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Patients with untreated anterior cruciate ligament insufficiency often develop osteoarthritis. In Japan, laterally or medially elevated insoles have been widely used for the relief of symptoms associated with unicompartmental osteoarthritis of the knee.
The use of a valgus wedge in the shoe of a patient with anterior cruciate ligament insufficiency...
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... was evaluated with a technique described previously by Ogata et al. 11, 12 The reliability and accuracy of the technique was demonstrated previously by the au- thors. Unidirectional accelerometers (1823, NEC Sanei, Tokyo, Japan) were used to record the medial-lateral and perpendicular components of acceleration while the sub- ject was walking (Fig. 2). The devices were attached with adhesive tape to the skin overlying the subject's tibial tubercles. In an attempt to minimize skin-motion arti- facts, which are commonly produced when accelerometers are attached to the skin, we preloaded the accelerometers against the skin as described elsewhere. 12 Time of heel strike was confirmed ...
Citations
... The walking task was performed to investigate the acceleration of the greater trochanter in the braced and unbraced conditions at 3 weeks postoperatively. The reliability of evaluating instability using accelerometry was demonstrated in a previous study [21]. As previous studies used an accelerometer to effectively measure hip instability during walking movements [12,13], we decided to use the same method. ...
Currently, hip braces are recommended and typically worn by femoroacetabular impingement (FAI) patients after hip arthroscopic surgery. However, there is currently a lack of literature regarding the biomechanical effectiveness of hip braces. The purpose of this study was to investigate the biomechanical effect of hip braces after hip arthroscopic surgery for FAI. Overall, 11 patients who underwent arthroscopic FAI correction and labral preservation surgery were included in the study. Standing-up and walking tasks in unbraced and braced conditions were performed at 3 weeks postoperatively. For the standing-up task, videotaped images of the hip’s sagittal plane were recorded while patients stood from a seated position. After each motion, the hip flexion-extension angle was calculated. For the walking task, acceleration of the greater trochanter was measured using a triaxial accelerometer. For the standing-up motion, the mean peak hip flexion angle was found to be significantly lower in the braced condition than in the unbraced condition. Furthermore, the mean peak acceleration of the greater trochanter was significantly lower in the braced condition than in the unbraced condition. Patients undergoing arthroscopic FAI correction surgery would benefit from usage of a hip brace in terms of protecting repaired tissues during early postoperative recovery.
... Furthermore, recent studies have reported the positive efect of the LWI on the reduction of structural instability in the medial compartment of the knee [25,26]. Especially, Te LWI reduces lateral thrust by inhibiting dynamic varus movement during gait [22,27,28]. Tese previous studies show LWI may have a favorable efect on gait variability by inhibiting varus instability. ...
... Te dynamic varus movement during the stance phase often presents as the lateral thrust, known as dynamic knee instability [17]. Previous studies suggest that lateral thrust can be reduced by the use of LWI; this efect was described by the acceleration sensor data [22,27]. In this study, lateral thrust in the knee OA group was higher compared to the control group at baseline. ...
... Although lateral thrust and knee pain decreased at T0, gait variability did not change between baseline and T0. In contrast, previous biomechanical studies provided evidence that the LWI can immediately decrease the knee mechanical stress and pain [22,23,27,28]. A possible explanation is that compensatory adjustments in associated joints following a sharp correction for the mechanical stress on the knee could potentially worsen compliance and gait variability. ...
Background:
Lateral thrust seen in people with medial compartment knee osteoarthritis can cause dynamic knee instability and poor postural control during gait cycles. A lateral wedge insole can reduce the lateral thrust and may have a favorable effect on gait variability, which in turn may indicate gait instability improves. The aim of this study was to investigate the effect of lateral wedge insole on gait variability in knee osteoarthritis patients.
Method:
We involved 15 symptomatic knee osteoarthritis patients who were provided with lateral wedge insole and 13 healthy asymptomatic volunteers as the control group. The gait variability was evaluated as the coefficient of variation of stride, stance, and swing duration based on acceleration monitoring using a wearable sensor. The lateral thrust was estimated as the lateral acceleration peak on the shank sensor. These measurements were performed without lateral wedge insole (baseline), immediately with lateral wedge insole (T0) at the initial office visit and one month after intervention (T1).
Result:
Our data showed that the stance duration coefficient of variation and lateral thrust at T1 in the knee osteoarthritis group, were significantly decreased compared to the baseline values and these values were identical to those in the control group.
Conclusion:
The lateral wedge insole reduces dynamic knee instability and could improve gait variability in medial compartment knee osteoarthritis.
... 1) However, in many cases, it is difficult to clearly determine whether varus thrust is present in early-stage knee OA, and the inter-rater reliability is not high enough in these instances. From a clinical perspective, the accurate identification and quantification of varus thrust is important, and IMUs are now being increasingly used in the assessment of patients with knee OA. 8,19) IMUs are inexpensive, portable, wireless devices that orthopedic specialists and physical therapists can easily use in clinical practice. Our current results demonstrated a high sensitivity for the quantitative assessment of varus thrust using these devices. ...
