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Trivedi U, Joshi AY. Advances in active knee brace technology: A review of gait analysis, actuation, and control applications. Heliyon 2024; 10:e26060. [PMID: 38384524 PMCID: PMC10878936 DOI: 10.1016/j.heliyon.2024.e26060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
This article discusses the significance of knee joint mechanics and the consequences of knee dysfunctions on an individual's quality of life. The utilization of active knee braces, which incorporate concepts of mechatronics systems, is investigated here as a potential treatment option. The complexity of the construction of the knee joint, which has six degrees of motion and is more prone to injury since it bears weight, is emphasized in this article. By wearing braces and using other support devices, one's knee can increase stability and mobility. In addition, the paper discusses various technologies that can be used to measure the knee adduction moment and supply spatial information on gait. Actuators for active knee braces must be compact, lightweight, and capable of producing a significant amount of torque; as a result, electric, hydraulic, and pneumatic actuators are the most common types. Creating control mechanisms, such as position control techniques and force/torque control approaches, is essential to knee exoskeleton research and development. These methods might make knee joint rehabilitation and assistive technology safer and more effective.
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Affiliation(s)
- Udayan Trivedi
- Mechatronics Engineering Department, Parul University, Vadodara, Gujarat, India
| | - Anand Y. Joshi
- Mechatronics Engineering Department, Parul University, Vadodara, Gujarat, India
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Mian SH, Abouel Nasr E, Moiduddin K, Saleh M, Alkhalefah H. An Insight into the Characteristics of 3D Printed Polymer Materials for Orthoses Applications: Experimental Study. Polymers (Basel) 2024; 16:403. [PMID: 38337292 DOI: 10.3390/polym16030403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Knee orthoses assist patients with impaired gait through the amendment of knee abnormalities, restoration of mobility, alleviation of pain, shielding, and immobilization. The inevitable issues with laborious traditional plaster molding procedures for orthoses can be resolved with 3D printing. However, a number of challenges have limited the adoption of 3D printing, the most significant of which is the proper material selection for orthoses. This is so because the material used to make an orthosis affects its strength, adaptability, longevity, weight, moisture response, etc. This study intends to examine the mechanical, physical, and dimensional characteristics of three-dimensional (3D) printing materials (PLA, ABS, PETG, TPU, and PP). The aim of this investigation is to gain knowledge about these materials' potential for usage as knee orthosis materials. Tensile testing, Olympus microscope imaging, water absorption studies, and coordinate measuring machine-based dimension analysis are used to characterize the various 3D printing materials. Based on the investigation, PLA outperforms all other materials in terms of yield strength (25.98 MPa), tensile strength (30.89 MPa), and shrinkage (0.46%). PP is the least water absorbent (0.15%) and most flexible (407.99%); however, it is the most difficult to fabricate using 3D printing. When producing knee orthoses with 3D printing, PLA can be used for the orthosis frame and other structural elements, PLA or ABS for moving parts like hinges, PP for padding, and TPU or PP for the straps. This study provides useful information for scientists and medical professionals who are intrigued about various polymer materials for 3D printing and their effective utilization to fabricate knee orthoses.
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Affiliation(s)
- Syed Hammad Mian
- Advanced Manufacturing Institute, King Saud University, Riyadh 11421, Saudi Arabia
| | - Emad Abouel Nasr
- Department of Industrial Engineering, College of Engineering, King Saud University, Riyadh 11421, Saudi Arabia
| | - Khaja Moiduddin
- Advanced Manufacturing Institute, King Saud University, Riyadh 11421, Saudi Arabia
| | - Mustafa Saleh
- Department of Industrial Engineering, College of Engineering, King Saud University, Riyadh 11421, Saudi Arabia
| | - Hisham Alkhalefah
- Advanced Manufacturing Institute, King Saud University, Riyadh 11421, Saudi Arabia
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Kinematic study of the overall unloading brace for the knee. Heliyon 2023; 9:e13116. [PMID: 36747530 PMCID: PMC9898298 DOI: 10.1016/j.heliyon.2023.e13116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
Objective Traditional knee braces unloading forces primarily from a single compartment are insufficient for patients with knee injuries or knee osteoarthritis (KOA) involving multiple compartments. We investigated how knee kinematics were altered by an overall unloading brace (OUB) designed to unload both the medial and lateral tibiofemoral (TF) compartments simultaneously during dynamic movement. Methods Gait analysis was performed on 32 adults with normal knee alignment and no history of knee disease. Three-dimensional (3D) knee kinematic data collected during treadmill walking (3 km/h) and jogging (5 km/h) with an optical motion capture system were compared with versus without the OUB. Results In the stance phase, wearing the OUB, versus not wearing it, increased the proximal-distal translational range of motion (ROM) of the knee by 4.04 mm (Effect size, ES = 0.97) during walking and by 3.43 mm (ES = 0.97) during jogging, decreased abduction-adduction rotational ROM by 3.09°(ES = 1.05) during walking and by 2.88°(ES = 1.50) during jogging, and decreased internal-external rotation by 2.14°(ES = 0.81) during walking and by 4.66°(ES = 1.61) during jogging. In the swing phase, the OUB increased proximal-distal translational ROM by 12.64 mm (ES = 1.31) during walking and by 9.23 mm (ES = 0.92) during jogging, decreased abduction-adduction rotational ROM by 2.83°(ES = 0.54) during walking and by 3.37°(ES = 0.67) during jogging, and decreased internal-external rotational ROM by 2.71°(ES = 0.68) during jogging. Conclusions OUB use increased proximal-distal translation while reducing abduction-adduction rotation. This effect may increase the joint gap of the tibiofemoral joint, thereby reducing joint stress, and may contribute to disease rehabilitation in the knee of clinical orthopedics, rehabilitation, and sports medicine fields. However, additional studies are needed to assess the range of possible clinical and prophylactic benefits of OUB.
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Khosravi M, Jalali M, Babaee T, Ali Sanjari M, Rahimi A. Evaluating the effective pressure applied by a valgus knee orthosis in individuals with medial knee osteoarthritis based on the dose-response relationship. Knee 2023; 40:174-182. [PMID: 36463763 DOI: 10.1016/j.knee.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/23/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND There is evidence that valgus knee orthosis improves clinical and biomechanical outcomes in individuals with medial knee osteoarthritis (MKOA). It is unclear whether variations in pressure application by orthosis straps can affect the biomechanical outcomes. This study aimed to determine the dose-response relationship between different orthosis straps tensions and changes in knee adduction moment (KAM) parameters in individuals with MKOA. METHOD Twenty-four individuals with symptomatic MKOA were enrolled in this quasi-experimental study. Five tension conditions in orthosis straps were tested in 20-mmHg increments, from 0 (no pressure) to 100 (maximal pressure) mmHg. Patients were asked to adjust the orthosis strap tension based on their perceived comfort. After each condition, a 3D gait analysis was performed, and KAM parameters were calculated. The participants also reported their satisfaction with knee orthosis adjustment for each pressure condition. RESULTS With successive increases in strap tension from 40 to 80 mmHg, the first peak, second peak, and angular impulse of KAM decreased nonlinearly (from 6 % to 25 %). Increasing the orthosis strap tension to 100 mmHg significantly decreased (P < 0.05) the participants' satisfaction level. The effective dosages (IC50) of pressure for the first peak, second peak, and angular impulse of KAM as responses were 58, 65, and 69 mmHg, respectively. CONCLUSION The KAM decline was not linear as the strap pressure increased. Patients were dissatisfied with orthosis adjustment when strap tension was above 80 mmHg. The optimum dosage of pressure on the knee joint's lateral side for adjusting an orthosis' strap tension is approximately 69 mmHg.
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Affiliation(s)
- Mobina Khosravi
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Jalali
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Taher Babaee
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sanjari
- Biomechanics Lab, Rehabilitation Research Center and Department of Basic Rehabilitation Sciences, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Abbas Rahimi
- Department of Physiotherapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Barati K, Ebrahimi Takamjani I, Shamsoddini A, Ejraei Dolatabad H. A comparison of the biomechanical and clinical effects of a biaxial ankle-foot orthosis and lateral wedge insole in individuals with medial knee osteoarthritis. Disabil Rehabil 2022; 44:8501-8508. [PMID: 35014942 DOI: 10.1080/09638288.2021.2019841] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to compare a biaxial ankle-foot orthosis (AFO) with a lateral wedge insole in terms of the biomechanical and clinical outcomes in individuals with knee osteoarthritis. MATERIALS AND METHODS A cross-over randomized design was used where 31 individuals (25 females and six males, mean age of 52.19 ± 4.12 years) with knee osteoarthritis wore each intervention for two weeks with two weeks washout period. Three-dimensional kinematic and kinetic data and clinical outcomes were collected to evaluate the effects of each intervention on knee adduction moment (KAM), pain, stiffness, and function. RESULTS Both orthoses significantly improved pain by 17 and 22%, function by 11 and 14%, the first peak KAM by 15.7 and 19.2%, the second peak KAM by 10.4 and 16.7%, and KAM impulse by 14.8 and 22.2%, respectively. However, the biaxial AFO significantly reduced the KAM and improved function compared to the lateral wedge insole (p < 0.01). CONCLUSIONS The results of this study have shown that both orthoses have a potential role in the conservative management of medial knee osteoarthritis. The biaxial AFO proved statistically better at improving function and KAM; though these differences do not seem to be clinically significant.IMPLICATION FOR REHABILITATIONOrthotic interventions have been reported to be effective in the management of medial knee osteoarthritis.Lateral wedge insole and biaxial ankle-foot orthosis (AFO) are effective in the improvement of pain, function, and knee adduction moment (KAM) in people with medial knee osteoarthritis.The biaxial AFO, compared with lateral wedge insole, contributes to statistically more improvement of function and KAM. However, these differences do not seem to be clinically significant.
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Affiliation(s)
- Kourosh Barati
- Department of Orthotics & Prosthetics, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ismail Ebrahimi Takamjani
- Department of Physiotherapy, School of Rehabilitation Sciences, Rehabilitation Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Shamsoddini
- Exercise Physiology Research Center, Research Institute for Life Style, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Habib Ejraei Dolatabad
- Department of Orthotics & Prosthetics, School of Rehabilitation Sciences, Rehabilitation Research Centre, Iran University of Medical Sciences, Tehran, Iran
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Rezaei M, Saeedi H, Hajiaghaei B, Khademi-Kalantari K, Arazpour M. Comparison of Immediate Effect of New Knee brace and Conventional Three-Points Knee Valgus Brace on Knee Adduction Moment and ROM in Patients with Medial Knee Osteoarthritis. J Biomed Phys Eng 2022; 12:431-436. [PMID: 36059283 PMCID: PMC9395621 DOI: 10.31661/jbpe.v0i0.1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/14/2019] [Indexed: 06/15/2023]
Abstract
The knee unloader brace can change loading on knee which may be effective in reducing symptoms and progression of disease in people with knee osteoarthritis. The purpose of this study was to evaluate the effect of a new knee brace during walking in a patient with medial compartment knee osteoarthritis. Two brace types were used: new brace and conventional brace. A pneumatic cuff of novel brace was fitted in the bottom of the medical slipper that was connected to the cuff section of the knee through the tube. After the knee brace is deployed, its force can vary in different stages of the gait. During the heel strike, the weight of the cuff is compressed on the floor, causing the air to flow inside it and entering the volume of air into the knee pad. The results of using this pneumatic knee brace compared with conventional knee braces on a patient showed that in both cases, the open and closed palatal pump, the adduction moment and ROM was decreased in the stance phase. But the three-point knee pressure, however, was less effective in reducing the adduction moment but also reduced the knee ROM. Using novel brace can eliminate the patient's need for painful and costly surgery to reduce the symptoms of osteoarthritis.
