThe participants in the aquatic-exercise (n=31; mean age 56·2 years; SD 9·8 years) and control group (n=52; mean age 61·4 years; SD 10·7 years) were largely similar at baseline except that the knee-flexion range of motion was lowest in the participants within the aquatic-exercise group (p=0·008). The results of an intention-to-treat analysis revealed that knee pain was reduced exclusively in the aquatic-exercise group by 0·66 points (17·2%) at post-test measurements (F1,79=4·253; p=0·042; ηp2=0·05; 95% CI 3·93–5·20). Knee-flexion range of motion in the aquatic-exercise group became similar to that of participants in the control group at post-test measurements (p=0·286; 95% CI −8·61 to 2·58). No group, time, or group-by-time interaction effects were noted in any other outcome variables. No adverse events were reported. InterpretationThe aquatic exercise programme was safe and effective in reducing knee pain and improving knee-flexion mobility of elderly Chinese adults with osteoarthritis of the knee. Further studies comparing the effectiveness of aquatic and land-based physiotherapeutic exercises are warranted. FundingThe Education University of Hong Kong (RG10/2012-2013R)

Arthroscopic meniscectomy for degenerative meniscal tears reduces knee pain but is not cost-effective in a routine health care setting: a multi-center longitudinal observational study using data from the osteoarthritis initiative.

It is disputed whether arthroscopic meniscectomy is an (cost-) effective treatment for degenerative meniscus tears in day-to-day clinical practice. The objective of this study was to assess the cost-effectiveness of arthroscopic meniscectomy in subjects with knee osteoarthritis, in routine clinical practice, while taking into account the increased risk for future knee replacement surgery. We compared cost-effectiveness of arthroscopic meniscectomy compared to no surgery. We used a state transition (Markov) simulation model to evaluate the cost-effectiveness of arthroscopic meniscectomy compared to no surgery in subjects with knee osteoarthritis (age range 45-79 years). Data used in the preparation of the current study were obtained from the Osteoarthritis Initiative (AOI) database. We applied a 9 years' time horizon (which is equal to the current OAI study follow up period), and evaluated cost-effectiveness from a societal perspective. The main outcome measure was the incremental cost-effectiveness ratio (Euros per quality adjusted life-year (QALY) gained). Arthroscopic meniscectomy was associated with 8.09 (SD±0.07) QALYs at a cost of € 21,345 (SD±841), whereas the no surgery was associated with 8.05 (SD±0.07) QALYs at a cost of € 16,284 (SD±855). For arthroscopic meniscectomy, the incremental cost per QALY gained was € 150,754. In day-to-day clinical practice, arthroscopic meniscectomy in subjects with knee osteoarthritis is associated with € 150,754 per QALY gained, which exceeds the generally accepted willingness to pay (WTP) (range € 20,000-€ 80,000).

Dietary Fiber Intake in Relation to Knee Pain Trajectory.

Dietary fiber may reduce knee pain, in part by lowering body weight and reducing inflammation. In this study, we assessed whether fiber intake was associated with patterns of knee pain development. In a prospective, multicenter cohort of 4,796 men and women ages 45-79 years with or at risk of knee osteoarthritis, participants underwent annual followups for 8 years. Dietary fiber intake was estimated using a validated food frequency questionnaire at baseline. Group-based trajectory modeling was used to identify Western Ontario and McMaster Universities Osteoarthritis Index pain trajectories, which were assessed for associations with dietary fiber intake using polytomous regression models. Of the eligible participants (4,470 persons and 8,940 knees, mean ± SD age 61.3 ± 9.1 years, 58% women), 4.9% underwent knee replacement and were censored at the time of surgery. Four distinct knee pain patterns were identified: no pain (34.5%), mild pain (38.1%), moderate pain (21.2%), and severe pain (6.2%). Dietary total fiber was inversely related to membership in the moderate or severe pain groups (P ≤ 0.006 for trend for both). Subjects in the highest versus those in the lowest quartile of total fiber intake had a lower risk of belonging to the moderate pain pattern group (odds ratio [OR] 0.76 [95% confidence interval (95% CI) 0.61-0.93]) and severe pain pattern group (OR 0.56 [95% CI 0.41-0.78]). Similar results were found with grain fiber and these 2 pain pattern groups. Our findings suggest that a high intake of dietary total or grain fiber, particularly the recommended daily fiber average intake of 25 gm per day, is associated with a lower risk of developing moderate or severe knee pain over time.

