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The effect of orthotic devices on knee adduction moment, pain and function in medial compartment knee osteoarthritis: a literature review.

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Journal Disability and rehabilitation. Assistive technology
Year 2017
Links Pubmed DOI www.epistemonikos.org

This article includes 29 Primary studies 29 Primary studies (29 references)

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Background Knee braces and foot orthoses are commonly used to improve knee adduction moment, pain and function in subjects with knee osteoarthritis (OA). However, no literature review has been performed to compare the effects of foot orthoses and knee braces in this group of patients. Purpose The aim of this review was to evaluate the effects of foot orthoses and knee braces on knee adduction moment, pain and function in individuals with knee OA. Study design Literature review. Method The search strategy was based on the Population Intervention Comparison Outcome method. A search was performed in PubMed, Science Direct, Google Scholar and ISI web of knowledge databases using the PRISMA method and based on selected keywords. Thirty-one related articles were selected for final evaluation. Results The results of the analysis of these studies demonstrated that orthotic devices reduce knee adduction moment and also improve pain and function in individuals with knee OA. Conclusion Foot orthoses may be more effective in improving pain and function in subjects with knee OA. Both knee braces and foot orthoses reduce the knee adduction moment in knee OA and consequently patients typically do not need to use knee braces for a long period of time. Also, foot orthoses and knee braces may be more effective for medial compartment knee OA patients due to the fact that this treatment helps improve pain and function. Implications for Rehabilitation Knee braces and foot orthoses are commonly used for improving knee adduction moment, pain and function in subjects with knee osteoarthritis (OA). Orthotic devices can reduce knee adduction moment, pain and improve function in knee OA. The combined use of a knee braces and foot orthoses can provide more improvement in knee adduction moment, reduced pain and increased function.

Systematic review

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Effects of gait retraining with real-time biofeedback in patients with knee osteoarthritis: Systematic review and meta-analysis.

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Journal Osteoarthritis and Cartilage
Year 2016

This article includes 12 Primary studies 12 Primary studies (12 references)

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Effect of exercise and gait retraining on knee adduction moment in people with knee osteoarthritis.

Journal Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine
Year 2014
Links Pubmed DOI

This article includes 12 Primary studies 12 Primary studies (12 references)

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The knee adduction moment represents the medial knee joint load, and greater value is associated with higher load. In people with knee osteoarthritis, it is important to apply proper treatment with the least side effects to reduce knee adduction moment and, consequently, reduce medial knee joint load. This reduction may slow the progression of knee osteoarthritis. The research team performed a literature search of electronic databases. The search keywords were as follows: knee osteoarthritis, knee adduction moment, exercise program, exercise therapy, gait retraining, gait modification and knee joint loading. In total, 12 studies were selected, according to the selection criteria. Findings from previous studies illustrated that exercise and gait retraining programs could alter knee adduction moment in people with knee osteoarthritis. These treatments are noninvasive and nonpharmacological which so far have no or few side effects, as well as being low cost. The results of this review revealed that gait retraining programs were helpful in reducing the knee adduction moment. In contrast, not all the exercise programs were beneficial in reducing knee adduction moment. Future studies are needed to indicate best clinical exercise and gait retraining programs, which are most effective in reducing knee adduction moment in people with knee osteoarthritis.

Systematic review

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Biomechanical deviations during level walking associated with knee osteoarthritis: a systematic review and meta-analysis.