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Affiliation(s)
- Mehdi Rezaei
- PhD, Department of Orthotics and Prosthetics, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Hassan Saeedi
- PhD, Department of Orthotics and Prosthetics, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Behnam Hajiaghaei
- PhD, Department of Orthotics and Prosthetics, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Khosro Khademi-Kalantari
- PhD, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mokhtar Arazpour
- PhD, Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
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Robert-Lachaine X, Dessery Y, Belzile ÉL, Corbeil P. Knee braces and foot orthoses multimodal treatment of medial knee osteoarthritis. Gait Posture 2022; 96:251-256. [PMID: 35709608 DOI: 10.1016/j.gaitpost.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/19/2022] [Accepted: 06/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee braces and lateral wedge foot orthoses are two treatment options recommended for medial knee osteoarthritis, but the combination of both of them could further improve their effectiveness. RESEARCH QUESTION The aim was to evaluate whether the combination of lateral wedge foot orthoses with two types of knee brace enhances the biomechanical effects and pain relief during the stance phase of gait while maintaining comfort. METHODS Ten patients with medial knee osteoarthritis were fitted with a standard valgus brace, an unloader brace with valgus and external rotation functions, and 7° lateral wedge foot orthoses. The pain relief, comfort, kinematics and kinetics of the lower limb were measured during walking without orthotics, with the combined and with the isolated treatments. RESULTS The valgus and external rotation brace significantly reduced the knee adduction moment and allowed more knee flexion both in isolation and in combination to foot orthoses compared to the valgus brace or without treatment. Pain relief was not significant with the different orthotic treatment modalities. The valgus brace and combined treatment with either brace significantly increased the discomfort level, whereas the valgus and external rotation brace or foot orthoses in isolation did not induce significant discomfort. SIGNIFICANCE Amongst the tested orthotic treatment modalities, the valgus and external rotation brace obtained better biomechanical outcomes while maintaining comfort. The combined treatment with foot orthoses enhanced the effectiveness of the valgus brace, however foot orthoses may be unnecessary with the valgus and external rotation brace.
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Affiliation(s)
- Xavier Robert-Lachaine
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC, Canada; Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, QC, Canada
| | - Yoann Dessery
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
| | - Étienne L Belzile
- Division de Chirurgie Orthopédique, CHU de Québec Université Laval, Quebec City, QC, Canada; Département de Chirurgie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
| | - Philippe Corbeil
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC, Canada.
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Hall M, Starkey S, Hinman RS, Diamond LE, Lenton GK, Knox G, Pizzolato C, Saxby DJ. Effect of a valgus brace on medial tibiofemoral joint contact force in knee osteoarthritis with varus malalignment: A within-participant cross-over randomised study with an uncontrolled observational longitudinal follow-up. PLoS One 2022; 17:e0257171. [PMID: 35657960 PMCID: PMC9165832 DOI: 10.1371/journal.pone.0257171] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/18/2021] [Indexed: 12/02/2022] Open
Abstract
Background Previous investigations on valgus knee bracing have mostly used the external knee adduction moment. This is a critical limitation, as the external knee adduction moment does not account for muscle forces that contribute substantially to the medial tibiofemoral contact force (MTCF) during walking. The aims of this pilot study were to: 1) determine the effect of a valgus knee brace on MTCF; 2) determine whether the effect is more pronounced after 8 weeks of brace use; 3) assess the feasibility of an 8-week brace intervention. Methods Participants with medial radiographic knee OA and varus malalignment were fitted with an Össur Unloader One© brace. Participants were instructed to wear the brace for 8 weeks. The MTCF was estimated via an electromyogram-assisted neuromuscular model with and without the knee brace at week 0 and week 8. Feasibility outcomes included change in symptoms, quality of life, confidence, acceptability, adherence and adverse events. Results Of the 30 (60% male) participants enrolled, 28 (93%) completed 8-week outcome assessments. There was a main effect of the brace (p<0.001) on peak MTCF and MTCF impulse, but no main effect for time (week 0 and week 8, p = 0.10), and no interaction between brace and time (p = 0.62). Wearing the brace during walking significantly reduced the peak MTCF (-0.05 BW 95%CI [-0.10, -0.01]) and MTCF impulse (-0.07 BW.s 95%CI [-0.09, -0.05]). Symptoms and quality of life improved by clinically relevant magnitudes over the 8-week intervention. Items relating to confidence and acceptability were rated relatively highly. Participants wore the brace on average 6 hrs per day. Seventeen participants reported 30 minor adverse events over an 8-week period. Conclusion Although significant, reductions in the peak MTCF and MTCF while wearing the knee brace were small. No effect of time on MTCF was observed. Although there were numerous minor adverse events, feasibility outcomes were generally favourable. Trial registration Australian and New Zealand Clinical Trials Registry (12619000622101).
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Affiliation(s)
- Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Melbourne, Victoria, Australia
- * E-mail:
| | - Scott Starkey
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Melbourne, Victoria, Australia
| | - Rana S. Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Melbourne, Victoria, Australia
| | - Laura E. Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Gavin K. Lenton
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Gabrielle Knox
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Melbourne, Victoria, Australia
| | - Claudio Pizzolato
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David J. Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Yan Y, Liu G, Zhang L, Gong R, Fu P, Han B, Li H. Biomechanical Effect of Valgus Knee Braces on the Treatment of Medial Gonarthrosis: A Systematic Review. Appl Bionics Biomech 2022; 2022:4194472. [PMID: 35677195 PMCID: PMC9168205 DOI: 10.1155/2022/4194472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022] Open
Abstract
Background Valgus braces are prescribed as a common conservative treatment option for patients with medial gonarthrosis to improve their quality of life. Many studies had reviewed the effects of the valgus braces on patients with medial gonarthrosis, while they mainly focused on the knee adduction moment (KAM), with less attention paid to other parameters such as spatiotemporal and morphological parameters. Objectives The purpose of this study was to review the effects of valgus braces on the spatiotemporal, kinematic/kinetic, morphological, and muscle parameters. Methods Based on the selected keywords, a survey of literatures was performed in Web of Science, PubMed, Scopus, and Google Scholar using the PRISMA methods, and the search period was established from January 2000 to March 2022. Results Thirty-four articles were included. According to the conclusion of these articles, the valgus brace can be used to relieve the symptoms of patients with medial gonarthrosis by decreasing the varus angle, decreasing the KAM, and redistributing the knee compartment loads. However, the effects of valgus braces on other biomechanical parameters (e.g., walking speed, cadence, joint angle, and joint space) had not reached a consensus. Conclusions The valgus knee brace can effectively relieve the symptoms of medial gonarthrosis through multiple mechanisms, while there is still some confusion about the effectiveness of the valgus brace on the other biomechanical parameters.
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Affiliation(s)
- Yuzhou Yan
- Innovation Center of Bioengineering, Shaanxi Engineering Laboratory for Transmissions and Controls, Northwestern Polytechnical University, Xi'an 710072, China
| | - Geng Liu
- Innovation Center of Bioengineering, Shaanxi Engineering Laboratory for Transmissions and Controls, Northwestern Polytechnical University, Xi'an 710072, China
| | - Li Zhang
- Innovation Center of Bioengineering, Shaanxi Engineering Laboratory for Transmissions and Controls, Northwestern Polytechnical University, Xi'an 710072, China
| | - Ruitao Gong
- Innovation Center of Bioengineering, Shaanxi Engineering Laboratory for Transmissions and Controls, Northwestern Polytechnical University, Xi'an 710072, China
| | - Pengge Fu
- Innovation Center of Bioengineering, Shaanxi Engineering Laboratory for Transmissions and Controls, Northwestern Polytechnical University, Xi'an 710072, China
| | - Bing Han
- Innovation Center of Bioengineering, Shaanxi Engineering Laboratory for Transmissions and Controls, Northwestern Polytechnical University, Xi'an 710072, China
| | - Hui Li
- Joint Surgery Department, Xi'an Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, China
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Katsube G, Qi S, Itami T, Yano K, Mori I, Kameda K. Ankle foot orthosis that prevents slippage for tibial rotation in knee osteoarthritis patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4728-4731. [PMID: 34892267 DOI: 10.1109/embc46164.2021.9631003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Knee osteoarthritis (OA) is a disease caused by age-related muscle weakness, obesity, or sports injury that leads to gait disability due to pain during walking. Knee OA is characterized by abnormal knee joint alignment and rotational dyskinesia, which are believed to worsen the symptoms. We previously developed an ankle orthosis that mechanically induces the rotation of the lower limb in conjunction with that of the ankle joint. This orthosis can effectively correct the alignment of the knee joint. However, slippage between the orthosis and leg can occur during walking, decreasing the corrective force. In this study, we clarify the effect of slippage between the orthosis and body on the correction force of the orthosis, and develop a lower leg tracking mechanism to suppress slippage and minimize reduction of force. The effectiveness of the proposed mechanism was evaluated by three-dimensional motion analysis of gait. Analysis results confirmed that the proposed mechanism was effective in suppressing slippage and improving correction force, demonstrating the effectiveness of the mechanism for knee OA.