With a biomechanical treatment in knee osteoarthritis, less knee pain did not correlate with synovitis reduction

BackgroundBraces are used to treat pain in patellofemoral joint osteoarthritis (PFJOA). In a trial, we previously reported pain improvement after 6-weeks brace use. The pain reduction did not correlate with changes in Magnetic Resonance Imaging (MRI) assessed Bone Marrow Lesion volume or static synovial volume. Studies show that changes in the synovium on dynamic contrast enhanced (DCE) MRI are more closely associated with symptom change than static synovial volume changes. We hypothesised change in synovitis assessed using dynamic imaging could explain the reduction in pain.MethodOne hundred twenty-six men and women aged 40–70 years with painful radiographically confirmed PFJOA were randomised to either brace wearing or no brace for 6-weeks. Pain assessment and DCE-MRI were performed at baseline and 6 weeks. DCE data was analysed using Tofts’s equation. Pain measures included a VAS of pain on nominated aggravating activity (VASNA), and the KOOS pain subscale. Paired t-tests were used to determine within person change in outcome measures and Spearman’s correlation coefficients were used to determine the correlation between change in pain and change in the DCE parameters.ResultsMean age of subjects was 55.5 years (SD = 7.5) and 57% were female. There was clear pain improvement in the brace users compared to controls (VASNA − 16.87 mm, p = <0.001). There was no significant change to the dynamic synovitis parameters among brace users nor was pain change correlated with change in dynamic synovitis parameters.ConclusionThe reduction in knee pain following brace wearing in patients with PFJOA is not explained by changes in synovitis.Trial registrationTrial registration number UK. ISRCTN50380458/Registered 21.5.2010.

Intra-articular Injection of Mesenchymal Stem Cells for the Treatment of Osteoarthritis of the Knee: A 2-Year Follow-up Study

Background: The intra-articular injection of mesenchymal stem cells (MSCs) into the knee has shown a potential for the treatment of generalized cartilage loss in osteoarthritis (OA). However, there have been few midterm reports with clinical and structural outcomes. Purpose: To assess the midterm safety and efficacy of an intra-articular injection of autologous adipose tissue–derived (AD) MSCs for knee OA at 2-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Eighteen patients with OA of the knee were enrolled (3 male, 15 female; mean age, 61.8 ± 6.6 years [range, 52-72 years]). Patients in the low-, medium-, and high-dose groups received an intra-articular injection of 1.0 × 107, 5.0 × 107, and 1.0 × 108 AD MSCs into the knee, respectively. Clinical and structural evaluations were performed with widely used methodologies including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and measurements of the size and depth of the cartilage defect, signal intensity of regenerated cartilage, and cartilage volume using magnetic resonance imaging (MRI). Results: There were no treatment-related adverse events during the 2-year period. An intra-articular injection of autologous AD MSCs improved knee function, as measured with the WOMAC, Knee Society clinical rating system (KSS), and Knee injury and Osteoarthritis Outcome Score (KOOS), and reduced knee pain, as measured with the visual analog scale (VAS), for up to 2 years regardless of the cell dosage. However, statistical significance was found mainly in the high-dose group. Clinical outcomes tended to deteriorate after 1 year in the low- and medium-dose groups, whereas those in the high-dose group plateaued until 2 years. The structural outcomes evaluated with MRI also showed similar trends. Conclusion: This study identified the safety and efficacy of an intra-articular injection of AD MSCs into the OA knee over 2 years, encouraging a larger randomized clinical trial. However, this study also showed potential concerns about the durability of clinical and structural outcomes, suggesting the need for further studies. Clinical Trial Registration: NCT01300598

Correlations between inflammatory cytokines, muscle damage markers and acute postoperative pain following primary total knee arthroplasty