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Authors Mills K , Hunt MA , Ferber R
Journal Arthritis care & research
Year 2013
Links Pubmed DOI

This article includes 41 Primary studies 41 Primary studies (41 references)

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OBJECTIVE: To identify which gait deviations are consistently associated with knee osteoarthritis (KOA) and how these are influenced by disease severity, the involved compartment, and sex. METHODS: Five electronic databases and reference lists of publications were searched. Cross-sectional, observational studies comparing temporospatial variables, joint kinematics, and joint moments between individuals with KOA and healthy controls or between KOA subgroups were considered for review. Only publications scoring ≥50% on a modified methodology quality index were included. Because of the number of gait deviations examined, only biomechanical variables reported by ≥4 publications were further analyzed. Where possible, a meta-analysis was performed using effect sizes (ES) calculated from discrete variables. RESULTS: In total, 41 publications examining 20 variables were included. The majority of consistent gait deviations associated with KOA were exhibited by those with severe disease in the temporospatial domain. Individuals with severe KOA exhibited greater stride duration than controls (ES 1.35 [95% confidence interval (95% CI) 1.03, 1.67]) and a decrease in cadence (ES -0.75 [95% CI -1.12, -0.39]) compared with controls. The evidence for kinematic and joint moment change was primarily limited or conflicting. There was a lack of evidence for alterations in the external knee adduction moment. CONCLUSION: Individuals with KOA exhibit a range of gait deviations compared with controls. Despite its common usage in KOA gait studies, we did not find consistent evidence that knee adduction moment differs between those with and without KOA or between disease severity levels. Further research examining the reasons for a lack of difference in many gait variables in those with knee OA is needed.

Systematic review

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Effect of footwear on the external knee adduction moment - A systematic review.

Journal The Knee
Year 2012
Links Pubmed DOI

This article includes 33 Primary studies 33 Primary studies (33 references)

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CONTEXT: Footwear modifications have been investigated as conservative interventions to decrease peak external knee adduction moment (EKAM) and pain associated with knee osteoarthritis (OA). OBJECTIVE: To evaluate the literature on the effect of different footwear and orthotics on the peak EKAM during walking and/or running. METHODS: A systematic search of databases resulted in 348 articles of which 33 studies were included. RESULTS: Seventeen studies included healthy individuals and 19 studies included subjects with medial knee OA. Quality assessment (modified Downs and Black quality index) showed an (average±SD) of 73.1±10.1%. The most commonly used orthotic was the lateral wedge, with three studies on the medial wedge. Lateral wedging was associated with decreased peak EKAM in healthy participants and participants with medial knee OA while there is evidence for increased peak EKAM with the use of medial wedges. Modern footwear (subjects' own shoe, "stability" and "mobility" shoes, clogs) were likely to increase the EKAM compared to barefoot walking in individuals with medial knee OA. Walking in innovative shoes ("variable stiffness") decreased the EKAM compared to control shoes. Similarly, shoes with higher heels, sneakers and dress shoes increased EKAM in healthy individuals compared to barefoot walking. CONCLUSIONS: Further development may be needed toward optimal footwear for patients with medial knee OA with the aim of obtaining similar knee moments to barefoot walking.

Systematic review

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A systematic review on changed biomechanics of lower extremities in obese individuals: a possible role in development of osteoarthritis.

Journal Obesity reviews : an official journal of the International Association for the Study of Obesity
Year 2011
Links Pubmed DOI

This article includes 12 Primary studies 12 Primary studies (12 references)

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Obesity has been identified as a risk factor for osteoarthritis. For the weight-bearing joints, the combination of increased load and changed joint biomechanics could be regarded as underlying principle for this relation. This systematic review of the literature focused on the differences between obese and normal-weight subjects in biomechanics of the hip, knee and ankle joint during every day movements to summarize differences in joint load due to both higher body weight and differences in movement patterns. A systematic search, up to November 2010, was performed in the Pubmed and Embase databases. This review showed that obese individuals adjust their movement strategy of every day movements. At self-selected speed, obese individuals walked slower, with shorter and wider steps, had longer stance duration and had a greater toe-out angle compared with normal-weight individuals. Obese sit-to-stand movement was characterized by less hip flexion and greater foot displacement. Obese individuals showed altered biomechanics during every day movements. These altered biomechanics could be related to the initiation of osteoarthritis by a change in the load-bearing regions of the articular cartilage in the weight-bearing joints.