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Alfatafta H, Onchonga D, Alfatafta M, Zhang L, Boncz I, Lohner S, Molics B. Effect of using knee valgus brace on pain and activity level over different time intervals among patients with medial knee OA: systematic review. BMC Musculoskelet Disord 2021; 22:687. [PMID: 34384421 PMCID: PMC8362244 DOI: 10.1186/s12891-021-04513-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022] Open
Abstract
Background The Knee valgus brace is one of the accepted conservative interventions for patients with medial compartment knee osteoarthritis to correct the knee varus and increase functional activity level. Nevertheless, comprehensive overview of the effects of using this brace on self-reported pain activity level over time is not available. Thus, this study aimed to systematically review the effect of using this brace on pain and activity levels in the last 20 years in patients with medial compartment knee osteoarthritis. Methods Five databases were searched to find articles from the year 2000 to the end of November 2020: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PubMed, Web of Science, and Scopus. Two reviewers independently evaluated the available articles for eligibility and assessed quality. The risk of bias in each study was assessed by two reviewers independently according to the Strengthening the Reporting of Observational Studies in Epidemiology tool (STROBE) for the non-randomized controlled studies and the Cochrane risk-of-bias tool for the randomized controlled studies. Results Seven randomized controlled studies and 17 cohort studies (in total 579 participants) were included in the systematic review. Most of these studies found using a knee valgus brace effective in reducing pain and improving activity level over different time intervals. The majority of the included studies (14 studies) evaluated the impact of the brace for a considerably short-term (less than 6 months). Thus, limited evidence is available on the long-term use of the knee valgus brace and its associated complications. Conclusion The knee valgus brace is an effective conservative intervention to improve the quality of life and reduce pain during daily activities for some patients. However, the long term of using this brace is still not very convenient, and the patients who benefit most from using the brace should be identified with high methodological quality studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04513-0.
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Affiliation(s)
- Huda Alfatafta
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Vörösmarty utca 4, 7621, Pécs, Hungary.
| | - David Onchonga
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Vörösmarty utca 4, 7621, Pécs, Hungary
| | | | - Lu Zhang
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Vörösmarty utca 4, 7621, Pécs, Hungary
| | - Imre Boncz
- Faculty of Health Sciences, Institute for Health Insurance, University of Pecs, Pécs, Hungary
| | - Szimonetta Lohner
- Clinical Center, Medical School, Cochrane Hungary, University of Pécs, Pécs, Hungary
| | - Bálint Molics
- Institute of Physiotherapy and Sport Science, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
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Huber M, Eschbach M, Kazerounian K, Ilies H. Functional Evaluation of a Personalized Orthosis for Knee Osteoarthritis: A Motion Capture Analysis. J Med Device 2021. [DOI: 10.1115/1.4051626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Orthotic treatments for knee osteoarthritis (OA) typically rely on simple mechanisms such as three-point bending straps and single-pin hinges. These commonly prescribed braces cannot treat bicompartmental knee OA, do not consider the muscle weakness that typically accompanies the condition, and employ hinges that restrict the knee's natural biomechanics. Utilizing a novel, personalized joint mechanism in conjunction with magnetorheological dampers, we have developed and evaluated a brace which attempts to address these shortcomings. This process has respected three principal design goals: reducing the load experienced across the entire knee joint, generating a supportive moment to aid the thigh muscles in shock absorption, and interfering minimally with gait kinematics. Two healthy volunteers were chosen to test the system's basic functionality through gait analysis in a motion capture laboratory. Combining the collected kinematic and force-plate data with data taken from sensors onboard the brace, we integrated the brace and leg system into a single inverse dynamics analysis, from which we were able to evaluate the effect of the brace design on the subjects' knee loads and moments. Of the three design goals: a reduction in knee contact forces was demonstrated; increased shock absorption was observed, but not to statistical significance; and natural gait was largely preserved. Taken in total, the outcome of this study supports additional investigation into the system's clinical effectiveness, and suggests that further refinement of the techniques presented in this paper could open the doors to more effective OA treatment through patient specific braces.
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Affiliation(s)
- Martin Huber
- Department of Mechanical Engineering, University of Connecticut, 191 Auditorium Road, Storrs, CT 06269
| | - Matthew Eschbach
- Department of Mechanical Engineering, University of Connecticut, 191 Auditorium Road, Storrs, CT 06269
| | - Kazem Kazerounian
- Department of Mechanical Engineering, University of Connecticut, 191 Auditorium Road, Storrs, CT 06269
| | - Horea Ilies
- Department of Mechanical Engineering, University of Connecticut, 191 Auditorium Road, Storrs, CT 06269
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Gueugnon M, Fournel I, Soilly AL, Diaz A, Baulot E, Bussière C, Casillas JM, Cherasse A, Conrozier T, Loeuille D, Maillefert JF, Mazalovic K, Timsit M, Wendling D, Ramon A, Binquet C, Morisset C, Ornetti P. Effectiveness, safety, and cost-utility of a knee brace in medial knee osteoarthritis: the ERGONOMIE randomized controlled trial. Osteoarthritis Cartilage 2021; 29:491-501. [PMID: 33524515 DOI: 10.1016/j.joca.2020.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 09/15/2020] [Accepted: 11/30/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This pragmatic, multicenter, open-label, randomized controlled trial (RCT) aimed to compare the effectiveness, safety, and cost-utility of a custom-made knee brace versus usual care over 1 year in medial knee osteoarthritis (OA). DESIGN 120 patients with medial knee OA (VAS pain at rest >40/100), classified as Kellgren-Lawrence grade II-IV, were randomized into two groups: ODRA plus usual care (ODRA group) and usual care alone (UCA group). The primary effectiveness outcome was the change in VAS pain between M0 and M12. Secondary outcomes included changes over 1 year in KOOS (function) and OAKHQOL (quality of life) scores. Drug consumption, compliance, safety of the knee brace, and cost-utility over 1 year were also assessed. RESULTS The ODRA group was associated with a higher improvement in: VAS pain (adjusted mean difference of -11.8; 95% CI: -21.1 to -2.5); all KOOS subscales (pain: +8.8; 95% CI: 1.4-16.2); other symptoms (+10.4; 95% CI: 2.7-18); function in activities of daily living (+9.2; 95% CI: 1.1-17.2); function in sports and leisure (+12.3; 95% CI: 4.3-20.3); quality of life (+9.9; 95% CI: 0.9-15.9), OAKHQOL subscales (pain: +14.8; 95% CI: 5.0-24.6); and physical activities (+8.2; 95% CI: 0.6-15.8), and with a significant decrease in analgesics consumption at M12 compared with the UCA group. Despite localized side-effects, observance was good at M12 (median: 5.3 h/day). The ODRA group had a more than 85% chance of being cost-effective for a willingness-to-pay threshold of €45 000 per QALY. CONCLUSIONS The ERGONOMIE RCT demonstrated significant clinical benefits of an unloader custom-made knee brace in terms of improvements in pain, function, and some aspects of quality of life over 1 year in medial knee OA, as well as its potential cost-utility from a societal perspective.
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Affiliation(s)
- M Gueugnon
- INSERM, CIC 1432, Centre D'Investigation Clinique, Module Plurithématique, Plateforme D'Investigation Technologiques, Dijon, France CHU Dijon-Bourgogne, Dijon, France.
| | - I Fournel
- INSERM, CIC 1432, Centre D'Investigation Clinique, Module EC, CHU Dijon-Bourgogne, Dijon, France.
| | - A-L Soilly
- Department of Clinical Research, Clinical Research Unit-Methodological Support Network CHU Dijon-Bourgogne, F-21000, Dijon, France.
| | - A Diaz
- Department of Rheumatology, CHU Dijon Bourgogne, F-21000 Dijon, France.
| | - E Baulot
- Department of Orthopedic Surgery, CHU Dijon Bourgogne, F-21000 Dijon, France; INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences et Du Sport.
| | - C Bussière
- Department of Orthopedic Surgery, Centre Orthopédique Medico-chirugical, Dracy-Le-Fort, France.
| | - J M Casillas
- INSERM, CIC 1432, Centre D'Investigation Clinique, Module Plurithématique, Plateforme D'Investigation Technologiques, Dijon, France CHU Dijon-Bourgogne, Dijon, France; INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences et Du Sport; Department of Physical Medicine and Rehabilitation, CHU Dijon Bourgogne, F-2100 Dijon, France.
| | - A Cherasse
- Department of Rheumatology, Hospital Center Mâcon, Mâcon, France.
| | - T Conrozier
- Department of Rheumatology, Hospital Nord Franche-Comté, Belfort, France.
| | - D Loeuille
- Department of Rheumatology, CHU Nancy, F-54500 Vandoeuvre-lès-Nancy, France INSERM, CIC-EC CIE6, Nancy, France University Hospital of Nancy, Epidemiology and Clinical Evaluation, F-54500 Vandoeuvre-lès-Nancy, France.
| | - J-F Maillefert
- Department of Rheumatology, CHU Dijon Bourgogne, F-21000 Dijon, France; INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences et Du Sport.
| | - K Mazalovic
- INSERM, CIC 1432, Centre D'Investigation Clinique, Module EC, CHU Dijon-Bourgogne, Dijon, France; Department of General Medicine, Bourgogne Franche-Comté University, UFR des Sciences de Santé, Dijon, France.
| | - M Timsit
- Department of Physical Medicine and Rehabilitation, Clinique de Provence Bourbonne, F-13400 Aubagne, France.
| | - D Wendling
- Department of Rheumatology, CHU Besançon EA4266 Bourgogne Franche-Comté University, F-25030 Besançon, France.
| | - A Ramon
- Department of Rheumatology, CHU Dijon Bourgogne, F-21000 Dijon, France.
| | - C Binquet
- INSERM, CIC 1432, Centre D'Investigation Clinique, Module EC, CHU Dijon-Bourgogne, Dijon, France.
| | - C Morisset
- INSERM, CIC 1432, Centre D'Investigation Clinique, Module Plurithématique, Plateforme D'Investigation Technologiques, Dijon, France CHU Dijon-Bourgogne, Dijon, France.
| | - P Ornetti
- INSERM, CIC 1432, Centre D'Investigation Clinique, Module Plurithématique, Plateforme D'Investigation Technologiques, Dijon, France CHU Dijon-Bourgogne, Dijon, France; Department of Rheumatology, CHU Dijon Bourgogne, F-21000 Dijon, France; INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences et Du Sport.
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14
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Khosravi M, Babaee T, Daryabor A, Jalali M. Effect of knee braces and insoles on clinical outcomes of individuals with medial knee osteoarthritis: A systematic review and meta-analysis. Assist Technol 2021; 34:501-517. [PMID: 33507124 DOI: 10.1080/10400435.2021.1880495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Knee osteoarthritis is a disabling disease, causing pain and reduced function.Orthoses are used to manage this problem, including knee braces and lateral wedge insoles. However, there is still controversy on which type of intervention is more effective. This systematic review and meta-analysis aimed toevaluate the effect of knee braces and lateral wedge insoles and compare their clinical outcomes onindividuals with medial knee osteoarthritis. We conducted the search strategy based on the population, intervention, comparison, andoutcome (PICO) method. We searched with PubMed, EMBASE, Web of Science, and Scopus databases for the related studies. The articles quality assessment was done based on the modified Downs and Black checklist. Totally, we chose 32 controlled trials, including 1.849 participants, for the final evaluation. Almosttwo-thirds of the studies had a moderate quality. The overall outcome suggested that both interventionshad improved pain and function. The difference between both interventions on pain reduction was not significant (standardized mean difference = 0.12, 95% confidence interval = 0.34 to 0.1) based on meta-analysis. Both knee brace and lateral wedge insole can improve pain and function in people with knee osteoarthritis. Using either separately or both of them together are effective.