BackgroundDespite the success of total knee arthroplasty (TKA) in reducing knee pain and improving functional disability, the management of acute postoperative pain is still unsatisfactory. This study was aimed to quantitatively analyze the possible correlations between inflammatory cytokines, muscle damage markers and acute postoperative pain following primary TKA.MethodsPatients scheduled for unilateral primary TKA were consecutively included, the serial changes of the numerical rating scale (NRS) at rest (NRSR) and at walking (NRSW), serum inflammatory cytokines and muscle damage markers were assessed before surgery (T0) and at postoperative day 1, 2, 3 and 5 (T1-T4, respectively); while pain disability questionnaire (PDQ) and synovial fluid inflammatory cytokines were evaluated at T0. The correlations between inflammatory cytokines, muscle damage markers and pain scores were examined, and Bonferroni correction was applied for multiple comparisons.ResultsNinety six patients were included for serum markers and pain evaluations at T0-T4, while 54 (56.25%) for synovial fluid cytokines at T0. The NRSR at T1 and T2 were positively correlated with preoperative NRSW, while the NRSW at T1 to T4 were positively correlated with preoperative NRSR, NRSW and PDQ (all p < 0.05). The NRSR was positively correlated with serum PGE2, IL-6, and CK at T1; the NRSW was positively correlated with serum CRP at T1, with PGE2 and IL-6 at T1 to T3, with CK at T2 and T4, and with Mb and LDH at T1 to T4 (all p < 0.003). Meanwhile, positive correlations were observed between preoperative NRSW and synovial fluid PGE2, IL-6, IL-8, or TNF-α, as well as between PDQ and PGE2 (all p < 0.003), but no associations between postoperative pain scores and preoperative synovial fluid cytokines was found (all p ≥ 0.003). Additionally, the NRSR at T1 and T2, and NRSW at T1 to T4 were positively correlated with body mass index (all p < 0.05).ConclusionsSerum inflammatory cytokines and muscle damage markers are positively correlated with acute postoperative pain following primary TKA, and the key cytokines (CRP, PGE2, and IL-6) and markers (Mb, CK and LDH) may serve as the targets for developing novel analgesic strategies.

Does Kinesiology Taping Improve the Early Postoperative Outcomes in Anterior Cruciate Ligament Reconstruction? A Randomized Controlled Study

The efficacy of kinesiology taping in arthroscopic knee surgery has not been reported. The objective of this study is to investigate the efficacy of kinesiology taping in the early postoperative phase after anterior cruciate ligament reconstruction (ACLR). We hypothesized that kinesiology taping reduces knee pain and swelling and improves knee range of movement and functional outcome. Randomized controlled study. Primary Institutional Hospital. Sixty subjects who underwent an elective ACLR with or without concurrent meniscectomy were randomized into intervention (with kinesiology taping postsurgery) and control groups. Subjects from both groups received standardized postoperative physiotherapy. Subjects from the intervention group received additional kinesiology taping on the first and second weeks postsurgery, each application lasting 5 days. Pain visual analogue score (VAS), total range of motion (ROM) of the knee, Lysholm-Tegner scale, and mid patella circumferential girth were measured before the surgery and at the first, second, and sixth week postsurgery. Within each group, statistically significant differences were found in all study parameters in both groups. Comparison of the study parameters between both groups revealed no statistical significance at various time points except the reduction of pain in the taping group in the early postoperative phase (between the first and second week) (P < 0.05). This is the first randomized controlled study investigating the efficacy of kinesiology taping in arthroscopic knee surgery. Our study showed that kinesiology taping reduced pain in the early postoperative period after ACLR. There was no statistical significance in the reduction of swelling or improvement of knee score and total range of motion with kinesiology taping.

Effect of a low intensity, self-management lifestyle intervention on knee pain in community-based young to middle-aged rural women: a cluster randomised controlled trial

Yuanyuan Wang, Catherine Lombard, Sultana Monira Hussain, Cheryce Harrison, Samantha Kozica, Sharmayne R. E. Brady, Helena Teede and Flavia M. Cicuttini

Assessing Mediating Effect of Bone Marrow Lesions and Synovitis Following Extreme Weight Loss on Knee Pain Reduction

Assessing Mediating Effect of Bone Marrow Lesions and Synovitis Following Extreme Weight Loss on Knee Pain Reduction

Effectiveness of curcuminoids in the treatment of knee osteoarthritis: a systematic review and meta-analysis of randomized clinical trials.

