Article

Increases in the external knee adduction moment (EKAM) have been associated with
increased mechanical load at the knee and progression of knee osteoarthritis.
Valgus knee braces and lateral wedged insoles are common approaches to reducing
this loading; however no study has directly compared the biomechanical and
clinical effects of these two treatments in patients with medial tibiofemoral
osteoarthritis. A cross-over randomised design was used where each intervention
was worn by 28 patients for a two week period. Pre- and post-intervention gait
kinematic/kinetic data and clinical outcomes were collected to evaluate the
biomechanical and clinical effects on the knee joint.
The valgus knee brace and
the lateral wedged insole significantly increased walking speed, reduced the
early stance EKAM by 7% and 12%, and the knee adduction angular impulse by 8.6
and 16.1% respectively. The lateral wedged insole significantly reduced the early
stance EKAM compared to the valgus knee brace (p=0.001). The valgus knee brace
significantly reduced the knee varus angle compared to the baseline and lateral
wedged insole. Improvements in pain and function subscales were comparable for
the valgus knee brace and lateral wedged insole. There were no significant
differences between the two treatments in any of the clinical outcomes; however
the lateral wedged insoles demonstrated greater levels of acceptance by patients.
This is the first study to biomechanically compare these two treatments, and
demonstrates that given the potential role of knee loading in osteoarthritis
progression, that both treatments reduce this but lateral wedge insoles appear to
have a greater effect.
CI - Copyright (c) 2012 Elsevier B.V. All rights reserved.

Langue : ANGLAIS