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Affiliation(s)
- Mobina Khosravi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Taher Babaee
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aliyeh Daryabor
- Department of Physiotherapy, Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Jalali
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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15
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Khosravi M, Arazpour M, Sharafat Vaziri A. An evaluation of the use of a lateral wedged insole and a valgus knee brace in combination in subjects with medial compartment knee osteoarthritis (OA). Assist Technol 2021; 33:87-94. [PMID: 30945994 DOI: 10.1080/10400435.2019.1595788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Aim: The aim of this study was to evaluate the effect (6 weeks) of the use of a knee brace and a lateral wedge insole, both in isolation and combined, on the knee adduction moment (KAM), pain levels, kinematics (velocity, stride length, cadence), knee ROM, function, and satisfaction in patients with knee osteoarthritis (OA).Methods: Twenty-one patients with medial compartment knee OA were participated in this study. A relatively light three-point valgus knee brace (VB) and full length custom-made lateral wedge insole with arch support were prepared for each subject. Patients divided into three groups at random.Results: The use of a custom fit valgus brace with lateral edge insole concurrently can reduce a greater peak KAM than use in isolation (30%). In addition, the use of both interventions can improve walking velocity, cadence, and reduce levels of pain in patients with medial compartment OA.Conclusion: All parameters except stride length and KAM in comparison with first day of wearing interventions improved significantly in the combined, concurrent usage group. The use of a lateral wedge insole and a valgus knee brace in combination can improve the kinetic and kinematic parameters in patients with medial compartment knee OA.
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Affiliation(s)
- Mobina Khosravi
- Orthotics and Prosthetics department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran (the Islamic Republic of)
| | - Mokhtar Arazpour
- Orthotics and Prosthetics department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran (the Islamic Republic of)
| | - Arash Sharafat Vaziri
- Orthopedic surgery department, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
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16
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Different Prevention and Treatment Strategies for Knee Osteoarthritis (KOA) with Various Lower Limb Exoskeletons – A Comprehensive Review. ROBOTICA 2021. [DOI: 10.1017/s0263574720001216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY
It was reported that about 10% of people suffer from painful knee arthritis, and a quarter of them were severely disabled. The core activities of daily living were severely limited by knee osteoarthritis (KOA). In order to reduce knee pain and prolong the life of the knee joint, there has been an increasing demand on the development of exoskeletons, for prevention and treatment. The course of KOA was closely related to the biomechanics of knee joint, and the pathogenesis was summarized based on the biomechanics of knee joint. For the prevention and clinical treatment, exoskeletons are classified into three categories: prevention, treatment, and rehabilitation after the operation. Furthermore, the design concepts, actuators, sensors, control strategies, and evaluation criteria were presented. Finally, the shortcomings and limitations were summarized. It is useful for researchers to develop suitable exoskeletons in the future.
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17
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Fesharaki SA, Farahmand F, Saeedi H, Raeissadat SA, Abdollahy E, Ahmadi A, Maroufi N. The Effects of Knee Orthosis with Two Degrees of Freedom Joint Design on Gait and Sit-to-Stand Task in Patients with Medial Knee Osteoarthritis. Sultan Qaboos Univ Med J 2021; 20:e324-e331. [PMID: 33414937 PMCID: PMC7757919 DOI: 10.18295/squmj.2020.20.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/22/2020] [Accepted: 04/19/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives Knee bracing as a conservative treatment option for patients with medial knee osteoarthritis (KOA) is of great interest to health practitioners and patients alike. Optimal orthotic knee joint structure is essential to achieve biomechanical and clinical effectiveness. Therefore, this study aimed to identify the effects of a knee orthosis with a new two-degrees-of-freedom (DOF) joint design on selected gait parameters and in a sit-to-stand task in patients with mild-to-moderate medial KOA. Methods This study was conducted both at the Physical Medicine and Rehabilitation Clinic in Shahid Modarres Academic Hospital and the Biomechanical Laboratory of Rehabilitation Faculty of Iran University of medical Sciences in Tehran, Iran from September 2015 to October 2017. The gait performance of 16 patients was assessed without an orthosis, using a common one-DOF (DOF) knee orthosis and using the same knee orthosis with a two-DOF orthotic joint design. The interactive shearing force between limb and brace in the shell area during a sit-to-stand test was also identified. Repeated measures analysis of variance was used to analyse the data. Results Compared with walking with no orthosis, both orthosis conditions reduced the external knee adduction moment significantly (P ≤0.05). A significant increase between the one-DOF and two-DOF conditions in terms of walking speed (P = 0.041 and P = 0.009, respectively) and stride length (P = 0.028 and P = 0.038, respectively) was observed. In a sit-to-stand test, wearing the orthosis significantly decreased knee transverse plane range of motion (P ≤0.05). There was a 41.31 ± 8.34 Newtons reduction in knee flexion constraint force. Conclusion The two-DOF knee orthosis was more comfortable compared to the one-DOF knee orthosis during deep knee flexion. Otherwise, the one-DOF- and two-DOF-braces performed similarly.
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Affiliation(s)
- Siamak Aghajani Fesharaki
- Department of Orthotics & Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.,Under-Secretary General for Health, Treatment and Rehabilitation of Iranian Red Crescent Society, Tehran, Iran
| | - Farzam Farahmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Hassan Saeedi
- Department of Orthotics & Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Raeissadat
- Physical Medicine & Rehabilitation Department, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Abdollahy
- Department of Biomechanics, Djavad Mowafaghian Research Centre of Intelligent Neuro-Rehabilitation Technologies, Tehran, Iran
| | - Amir Ahmadi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Maroufi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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18
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Robert-Lachaine X, Dessery Y, Belzile ÉL, Turmel S, Corbeil P. Three-month efficacy of three knee braces in the treatment of medial knee osteoarthritis in a randomized crossover trial. J Orthop Res 2020; 38:2262-2271. [PMID: 32077519 DOI: 10.1002/jor.24634] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 01/24/2020] [Accepted: 02/11/2020] [Indexed: 02/04/2023]
Abstract
Immediate biomechanical and functional effects of knee braces are often reported, however, the duration and type of knee brace treatment for knee osteoarthritis (KOA) remain unclear. The objective was to evaluate usage, comfort, pain, and knee adduction moment (KAM) of three knee braces each worn 3 months by patients. Twenty-four patients with KOA were assigned in a randomized crossover trial a valgus three-point bending system brace (V3P-brace), an unloader brace with valgus and external rotation functions (VER-brace) and a stabilizing brace used after ligament injuries (ACL-brace). Functional questionnaires and gait assessment were carried out before and after each brace wear period of 3 months. A Friedman test was applied between brace wear diary recordings. Repeated measures analyses of variance contrasted the factors brace type (ACL, V3P, and VER), time (pre and post) and wear (without and with) on comfort, pain, function, and KAM. Brace usage was similar, but the V3P-brace was slightly less worn. Discomfort was significantly lowered with the VER-brace. All knee braces relieved pain and symptoms from 10% to 40%. KAM angular impulse was reduced with the three braces, but the VER-brace obtained the lowest relative reduction of 9%. The interaction between time and wear indicated that part of the KAM reduction with brace wear was maintained post treatment. All three knee braces have great benefits for pain and function among the medial KOA population. The VER-brace offers additional advantages on daily use, comfort and KAM, which could improve compliance to brace treatment.
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Affiliation(s)
- Xavier Robert-Lachaine
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada.,Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC, Canada
| | - Yoann Dessery
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
| | - Étienne L Belzile
- Division de Chirurgie Orthopédique, CHU, Quebec City, QC, Canada.,Département de Chirurgie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
| | - Sylvie Turmel
- Division de Chirurgie Orthopédique, CHU, Quebec City, QC, Canada
| | - Philippe Corbeil
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC, Canada
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19
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Fan Y, Li Z, Zhang H, Hong G, Wu Z, Li W, Chen L, Wu Y, Wei Q, He W, Chen Z. Valgus knee bracing may have no long-term effect on pain improvement and functional activity in patients with knee osteoarthritis: a meta-analysis of randomized trials. J Orthop Surg Res 2020; 15:373. [PMID: 32873332 PMCID: PMC7466786 DOI: 10.1186/s13018-020-01917-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/24/2020] [Indexed: 12/20/2022] Open
Abstract
Background Knee osteoarthritis (KOA), with a high incidence in old-age population, adversely affects their life quality. The valgus knee bracing is an important physical therapy for KOA, but its clinical effects on pain release and functional improvement remained unclear. This meta-analysis is to systematically evaluate the clinical outcomes of valgus knee bracing in patients with KOA. Methods A meta-analysis of clinical randomized controlled trials (RCTs) on pain and functional changes in patients with KOA after using valgus knee braces. The search period was ranged from the inception of the database to May 2020. The enrolled research databases included PubMed, Embase, and Web of Science databases. Two investigators independently formulated inclusion criteria and exclusion criteria and screened and determined the final enrolled literature. Then the outcome indicators were extracted and organized from the included literature, and the risk of bias was assessed by Cochrane Handbook 5.0.1. Results A total of 10 articles were included in this study, including 739 patients. Eight articles were related to the visual analog scale (VAS) pain score, and the results showed that RR = − 0.29, 95% CI − 0.73, 0.15], P = 0.20; four articles were related to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score, and the results showed that RR = − 0.15, 95% CI [− 0.41, 0.11], P = 0.26; two articles were related to the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the results showed that RR = 0.58, 95% CI [− 4.25, 5.42], P = 0.81; and three articles were related to the KOOS Activities of Daily Living (KOOS-ADL), and the results showed that RR = 0.04, 95% CI [− 0.62, 0.69], P = 0.91. These results indicated that the valgus knee bracing has no statistical significance in pain and functional activity improvement of patients with KOA. The subgroup analysis showed that the follow-up time was the source of the heterogeneity of the VAS pain score. Conclusion Our current evidence suggests that valgus knee bracing may not improve pain release and function activates in KOA patients in the long-term period, but only being beneficial to the short-term rehabilitation.
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Affiliation(s)
- Yinuo Fan
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China
| | - Zhongfeng Li
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China
| | - Haitao Zhang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China
| | - Guoju Hong
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China
| | - Zhongshu Wu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China
| | - Weifeng Li
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China
| | - Lixin Chen
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China
| | - Yunlong Wu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China
| | - Qiushi Wei
- Department of Joint Diseases, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, NO. 261 Longxi Road, Liwan District, Guangzhou, Guangdong Province, China
| | - Wei He
- Department of Joint Diseases, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, NO. 261 Longxi Road, Liwan District, Guangzhou, Guangdong Province, China
| | - Zhenqiu Chen
- The Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong Province, China.