To critically appraise and evaluate the evidence for effectiveness of curcuminoids in the treatment of osteoarthritis (OA) in adults. We conducted electronic searches in Medline, Embase, AMED, Cinahl and the Cochrane library. We included randomized controlled trials (RCTs) that investigated the effectiveness of orally-administered curcuminoids in OA in adults, and assessed risk of bias using the Cochrane risk of bias criteria. We used a random-effect model for meta-analysis. We included seven studies with a total of 797 participants with primarily knee OA. All studies were conducted in Asia. The overall risk of bias was moderate. Compared with placebo, curcuminoids significantly reduced knee pain (visual analogue scale): (standardized mean difference: -3.45; 95% CI: -5.52 to -1.38; I2 =95% P=0.001), and improved quality of life (Lequesne pain-function index): (mean difference: -2.69; 95% CI: -3.48 to -1.90; I2 =0% P<0.00001). There were significantly fewer effects on pain relief, knee stiffness and physical function with curcuminoids compared with ibuprofen. Significant improvements in Western Ontario and McMaster Universities Arthritis Index total scores, with significant reductions in the use of rescue medication were also observed with curcuminoids. No serious adverse events were reported. Curcuminoids may have some beneficial effects on knee pain and quality of life in patients with knee OA. However, they are less effective at relieving pain compared with ibuprofen. Curcuminoids appear safe on the short-term, and may reduce the need for rescue medication. Published RCTs vary in reporting quality, are characterized by small sample sizes, and have all been conducted in Asia. Further clinical trials are therefore warranted.

Preliminary study of modifications of gait and ADL to reduce knee pain and improve knee joint function

Preliminary study of modifications of gait and ADL to reduce knee pain and improve knee joint function

Bipolar Versus Unipolar Intraarticular Pulsed Radiofrequency Thermocoagulation in Chronic Knee Pain Treatment: A Prospective Randomized Trial

Background: Chronic knee pain is a major widespread problem causing significant impairment of daily function. Pulsed radiofrequency has been shown to reduce severe chronic joint pain as a non-pharmacological and less invasive treatment method. Objective: We aimed to compare the effectiveness of unipolar and bipolar intraarticular pulsed radiofrequency methods in chronic knee pain control. Study Design: Prospective, randomized, double-blind study. Setting: Pain clinic in Cukurova University Faculty of Medicine. Methods: One hundred patients, aged 20 – 70 years with grade 2 or 3 knee osteoarthritis were included in this study. Patients were randomly allocated into 2 groups to receive either unipolar (group U, n = 50) or bipolar (group B, n = 50) intraarticular pulsed radiofrequency (IAPRF) with a 45 V voltage, 2 Hz frequency, 42° C temperature, 10 msec pulse width, and 10 minute duration. We recorded visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index LK 3.1WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index LK 3.1) scores of patients at baseline and one, 4, and 12 weeks after the procedure. The primary outcome was the percentage of patients with ≥ 50% reduction in knee pain at 12 weeks after the procedure. Results: There was a significant difference between the groups according to VAS scores at all post-intervention time points. In group B, 84% of patients, and in the group U, 50% of patients achieved at least 50% knee pain relief from the baseline to 3 months. In group B, WOMAC scores were significantly lower than the group U at one and 3 months. Limitations: Lack of long-term clinical results and supportive laboratory tests. Conclusion: Bipolar IAPRF is more advantageous in reducing chronic knee pain and functional recovery compared with unipolar IAPRF. Further studies with longer follow-up times, laboratorybased tests, and different generator settings are required to establish the clinical importance and well-defined mechanism of action of PRF. This study protocol was registered at clinicaltrials.gov (identifier: NCT02141529), on May 15, 2014. Institutional Review Board (IRB) approval date: January 16, 2014, and number: 26/9 Key words: Chronic pain, intraarticular, knee joint, knee osteoarthritis, pain management, pulsed radiofrequency treatment, quality of life, recovery of function