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20
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Christine W, Victor H, Daryl O, Todd F, Tyler F. A patient-specific lower extremity biomechanical analysis of a knee orthotic during a deep squat movement. Med Eng Phys 2020; 80:1-7. [PMID: 32430232 DOI: 10.1016/j.medengphy.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/20/2020] [Accepted: 04/05/2020] [Indexed: 10/24/2022]
Abstract
Although knee orthotics have become the preferred treatment method for rehabilitation and injury prevention, their biomechanical influence has not yet been quantified. A new type of knee joint orthosis (KJO) using a non-linear spring-loaded (NLSL) component was recently introduced to help prevent the growing number of knee injuries and aid during rehabilitation. The purpose of this case study is to quantify the lower extremity biomechanical effects and evaluate functional benefits of a new KJO as a precision treatment option. Kinematic and kinetic data obtained from two dynamic squat trials were recorded using VICONⓇ motion capture system and an AMTIⓇ force plate. This data was then applied to a modified computational musculoskeletal model. Inverse kinematics and dynamics were performed to calculate joint angles and joint moments while a static equilibrium problem was solved at each instant during the squat cycle, with and without the NLSL KJO to find individual muscle forces of the lower extremity. The NLSL KJO was seen to improve the activation in the subject's posterior chain musculature encouraging a more balanced synergy versus the inherent quadriceps dominant strategy during the squat movement, and encourage a more neutral behavior in the upright position by inhibiting movement towards terminal knee extension.
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Affiliation(s)
- Walck Christine
- Department of Mechanical Engineering, Embry-Riddle Aeronautical University, Daytona Beach, Florida, USA.
| | - Huayamave Victor
- Department of Mechanical Engineering, Embry-Riddle Aeronautical University, Daytona Beach, Florida, USA
| | - Osbahr Daryl
- Orlando Health, Pediatric Orthopaedics, Orlando, Florida, USA
| | - Furman Todd
- Orlando Health, Pediatric Orthopaedics, Orlando, Florida, USA
| | - Farnese Tyler
- Department of Mechanical Engineering, Embry-Riddle Aeronautical University, Daytona Beach, Florida, USA
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21
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Khosravi M, Arazpour M, Saeedi H, Rezaei M. Design Evaluation in Novel Orthoses for Patients with Medial Knee Osteoarthritis. J Biomed Phys Eng 2020; 9:719-732. [PMID: 32039103 PMCID: PMC6943847 DOI: 10.31661/jbpe.v0i0.965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 07/10/2018] [Indexed: 11/22/2022]
Abstract
Osteoarthritis of the knee is a debilitating condition affecting increasing numbers of individuals each year. One option for treatment is orthotic knee braces, but a little independent reviews have taken place to date on their relative outcomes for users. This study therefore evaluates the efficacy of different types of knee orthoses (braces) with regard to key aspects of use, including gait parameters, mobility and levels of comfort and compliance in subjects presenting with osteoarthritis (OA) of the knee. The collated data is presented with relevant supporting literature and appropriate descriptions in relation to each knee orthosis type that was identified, within appropriate subsections with advantages and disadvantages appropriately allocated. An analysis of each brace as presented by the corresponding article is then described further in terms of the design and structure, user outcomes and assessment summaries. According to the study carried out in this paper, it is presented and proved that applying the use of knee braces can reduce the knee adduction moment (KAM), but the amount of reduction afforded varies between designs. All of the studies reported significant pain reduction and functional improvement with the use of a knee brace, although their effect on the knee joint range of motion vary. Knee braces long-term use depends upon high levels of comfort and patient compliance, and further studies need to be conducted on larger numbers of subjects over greater time periods to reflect the long-term outcomes accurately
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Affiliation(s)
- M Khosravi
- MSc, Students Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - M Arazpour
- PhD, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- PhD, Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - H Saeedi
- PhD, Orthotics and Prosthetics Department, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - M Rezaei
- PhD, Orthotics and Prosthetics Department, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
- PhD, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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22
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Mohd Sharif NA, Usman J, Wan Safwani WKZ, Siew Li G, Abdul Karim S, Mohamed NA, Khan SS, Khan SJ. Effects of simple knee sleeves on pain and knee adduction moment in early unilateral knee osteoarthritis. Proc Inst Mech Eng H 2019; 233:1132-1140. [PMID: 31597554 DOI: 10.1177/0954411919874614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Knee sleeves are often prescribed to alleviate pain in people with early knee osteoarthritis. However, the biomechanics underlying their pain-relieving effect are still not well understood. This pre-post study aims at evaluating and comparing the effects of two different types of knee sleeves on knee adduction moment. Patients with clinically diagnosed knee osteoarthritis were recruited from the University of Malaya Medical Centre and were randomly assigned to two test groups using (1) a simple knee sleeve and (2) a simple sleeve with patella cutout. Knee adduction moment was collected using the Vicon motion capture system with two Kistler force plates. Pain, stiffness and physical functions were recorded using the Western Ontario and McMaster Universities Osteoarthritis Index. All measurements were taken before, immediately after and at the completion of 6 weeks of application (primary time point). In total, 17 participants with early unilateral knee osteoarthritis (47.7 (9.7) years) completed the study. Overall results show significant reduction in pain, early stance and late stance knee adduction moment and increased walking speed after 6 weeks of both knee sleeves application. This study results suggest that knee sleeves can reduce knee adduction moments in early unilateral knee osteoarthritis by 14.0% and 12.1% using the simple sleeve and the sleeve with patella cutout, respectively, and can potentially delay disease progression. In addition, knee sleeve with patella cutout does not provide additional benefits when compared to the simple knee sleeve.
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Affiliation(s)
| | - Juliana Usman
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.,Centre for Applied Biomechanics, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Goh Siew Li
- Sports Medicine Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Samihah Abdul Karim
- Sports Medicine Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Anisah Mohamed
- Institute of Mathematical Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Soobia Saad Khan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Saad Jawaid Khan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.,Department of Biomedical Engineering, Faculty of Engineering Science and Technology, Ziauddin University, Karachi, Pakistan
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23
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Gueugnon M, Stapley PJ, Gouteron A, Lecland C, Morisset C, Casillas JM, Ornetti P, Laroche D. Age-Related Adaptations of Lower Limb Intersegmental Coordination During Walking. Front Bioeng Biotechnol 2019; 7:173. [PMID: 31380364 PMCID: PMC6652268 DOI: 10.3389/fbioe.2019.00173] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/04/2019] [Indexed: 01/04/2023] Open
Abstract
Lower-limb intersegmental coordination is a complex component of human walking. Aging may result in impairments of motor control and coordination contributing to the decline in mobility inducing loss of autonomy. Investigating intersegmental coordination could therefore provide insights into age-related changes in neuromuscular control of gait. However, it is unknown whether the age-related declines in gait performance relates to intersegmental coordination. The aim of this study was to evaluate the impact of aging on the coordination of lower limb kinematics and kinetics during walking at a conformable speed. We then assessed the body kinematics and kinetics from gait analyses of 84 volunteers from 25 to 85 years old when walking was performed at their self-selected speeds. Principal Component Analysis (PCA) was used to assess lower-limb intersegmental coordination and to evaluate the planar covariation of the Shank-Thigh and Foot-Shank segments. Ankle and knee stiffness were also estimated. Age-related effects on planar covariation parameters was evaluated using multiple linear regressions (i.e., without a priori age group determination) adjusted to normalized self-selected gait velocity. Colinearity between parameters was assessed using a variation inflation factor (VIF) and those with a VIF < 5 were entered in the analysis. Normalized gait velocity significantly decreased with aging (r = −0.24; P = 0.028). Planar covariation of inter-segmental coordination was consistent across age (99.3 ± 0.24% of explained variance of PCA). Significant relationships were found between age and intersegmental foot-shank coordination, range of motion of the ankle, maximal power of the knee, and the ankle. Lower-limb coordination was modified with age, particularly the coordination between foot, and shank. Such modifications may influence the ankle motion and thus, ankle power. This observation may explain the decrease in the ankle plantar flexor strength mainly reported in the literature. We therefore hypothesize that this modification of coordination constitutes a neuromuscular adaptation of gait control accompanying a loss of ankle strength and amplitude by increasing the knee power in order to maintain gait efficiency. We propose that foot-shank coordination might represent a valid outcome measure to estimate the efficacy of rehabilitative strategies and to evaluate their efficiency in restoring lower-limb synergies during walking.
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Affiliation(s)
- Mathieu Gueugnon
- INSERM, CIC 1432, Module Plurithematique, Plateforme d'Investigation Technologique, Dijon, France.,CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Plurithématique, Plateforme d'Investigation Technologique, Dijon, France
| | - Paul J Stapley
- Neural Control of Movement Laboratory, Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Anais Gouteron
- CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Plurithématique, Plateforme d'Investigation Technologique, Dijon, France.,INSERM, UMR 1093-CAPS, Université de Bourgogne Franche Comté, UFR des Sciences du sport, Dijon, France.,Department of Physical Medicine and Rehabilitation, Dijon-Bourgogne University Hospital, Dijon, France
| | | | - Claire Morisset
- INSERM, CIC 1432, Module Plurithematique, Plateforme d'Investigation Technologique, Dijon, France.,CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Plurithématique, Plateforme d'Investigation Technologique, Dijon, France
| | - Jean-Marie Casillas
- INSERM, CIC 1432, Module Plurithematique, Plateforme d'Investigation Technologique, Dijon, France.,CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Plurithématique, Plateforme d'Investigation Technologique, Dijon, France.,INSERM, UMR 1093-CAPS, Université de Bourgogne Franche Comté, UFR des Sciences du sport, Dijon, France.,Department of Physical Medicine and Rehabilitation, Dijon-Bourgogne University Hospital, Dijon, France
| | - Paul Ornetti
- INSERM, CIC 1432, Module Plurithematique, Plateforme d'Investigation Technologique, Dijon, France.,CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Plurithématique, Plateforme d'Investigation Technologique, Dijon, France.,INSERM, UMR 1093-CAPS, Université de Bourgogne Franche Comté, UFR des Sciences du sport, Dijon, France.,Department of Rheumatology, Dijon University Hospital, Dijon, France
| | - Davy Laroche
- INSERM, CIC 1432, Module Plurithematique, Plateforme d'Investigation Technologique, Dijon, France.,CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Plurithématique, Plateforme d'Investigation Technologique, Dijon, France.,INSERM, UMR 1093-CAPS, Université de Bourgogne Franche Comté, UFR des Sciences du sport, Dijon, France
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24
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Acutherapy for Knee Osteoarthritis Relief in the Elderly: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:1868107. [PMID: 30906410 PMCID: PMC6398067 DOI: 10.1155/2019/1868107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/22/2019] [Indexed: 12/20/2022]
Abstract
Purpose This systematic review and meta-analysis was conducted to investigate the effects of various acutherapies on knee osteoarthritis (KOA) relief in the elderly. Methods Five databases were accessed from inception to July 2017 for searching randomized controlled trials (RCTs) on acutherapy for KOA relief in the elderly. Data were pooled after trial quality assessment for meta-analysis. Outcomes were the scores of knee pain, knee stiffness, and physical function accessed by Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index. Results 17 RCTs including 4774 subjects were included. The results indicated that acutherapy significantly affected knee pain (standardized mean difference, i.e., SMD = - 0.73, [95% CI, -0.98 to -0.47], P <0.001), knee stiffness (SMD = -0.66, [95%CI, -0.85 to -0.47], P <0.001), and physical function (SMD = -1.56, [95%CI, -2.17 to -0.95], P<0.001) when compared with control condition without intervention of any acutherapy. Moreover, acutherapy was more effective than corresponding sham (placebo) intervention applied on nonacupoints (SMD = -0.16, [95% CI, -0.32 to -0.01], P = 0.04). However, no significant differences were found on treatment effects between acutherapy and sham acutherapy at the same acupoints (SMD= - 0.09, [95%CI, -0.40 to 0.21], P = 0.55). Conclusions Acutherapy was an effective approach for KOA relief in the elderly. The selection of acupoints position could be a crucial factor that influences the treatment efficacy of acutherapy.
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25
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Parween R, Shriram D, Mohan RE, Lee YHD, Subburaj K. Methods for evaluating effects of unloader knee braces on joint health: a review. Biomed Eng Lett 2019; 9:153-168. [PMID: 31168421 DOI: 10.1007/s13534-019-00094-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/13/2018] [Accepted: 01/08/2019] [Indexed: 02/01/2023] Open
Abstract
The paper aims to provide a state-of-the-art review of methods for evaluating the effectiveness and effect of unloader knee braces on the knee joint and discuss their limitations and future directions. Unloader braces are prescribed as a non-pharmacological conservative treatment option for patients with medial knee osteoarthritis to provide relief in terms of pain reduction, returning to regular physical activities, and enhancing the quality of life. Methods used to evaluate and monitor the effectiveness of these devices on patients' health are categorized into three broad categories (perception-, biochemical-, and morphology-based), depending upon the process and tools used. The main focus of these methods is on the short-term clinical outcome (pain or unloading efficiency). There is a significant technical, research, and clinical literature gap in understanding the short- and long-term consequences of these braces on the tissues in the knee joint, including the cartilage and ligaments. Future research directions may complement existing methods with advanced quantitative imaging (morphological, biochemical, and molecular) and numerical simulation are discussed as they offer potential in assessing long-term and post-bracing effects on the knee joint.
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Affiliation(s)
- Rizuwana Parween
- 1Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372 Singapore
| | - Duraisamy Shriram
- 1Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372 Singapore
| | - Rajesh Elara Mohan
- 1Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372 Singapore
| | - Yee Han Dave Lee
- 2Changi General Hospital, 2 Simei Street 3, Singapore, 529889 Singapore
| | - Karupppasamy Subburaj
- 1Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372 Singapore
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26
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Moon J, Kim H, Lee J, Panday SB. Effect of wearing a knee brace or sleeve on the knee joint and anterior cruciate ligament force during drop jumps: A clinical intervention study. Knee 2018; 25:1009-1015. [PMID: 30121150 DOI: 10.1016/j.knee.2018.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 06/19/2018] [Accepted: 07/18/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee braces are considered to be extremely useful tools in reducing the shear force of knee joints for non-contact anterior cruciate ligament (ACL) injury prevention. However, the effectiveness of sports knee braces and sleeves remains to be identified. Therefore, the purpose of this study was to evaluate the effectiveness of wearing commercialized sports knee braces and sleeves on knee kinematics, kinetics, and ACL force during drop jumps using musculoskeletal modeling analysis. METHODS Musculoskeletal modeling analysis was conducted on 19 male alpine skiers who performed drop jump motions from a 40-cm box under three conditions: without a brace/sleeve, with a brace, and while wearing a neoprene sleeve. RESULTS The physical performance (i.e., the center of mass of the jumping height) was not affected by the type of brace or sleeve. However, wearing a brace or sleeve during drop jump tasks reduced the knee joint's maximum flexion, abduction angles, and adduction moment. The knee joint shear force when wearing the brace or sleeve exhibited no statistical differences. Further, the ACL load estimated in this study did not exhibit any statistical differences in relation to wearing a brace or sleeve. CONCLUSIONS The knee braces and sleeves reduced flexion and abduction movement, and adduction moment but did not reduce the knee joint shear force, internal rotation moment, or the ACL force. Therefore, if a sports knee brace that controls the knee joint's shear force and internal rotation moment is developed, it may aid in preventing ACL injuries.
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Affiliation(s)
- Jeheon Moon
- Department of Sports Science, Korea Institute of Sport Science, Seoul, Republic of Korea
| | - Hyeyoung Kim
- Division of Liberal Arts and Science, Korea National Sport University, Seoul, Republic of Korea
| | - Jusung Lee
- Department of Leisure Sports, Kangwon National University, Samcheok, Republic of Korea
| | - Siddhartha Bikram Panday
- Department of Sport and Leisure Studies, Keimyung University, Daegu, Republic of Korea; Department of Physical Education, Seoul National University, Seoul, Republic of Korea.
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27
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Gohal C, Shanmugaraj A, Tate P, Horner NS, Bedi A, Adili A, Khan M. Effectiveness of Valgus Offloading Knee Braces in the Treatment of Medial Compartment Knee Osteoarthritis: A Systematic Review. Sports Health 2018. [PMID: 29543576 PMCID: PMC6204633 DOI: 10.1177/1941738118763913] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT: Knee osteoarthritis affects 9.3 million adults over age 45 years in the United States. There is significant disability associated with this condition. Given the potential complications and the significant cost to the health care system with the dramatic increase in total knee arthroplasties performed for this condition, assessment of the efficacy of nonoperative modalities, such as offloading knee braces, is essential as part of optimizing nonoperative treatment for this condition. OBJECTIVE: To determine the effectiveness of valgus offloader braces in improving clinical outcomes for patients with medial compartment knee osteoarthritis. DATA SOURCES: Three databases (PubMed, MEDLINE, and EMBASE) were searched from database inception through July 28, 2017. STUDY SELECTION: Studies reporting outcomes of valgus offloader knee braces in the treatment of medial compartment knee osteoarthritis were included. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Data pertaining to demographics, descriptive statistics, and clinical outcomes were extracted from the included studies. The methodological quality of included studies was evaluated. RESULTS: A total of 31 studies were included, with a total of 619 patients. The majority of studies reported improved pain outcomes using valgus offloader braces. However, variable results were reported as to whether valgus offloader braces significantly improved functional outcomes and stiffness. Offloader bracing was more effective at reducing pain when compared with neutral braces or neoprene sleeves. CONCLUSION: Valgus offloader bracing is an effective treatment for improving pain secondary to medial compartment knee osteoarthritis. The literature remains unclear on the effectiveness of valgus offloader braces with regard to functional outcomes and stiffness. Larger prospective randomized trials with consistent outcome assessment tools and consideration of patient compliance would be beneficial to more accurately determine treatment effects of valgus offloader bracing.
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Affiliation(s)
| | | | | | | | | | | | - Moin Khan
- Moin Khan, MD, MSc, FRCSC, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada () (Twitter: @moinkhan_md)
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28
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Laroche D, Mangin M, Besson D, Naaim A, Gouteron A, Casillas JM. Number of raised steps: A tool to assess brief and intense effort involving anaerobic metabolism. Ann Phys Rehabil Med 2018; 61:156-163. [PMID: 29471056 DOI: 10.1016/j.rehab.2017.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/02/2017] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the initial anaerobic component of exercise adaptation is unavoidable, no specific functional test is available for use in routine non-sporting practice to evaluate it. OBJECTIVE To assess the bioenergetic and biomechanical properties of the Short and Fast Step Test (SFST), which consists of walking up and down a step as many times as possible in 1minute and to analyse its ability to explore the initial anaerobic component of effort in comparison to a reference self-paced step test. METHODS Overall, 31 healthy subjects (19 women; mean [SD] age, 32.4 [10.2] years) completed a test-retest of a self-paced step test and the SFST, with pre- and post-test measurement of blood lactate concentration and continuous recording of VO2 and modelling of excess post-exercise oxygen consumption (EPOC), near-infrared spectroscopy (NIRS) of the quadriceps and mechanical power (estimated by the number of steps climbed and 3-D motion analysis). RESULTS Both step tests were well tolerated. The reliability of the bioenergetics parameters, number of raised steps, mechanical power and NIRS tissue saturation index was good. Indirect mechanical power (estimated from number of steps) was correlated with direct power (computed from the centre of mass). Lactate accumulation was significantly increased during exercise with only the SFST (mean [SD] increase, 3.86 [3.26]mmolL-1 from resting values, P<0.05). EPOC was higher with the SFST than the self-paced step test (P<0.05). Only the SFST showed significant correlations between number of steps climbed and EPOC (r=0.84; P<0.001) and decreased tissue saturation index (NIRS) and EPOC area (r=-0.39; P<0.05). CONCLUSIONS SFST is feasible, well tolerated, reliable and responsive to explore a brief exercise involving anaerobic metabolism at submaximal intensity. The number of steps taken in 1minute seems a suitable parameter for practical application.
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Affiliation(s)
- Davy Laroche
- CIC INSERM 1432, Plateforme d'Investigation Technologique, CHU de Dijon, 21000 Dijon, France; INSERM U1093, Cognition, Action, Plasticité Sensori-motrice, 21000 Dijon, France
| | - Morgane Mangin
- CIC INSERM 1432, Plateforme d'Investigation Technologique, CHU de Dijon, 21000 Dijon, France
| | - Delphine Besson
- CIC INSERM 1432, Plateforme d'Investigation Technologique, CHU de Dijon, 21000 Dijon, France
| | - Alexandre Naaim
- CIC INSERM 1432, Plateforme d'Investigation Technologique, CHU de Dijon, 21000 Dijon, France
| | - Anaïs Gouteron
- CIC INSERM 1432, Plateforme d'Investigation Technologique, CHU de Dijon, 21000 Dijon, France
| | - Jean-Marie Casillas
- CIC INSERM 1432, Plateforme d'Investigation Technologique, CHU de Dijon, 21000 Dijon, France; INSERM U1093, Cognition, Action, Plasticité Sensori-motrice, 21000 Dijon, France.