Weight-loss and exercise for communities with arthritis in North Carolina (we-can): design and rationale of a pragmatic, assessor-blinded, randomized controlled trial

BackgroundRecently, we determined that in a rigorously monitored environment an intensive diet-induced weight loss of 10% combined with exercise was significantly more effective at reducing pain in men and women with symptomatic knee osteoarthritis (OA) than either intervention alone. Compared to previous long-term weight loss and exercise trials of knee OA, our intensive diet-induced weight loss and exercise intervention was twice as effective at reducing pain intensity. Whether these results can be generalized to less intensively monitored cohorts is unknown. Thus, the policy relevant and clinically important question is: Can we adapt this successful solution to a pervasive public health problem in real-world clinical and community settings? This study aims to develop a systematic, practical, cost-effective diet-induced weight loss and exercise intervention implemented in community settings and to determine its effectiveness in reducing pain and improving other clinical outcomes in persons with knee OA.Methods/DesignThis is a Phase III, pragmatic, assessor-blinded, randomized controlled trial. Participants will include 820 ambulatory, community-dwelling, overweight and obese (BMI ≥ 27 kg/m2) men and women aged ≥ 50 years who meet the American College of Rheumatology clinical criteria for knee OA. The primary aim is to determine whether a community-based 18-month diet-induced weight loss and exercise intervention based on social cognitive theory and implemented in three North Carolina counties with diverse residential (from urban to rural) and socioeconomic composition significantly decreases knee pain in overweight and obese adults with knee OA relative to a nutrition and health attention control group. Secondary aims will determine whether this intervention improves self-reported function, health-related quality of life, mobility, and is cost-effective.DiscussionMany physicians who treat people with knee OA have no practical means to implement weight loss and exercise treatments as recommended by numerous OA treatment guidelines. This study will establish the effectiveness of a community program that will serve as a blueprint and exemplar for clinicians and public health officials in urban and rural communities to implement a diet-induced weight loss and exercise program designed to reduce knee pain and improve other clinical outcomes in overweight and obese adults with knee OA.Trial registrationclinicaltrials.gov Identifier: NCT02577549 October 12, 2015.

Does standard post-operative rehabilitation have its place after total knee replacement?

The pilot study objective was to evaluate the effect of comprehensive post-operative physiotherapeutic treatment on the selected physiotherapeutic parameters as well as patients' quality of life after a total knee joint replacement surgery. Thirty patients after total knee joint arthroplasty were enrolled into the pilot study. After completing the physiotherapeutic processes, we have observed among the patients who underwent a total knee replacement surgery, a significant increase in muscle strength as with the flexors as well as the extensors (p = 0.001), improvement in their range of motion in knee joint flexion, in comparison to its range before treatment (p = 0.001), knee pain reduction (p = 0.001) and post-operative swelling (p <0.001), respectively. After undergoing the physiotherapeutic procedures, we recorded a statistically significant improvement in the monitored physical components: dressing (p = 0.008) and toilet use (p = 0.001), transfer from bed to chair (p = 0.008), walking on flat surface (p = 0.001), climbing stairs (p = 0.001). Passing the physiotherapy significantly reduced the degree of dependence of operated patients (p = 0.001). Early post-operative physiotherapy treatment positively affects patients' general condition. In addition, it improves muscle strength, range of motion of the operated joint, eliminates post-operative pain and reduces swelling that improves patients' self-sufficiency. Standard physiotherapy nowadays and in the next few years will take a unique place in patients' management after total knee joint replacement (Tab. 5, Ref. 26).

Brief Report: Synovial Fluid White Blood Cell Count in Knee Osteoarthritis: Association With Structural Findings and Treatment Response.