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29
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Brand A, Klöpfer-Krämer I, Morgenstern M, Kröger I, Michel B, Thannheimer A, Müßig JA, Augat P. Effects of knee orthosis adjustment on biomechanical performance and clinical outcome in patients with medial knee osteoarthritis. Prosthet Orthot Int 2017; 41:587-594. [PMID: 29214918 DOI: 10.1177/0309364617691623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Valgus bracing in medial knee osteoarthritis aims to improve gait function by reducing the loading of the medial compartment. Orthosis composition and optimal adjustment is essential to achieve biomechanical and clinical effectiveness. OBJECTIVES To investigate biomechanical functionality during gait, pain relief and compliance in patients with knee osteoarthritis using a lightweight adjustable knee unloader orthosis. STUDY DESIGN Prospective observational clinical trial. METHODS Instrumented gait analysis in 22 patients with unilateral medial knee osteoarthritis was performed after a 2-week orthosis acclimatisation period. Kinematics and kinetics during gait as well as force transmission from the orthosis to the knee were analysed. Measurements were performed without, at individualised and at reduced orthosis setting. The assessment was supplemented by patient-related pain sensation and compliance questionnaires. RESULTS Orthosis wear significantly reduced the knee adduction moment by up to 20% depending on orthosis adjustment, whereas pain sensation was significantly reduced by 16%. A significant positive correlation was found between force transmissions and knee adduction moment as well as for frontal knee angle. Compliance was good with a main daily use of 2-6 h. CONCLUSION The orthosis provides significant biomechanical improvements, pain relief and good patient compliance. Patients had a biomechanical benefit for the individualised and reduced orthosis adjustments. Clinical relevance In patients with medial knee osteoarthritis, a lightweight medial unloader orthosis effectively reduced external knee adduction moment and pain sensation during daily activities. Thus, use of lightweight orthoses effectively supports conservative treatment in medial knee osteoarthritis.
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Affiliation(s)
- Andreas Brand
- 1 Institute of Biomechanics, Trauma Center Murnau, Germany
- 2 Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Isabella Klöpfer-Krämer
- 1 Institute of Biomechanics, Trauma Center Murnau, Germany
- 2 Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Mario Morgenstern
- 3 Trauma Center Murnau, Germany
- 4 University Hospital Basel, Switzerland
| | - Inga Kröger
- 1 Institute of Biomechanics, Trauma Center Murnau, Germany
- 2 Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Björn Michel
- 5 Endogap Hospital and Clinics Garmisch-Partenkirchen, Germany
| | | | - Janina Anna Müßig
- 1 Institute of Biomechanics, Trauma Center Murnau, Germany
- 2 Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Peter Augat
- 1 Institute of Biomechanics, Trauma Center Murnau, Germany
- 2 Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
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30
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Dong P, Tang X, Wang J, Jiang Y, Yao W, Gui J. [Short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in treatment of knee osteoarthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:794-798. [PMID: 29798521 PMCID: PMC8498158 DOI: 10.7507/1002-1892.201701099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/20/2017] [Indexed: 01/24/2023]
Abstract
Objective To investigate the short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in the treatment of knee osteoarthritis (KOA). Methods Between January 2014 and January 2015, 15 patients (15 knees) with KOA were treated using arthroscopic debridement assisting with the Ilizarov distraction technology. There were 7 males and 8 females, aged from 45 to 64 years (mean, 55 years). The left knee and the right knee were involved in 6 and 9 cases respectively. The disease duration was 2.0-9.5 years (median, 6 years). They all had received conservative treatment for 6 months and got poor clinical improvement. The preoperative visual analogue scale (VAS) score, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, the knee injury and osteoarthritis outcome score (KOOS), the range of motion (ROM) for knee, and the radiographic joint space width were 76.2±8.8, 59.3±5.7, 44.3±7.2, (75±21)°, and (2.5±0.4) mm respectively. According to Kellgren-Lawrence grade system, 11 cases were rated as grade III and 4 cases as grade IV. Results There was no poor incision healing, infection, and deep vein thrombosis. All the 15 patients were followed up 12-18 months (mean, 15.5 months). Patients achieved pain relief. The knee activity was obviously improved. The postoperative VAS score, WOMAC score, KOOS score, and ROM at 12 months were 20.9±7.8, 38.2±5.5, 92.1±6.9, and (118±14)° respectively, showing significant difference when compared with preoperative ones ( t=18.213, P=0.000; t=10.317, P=0.000; t=18.564, P=0.000; t=6.599, P=0.000). Postoperative X-ray film showed that joint space width at 12 months was (3.8±0.3) mm, showing significant difference when compared with preoperative one ( t=10.070, P=0.000). Conclusion Joint distraction by Ilizarov combined with arthroscopic debridement can effectively relieve pain, improve the function and quality of life. It was beneficial to cartilaginous tissue repair and delaying the degenerative process of KOA. The short-term effectiveness is satisfactory.
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Affiliation(s)
- Peilong Dong
- Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China;Department of Orthopedics, Jianhu Hospital Affiliated to Nantong University, Yancheng Jiangsu, 224700, P.R.China
| | - Xiaobo Tang
- Department of Orthopedics, Jianhu Hospital Affiliated to Nantong University, Yancheng Jiangsu, 224700, P.R.China
| | - Jian Wang
- Department of Orthopedics, Jianhu Hospital Affiliated to Nantong University, Yancheng Jiangsu, 224700, P.R.China
| | - Yiqiu Jiang
- Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China
| | - Wangxiang Yao
- Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China
| | - Jianchao Gui
- Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing Jiangsu, 210006,
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31
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Kess M, Stärke C, Henle P. [Unloading with insoles, orthotics and braces : Pre-operative leg axis correction or independent treatment?]. DER ORTHOPADE 2017; 46:575-582. [PMID: 28589390 DOI: 10.1007/s00132-017-3438-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) is a leading joint disease. In most of the early stages it does not involve the whole knee joint. Often, symptoms only or mainly concern the medial compartment combined with a slight varus malalignment. OBJECTIVES Do valgus braces or laterally wedged insoles influence biomechanics and thus improve pain and function in patients with medial OA? Does the OA grade, severity of malalignment or patient's body weight predict the efficacy of the above-mentioned conservative treatment options? MATERIALS AND METHODS The current literature was reviewed in regard to biomechanical changes to joint loading and their correlation to clinical results. RESULTS Valgus braces and laterally wedged insoles reduce knee adduction moment, varus malalignment and analgesic consumption. Some authors suggest that mainly an alteration in muscle activity (diminished muscle co-contractions) is responsible for pain relief. Body weight and severity of varus malalignment did not influence treatment results; a significant correlation with OA severity was shown only for laterally wedged insoles. For both devices, compliance problems - especially long-term - should be considered, and conclusive evidence of positive clinical effects cannot be stated. CONCLUSIONS Despite positive evidence in the current literature, a recommendation for or against valgus (unloader) braces in medial OA is not possible due to inconclusive results. Laterally wedged insoles are not recommended. Especially the long-term results are doubtful, and are possibly related to lacking compliance.
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Affiliation(s)
- M Kess
- Orthopädie Sonnenhof, Buchserstrasse 30, 3006, Bern, Schweiz.
| | - C Stärke
- Orthopädische Universitätsklinik, Universitätsklinikum Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - P Henle
- Orthopädie Sonnenhof, Buchserstrasse 30, 3006, Bern, Schweiz
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Naaim A, Morisset C, Ornetti P, Laroche D. In response to the article published by Fukaya et al., entitled: "Relationships between the center of pressure and the movements of the ankle and knee joints during the stance phase in patients with severe medial knee osteoarthritis". Knee 2017; 24:482-483. [PMID: 27955812 DOI: 10.1016/j.knee.2016.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/05/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Alexandre Naaim
- CIC-P INSERM 1432, Plateforme d'Investigation Technologique, Dijon University Hospital, Dijon F-21078, France
| | - Claire Morisset
- CIC-P INSERM 1432, Plateforme d'Investigation Technologique, Dijon University Hospital, Dijon F-21078, France
| | - Paul Ornetti
- INSERM U1093, Dijon F-21079, France; Department of Rheumatology, Dijon University Hospital, Dijon F-21078, France; University of Burgundy, Dijon F-21079, France
| | - Davy Laroche
- CIC-P INSERM 1432, Plateforme d'Investigation Technologique, Dijon University Hospital, Dijon F-21078, France; INSERM U1093, Dijon F-21079, France.
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Cherian JJ, Jauregui JJ, Leichliter AK, Elmallah RK, Bhave A, Mont MA. The effects of various physical non-operative modalities on the pain in osteoarthritis of the knee. Bone Joint J 2016; 98-B:89-94. [PMID: 26733650 DOI: 10.1302/0301-620x.98b1.36353] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The purpose of this study was to evaluate the effect of various non-operative modalities of treatment (transcutaneous electrical nerve stimulation (TENS); neuromuscular electrical stimulation (NMES); insoles and bracing) on the pain of osteoarthritis (OA) of the knee. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify the therapeutic options which are commonly adopted for the management of osteoarthritis (OA) of the knee. The outcome measurement tools used in the different studies were the visual analogue scale and The Western Ontario and McMaster Universities Arthritis Index pain index: all pain scores were converted to a 100-point scale. A total of 30 studies met our inclusion criteria: 13 on insoles, seven on TENS, six on NMES, and four on bracing. The standardised mean difference (SMD) in pain after treatment with TENS was 1.796, which represented a significant reduction in pain. The significant overall effect estimate for NMES on pain was similar to that of TENS, with a SMD of 1.924. The overall effect estimate of insoles on pain was a SMD of 0.992. The overall effect of bracing showed a significant reduction in pain of 1.34. Overall, all four non-operative modalities of treatment were found to have a significant effect on the reduction of pain in OA of the knee. This study shows that non-operative physical modalities of treatment are of benefit when treating OA of the knee. However, much of the literature reviewed evaluates studies with follow-up of less than six months: future work should aim to evaluate patients with longer follow-up.
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Affiliation(s)
- J J Cherian
- Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, Maryland, 21215, USA
| | - J J Jauregui
- Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, Maryland, 21215, USA
| | - A K Leichliter
- Philadelphia College of Osteopathic Medicine, 4170 City Ave, Philadelphia, PA 19131, USA
| | - R K Elmallah
- Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, Maryland, 21215, USA
| | - A Bhave
- Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, Maryland, 21215, USA
| | - M A Mont
- Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, Maryland, 21215, USA
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Baghaei Roodsari R, Esteki A, Aminian G, Ebrahimi I, Mousavi ME, Majdoleslami B, Bahramian F. The effect of orthotic devices on knee adduction moment, pain and function in medial compartment knee osteoarthritis: a literature review. Disabil Rehabil Assist Technol 2016; 12:441-449. [PMID: 26980073 DOI: 10.3109/17483107.2016.1151952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Roshanak Baghaei Roodsari
- a Department of Orthotics and Prosthetics , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
| | - Ali Esteki
- b Shahid Beheshti University of Medical Sciences , Tehran , Islamic Republic of Iran
| | - Gholamreza Aminian
- a Department of Orthotics and Prosthetics , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
| | - Ismaeil Ebrahimi
- c School of Rehabilitation Sciences, Iran University of Medical Sciences , Tehran , Islamic Republic of Iran
| | - Mohammad Ebramim Mousavi
- a Department of Orthotics and Prosthetics , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
| | - Basir Majdoleslami
- a Department of Orthotics and Prosthetics , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
| | - Fatemeh Bahramian
- a Department of Orthotics and Prosthetics , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
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Biomechanical effect of unloader braces for medial osteoarthritis of the knee: a systematic review (CRD 42015026136). Arch Orthop Trauma Surg 2016; 136:649-56. [PMID: 26739139 PMCID: PMC4842213 DOI: 10.1007/s00402-015-2388-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Indexed: 10/26/2022]
Abstract
PURPOSE There is a lack of consensus regarding biomechanical effects of unloader braces for the treatment of medial osteoarthritis (OA) of the knee. The purpose of this study was to perform a systematic review of studies examining the biomechanical effect of unloader braces. METHODS A systematic search for articles about the biomechanical effect of unloader braces was performed. Primary outcome measure was the influence of the brace on the knee adduction moment. Data sources were Pubmed central and google scholar. RESULTS Twenty-four articles were included. Twenty articles showed that valgus unloader braces significantly decrease the knee adduction moment. Seven of those studies reported a decrease of pain in braced patients (secondary outcome measure). Positive effects on the knee adduction moment could be found for custom made braces for conventional knee braces and for a foot ankle orthosis. Four studies could not show any effect of knee unloader braces on the knee adduction moment although one of these studies found decreased pain in braced patients. One of these studies examined healthy patients with a neutral axis. CONCLUSION This systematic review could demonstrate evidence that unloader braces reduce the adduction moment of the knee. Foresighted, a systematic review about the clinical effect of unloader braces is required.
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Abstract
Exoprostheses are devices that are secured to incomplete limbs to enable locomotion. By comparison, orthoses are devices externally applied to support or protect an injured body part. Orthoses also can be used to control, guide, protect, limit motion of, or immobilize an extremity, a joint, or a body segment. Exoprostheses and orthoses are a growing aspect of the physical rehabilitation of companion animals. They require precise design and fabrication. Patients and owners must be trained to use the devices. Exoprostheses and orthoses can have a profound beneficial impact on the mobility and the quality of life of companion animals.
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Ornetti P, Fortunet C, Morisset C, Gremeaux V, Maillefert JF, Casillas JM, Laroche D. Clinical effectiveness and safety of a distraction-rotation knee brace for medial knee osteoarthritis. Ann Phys Rehabil Med 2015; 58:126-31. [PMID: 26004814 DOI: 10.1016/j.rehab.2015.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Evaluation of the clinical effectiveness and safety of a new custom-made valgus knee brace (OdrA) in medial knee osteoarthritis (OA) in terms of pain and secondary symptoms. METHODS Open-label prospective study of patients with symptomatic medial knee OA with clinical evaluation at 6 and 52 weeks (W6, W52). We systematically assessed pain on a visual analog scale (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), spatio-temporal gait variables, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesic-sparing effects of the brace and tolerance. Mean scores were compared at baseline, W6 and W52 and the effect size (ES) and 95% confidence intervals (95% CIs) were calculated. RESULTS We included 20 patients with knee OA (mean age 64.2±10.2 years, mean body mass index 27.2±5.4 kg/m2). VAS pain and KOOS were improved at W6 and W52: pain (ES=0.9 at 1 year), amelioration of other symptoms (ES=0.4), and function in activities of daily living (ES=1.1), sports and leisure (ES=1.5), quality of life (ES=0.9) and gait speed (ES=0.41). In total, 76% of patients showed clinical improvement at 1 year. Analgesic and NSAIDs consumption was significantly decreased at W6 and W52. One serious adverse effect noted was lower-limb varices, and observance was deemed satisfactory at 1 year. CONCLUSION This new unloader brace appeared to have good effect on medial knee OA, with an acceptable safety profile and good patient compliance.
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Affiliation(s)
- P Ornetti
- Service de rhumatologie, CHU Bocage, 21078 Dijon, France; Inserm U1093, université de Bourgogne, 21079 Dijon, France.
| | - C Fortunet
- Service de rhumatologie, centre hospitalier William-Morey, 71321 Chalon-sur-Saône, France
| | - C Morisset
- CIC-P Inserm 803, plateforme d'investigation technologique, CHU de Dijon, 21078 Dijon, France
| | - V Gremeaux
- Inserm U1093, université de Bourgogne, 21079 Dijon, France; Service de médecine physique et réadaptation, CHU de Dijon, 21078 Dijon, France
| | - J F Maillefert
- Service de rhumatologie, CHU Bocage, 21078 Dijon, France; Inserm U1093, université de Bourgogne, 21079 Dijon, France
| | - J M Casillas
- Inserm U1093, université de Bourgogne, 21079 Dijon, France; Service de médecine physique et réadaptation, CHU de Dijon, 21078 Dijon, France
| | - D Laroche
- Inserm U1093, université de Bourgogne, 21079 Dijon, France; CIC-P Inserm 803, plateforme d'investigation technologique, CHU de Dijon, 21078 Dijon, France
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Cherian JJ, Bhave A, Kapadia BH, Starr R, McElroy MJ, Mont MA. Strength and Functional Improvement Using Pneumatic Brace with Extension Assist for End-Stage Knee Osteoarthritis: A Prospective, Randomized trial. J Arthroplasty 2015; 30:747-53. [PMID: 25499679 DOI: 10.1016/j.arth.2014.11.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/08/2014] [Accepted: 11/26/2014] [Indexed: 02/01/2023] Open
Abstract
Pneumatic unloader bracing with extension assists have been proposed as a non-operative modality that may delay the need for knee surgery by reducing pain and improving function. This prospective, randomized trial evaluated 52 patients who had knee osteoarthritis for changes in: (1) muscle strength; (2) objective functional improvements; (3); subjective functional improvements; (4) pain; (5) quality of life; and (6) conversion to total knee arthroplasty (TKA) compared to standard of care. Patient outcomes were evaluated at a minimum 3 months. Braced patient's demonstrated significant improvements in muscle strength, several functional tests, and patient reported outcomes when compared to the matched cohort. These results are encouraging and suggest that this device may represent a promising alternative to standard treatment methods for knee osteoarthritis.
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Affiliation(s)
- Jeffrey J Cherian
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Anil Bhave
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Bhaveen H Kapadia
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Roland Starr
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Mark J McElroy
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Dessery Y, Belzile EL, Turmel S, Corbeil P. Comparison of three knee braces in the treatment of medial knee osteoarthritis. Knee 2014; 21:1107-14. [PMID: 25156178 DOI: 10.1016/j.knee.2014.07.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/07/2014] [Accepted: 07/21/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Conservative orthotic treatments rely on different mechanisms, such as three-point bending systems or hinges forcing external rotation of the leg and knee stabilization, to alter the biomechanics of the lower limbs and thus reduce knee loading on the affected compartment in patients with knee osteoarthritis (KOA). No previous study had compared the effects of these mechanisms on external loading and leg kinematics in patients with KOA. METHODS Twenty-four patients with medial KOA (Kellgren-Lawrence grade II or III) wore three custom knee braces: a valgus brace with a three-point bending system (V3P-brace), an unloader brace with valgus and external rotation functions (VER-brace) and a functional knee brace used in ligament injuries (ACL-brace). Pain relief, comfort, lower extremity kinematics and kinetics during walking were compared with and without each knee brace. RESULTS Knee pain was alleviated with all three braces (p<0.01). The VER- and ACL-braces allowed a significant reduction in peak knee adduction moment (KAM) during terminal stance from 0.313 to 0.280 Nm/Bw∗Ht (p<0.001) and 0.293 to 0.268 (p<0.05), respectively, while no significant reduction was observed with the V3P-brace (p=0.52). Reduced knee adduction and lower ankle and knee external rotation were observed with the V3P-brace but not with the VER-brace. The ACL-brace did not modify lower limb kinematics. CONCLUSIONS No difference between the knee braces was found for pain reduction, discomfort or KAM. The VER-brace was slightly more comfortable, which could ensure better compliance with treatment over the long term.
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Affiliation(s)
- Yoann Dessery
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec, QC, Canada; Centre de recherche FRSQ du CHA universitaire de Québec, Québec, QC, Canada
| | - Etienne L Belzile
- Division de Chirurgie Orthopédique, CHUQ, Québec, QC, Canada; Département de Chirurgie, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Sylvie Turmel
- Division de Chirurgie Orthopédique, CHUQ, Québec, QC, Canada
| | - Philippe Corbeil
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec, QC, Canada; Centre de recherche FRSQ du CHA universitaire de Québec, Québec, QC, Canada.
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Moyer RF, Ratneswaran A, Beier F, Birmingham TB. Osteoarthritis year in review 2014: mechanics--basic and clinical studies in osteoarthritis. Osteoarthritis Cartilage 2014; 22:1989-2002. [PMID: 25456294 DOI: 10.1016/j.joca.2014.06.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/18/2014] [Accepted: 06/25/2014] [Indexed: 02/02/2023]
Abstract
The purpose of this review was to highlight recent research in mechanics and osteoarthritis (OA) by summarizing results from selected studies spanning basic and clinical research methods. Databases were searched from January 2013 through to March 2014. Working in pairs, reviewers selected 67 studies categorized into four themes--mechanobiology, ambulatory mechanics, biomechanical interventions and mechanical risk factors. Novel developments in mechanobiology included the identification of cell signaling pathways that mediated cellular responses to loading of articular cartilage. Studies in ambulatory mechanics included an increased focus on instrumented knee implants and progress in computational models, both emphasizing the importance of muscular contributions to load. Several proposed biomechanical interventions (e.g., shoe insoles and knee braces) produced variable changes in external knee joint moments during walking, while meta-analysis of randomized clinical trials did not support the use of lateral wedge insoles for decreasing pain. Results from high quality randomized trials suggested diet with or without exercise decreased indicators of knee joint load during walking, whereas similar effects from exercise alone were not detected with the measures used. Data from longitudinal cohorts suggested mechanical alignment was a risk factor for incidence and progression of OA, with the mechanism involving damage to the meniscus. In combination, the basic and clinical studies highlight the importance of considering multiple contributors to joint loading that can evoke both protective and damaging responses. Although challenges clearly exist, future studies should strive to integrate basic and clinical research methods to gain a greater understanding of the interactions among mechanical factors in OA and to develop improved preventive and therapeutic strategies.
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Affiliation(s)
- R F Moyer
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - A Ratneswaran
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - F Beier
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - T B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada.
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