ObjectivesOsteoarthritis (OA) is a disease with a significant inflammatory component. The aim of this analysis was to determine the relationship between synovial fluid white cell count (SF WCC) and two parameters: disease severity and the reduction in knee pain after intra-articular steroid injection.MethodsSubjects with painful knee OA were recruited for participation in an open label study of intra-articular steroid therapy. Information was obtained about knee pain using the KOOS questionnaire and a proportion of subjects had magnetic resonance imaging (MRI) performed. Prior to injection with methylprednisolone acetate (80mg), the index knee joint was aspirated and the fluid obtained forwarded for assessment of SF WCC.ResultsInformation on SF WCC was available in 55 subjects. An increase in white cell count category (< 100, 101–250 and > 250–1,000 cells/mm3) was associated with an increase in synovial tissue volume (p = 0.028) and with other MRI-based measures of disease severity. Also, with each category increase in SF WCC there was a greater mean reduction in KOOS pain score after steroid injection; ≤100 cells/mm3 12.5 (SD 19.9) [referent], 101–250 cells/mm3 21.3 (SD 20.6) [β coefficient 0.279 p=0.049 ] and 251–1000 cells/mm3 29.3 (SD 15.2) [β coefficient 0.320 p=0.024].ConclusionAlthough within the ‘normal’ range, total synovial fluid white cell count appears to be a biomarker for MRI synovitis and may also predict response to anti-inflammatory treatment.

The Effects of Exercise and Kinesio Tape on Physical Limitations in Patients with Knee Osteoarthritis

The aim of this study was to investigate the effects of kinesio taping (KT) in combination with moderate adapted exercise on the functional outcome of patients with knee osteoarthritis. We included 66 patients who presented pain and functional impairment with osteoarthritis. At the end of the treatment, only 57 patients remained because nine patients were excluded. Patients were randomly allocated to three treatment groups: (1) exercise group; (2) exercise KT with tension application (stabilizing effect) group; (3) exercise KT without tension application (draining effect) group. We used different methods of investigation: the Western Ontario and McMaster Universities Arthritis Index, the Visual Analogue Scaling Score for Pain, the Timed Up and Go test and analgesic consumption. Our results showed a reduction in knee pain, improvement in knee function and also less need for medication in patients with knee osteoarthritis treated with kinesio taping in combination with exercise for, at least, a period of three months. In conclusion, we can assert that therapeutic knee kinesio taping in association with a moderate adapted training is an effective method for the management of pain and disability limitations in patients with knee osteoarthritis.

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.

A smart cane with vibrotactile biofeedback improves cane loading for people with knee osteoarthritis.

Nine million adults have symptomatic knee osteoarthritis (OA) in the U.S. and almost half of those people have a walking aid such as a cane. Proper cane loading (e.g. 15% body weight [BW]) can reduce knee loading and may slow OA progression. The purpose of this study was to investigate the efficacy of a novel smart cane with vibrotactile biofeedback that aims to facilitate increased cane loading. Ten subjects with knee OA performed a 50 m hallway walk test under four conditions: 1) naïve, 2) conventional cane with verbal instruction, 3) smart cane, and 4) conventional cane post smart cane. The cane load (% BW; mean ± 1 standard deviation) for the four conditions was 9.0 ± 1.9 (naïve), 12.7 ± 2.6 (conventional cane), 17.6 ± 2.4 (smart cane), and 15.6 ±3.1 (conventional cane post smart cane). These results indicate that the smart cane's vibrotactile biofeedback helped the users achieve the target cane loading of 15% BW or more as compared to naïve or verbal instruction alone. After using the smart cane, conventional cane loading was higher than the naïve and verbal instruction conditions demonstrating a potential smart cane training effect. Long term increased cane loading may reduce knee pain and improve joint function.

Opening-Wedge Proximal Tibial Osteotomy

Varus knee malalignment caused by medial compartment arthritis results in progressive asymmetric wear of the tibiofemoral joint. This wear can cause progressively painful gonarthrosis. Surgical methods to address varus knee malalignment include lateral closing-wedge proximal tibial osteotomy, medial opening-wedge osteotomy, and arthroplasty. Medial opening-wedge proximal tibial osteotomy is an effective procedure for restoring proper coronal alignment and reducing knee pain. In this technical note, we present a reproducible technique for proximal tibial osteotomy.