Objectives: The purpose of this study was to clarify the diagnostic accuracy of the mobile assessment of varus thrust using inertial measurement units (IMUs).
Methods: A total of 80 knees in 49 patients were enrolled in this study. On visual analysis of gait to determine the presence or absence of varus thrust, 23 knees were assigned to the Present group, 17 to the Ambiguous group, and 40 to the Absent group. The peak knee varus angular velocities (PVVs), measured by quantitative gait analysis using nine-axis IMUs, were compared between these three groups. A receiver operating characteristic curve for the relationship between the visual assessment of varus thrust (Present and Ambiguous) and the measured PVV was created, and the cut-off PVV for visualized varus thrust was determined as the highest point for both sensitivity and specificity.
Results: The mean PVVs were significantly different between the three groups (Present, 47.7 ± 8.2 degree/s, Ambiguous, 34.1 ± 10.5 degree/s, and Absent, 28.1 ± 8.3 degree/s, respectively, ANOVA P=0.000). The PVV cut-off value for visualized varus thrust was 28.1 degree/s, yielding a sensitivity of 0.957 and a specificity of 0.579.
Conclusions: A PVV <28.1 degree/s is useful for ruling out varus thrust during gait. This quantitative varus thrust assessment method using IMUs has clinical utility as a screening test.
... Recent work has been ongoing to develop portable gait analysis devices using accelerometers, with some success, 45-47 while the use of accelerometer in examining varus thrust has well-established foundations. [48][49][50] Computational analysis techniques such as Fast Fourier Transform 51 or wavelet filtering 52 of accelerometer data allow exploration of frequency domain in knee movement. This will allow the exploration of fast knee vibration and oscillation that is suggested by reduced stiffness and increased contact point variability in the subjectively unstable knee in comparison to stable. ...
Patient-reported instability is a common complaint amongst those with knee arthritis.
Much research has examined the assessment of self-reported instability in the knee; however, no definitive quantitative measure of instability has been developed.
This review focuses on the current literature investigating the nature of self-reported instability in the arthritic knee and discusses the possibilities of further investigation.
Cite this article: EFORT Open Rev 2019;4:70-76. DOI: 10.1302/2058-5241.4.170079
... Various authors have reported that malalignment of the foot and anomalous movement causes stress on knee joints through a load chain mechanism 1,12,18) . From evaluations using a compact accelerometer it has been verified that insole is useful for lateral fluctuation in knee joints as seen in knee osteoarthritis patients and ACL patients 4,19) . Our results also suggest that stress generated in the foot may have an affect all the way up to the knee joint, and we conclude that it is important to evaluate the instability of the foot and anomalous movements for curing treatment of sports disorders. ...
[Purpose] In the present study, gait analysis was conducted using a compact accelerometer for analyzing the peak acceleration value of the lower extremity during walking by juvenile patients suffering from chronic sports knee injury to the knee extensor mechanism, through lower extremity malalignment and other causes. [Subjects] The painful knees group included 13 subjects with 13 lower extremities, while the control group included 12 subjects with 12 lower extremities and normal healthy lumbar regions and lower extremity. [Methods] We mounted a tri-axial accelerometer on the lateral malleolus ankle joint and the head of the fibula. The peak acceleration values of the forward and backward components, perpendicular component and mediolateral component during the stance phase were analyzed from acceleration waveforms. [Results] Backward-peak and revised medial-peak of the sensor mounted on the head of the fibula and lateral-peak of the sensor mounted on the lateral malleolus ankle joint were significantly large in the painful knees group as compared to the control group. [Conclusion] Significant increase in peak acceleration as observed in the painful knees group shows that strong stress is generated in the forward-backward and mediolateral directions in knee joints. This is in agreement with the condition of dynamic malalignment such as varus-valgus movements of knee joints, which are considered to be the causes of knee extensor mechanism disorders.
... 7 Lateral thrust associated with a shift of load when walking is considered to be the main cause of osteoarthritis of the knee joint. [8][9][10] Sutherland and Greenfield 11 noted that instability in dysplastic hips was evident in push-pull radiographs taken during arthrography. In a cadaver study, Wingstrand, Wingstrand and Krantz 12 found that the traction force required to overcome the stabilising effect of atmospheric pressure and subluxate the adult joint was approximately 200 N, and proportional to the square of the diameter of the femoral head. ...
... [29][30][31] The reliability, accuracy and reproducibility of evaluating hip instability using accelerometry have been demonstrated in previous studies. [8][9][10] We have described the use of accelerometry for the quantitative analysis of instability of the hip during walking. 7 In this study we used this technique to compare instability in hips before and at one year after the operation. ...
We compared the dynamic instability of 25 dysplastic hips in 25 patients using triaxial accelerometry before and one year after periacetabular osteotomy. We also evaluated the hips clinically using the Harris hip score and assessed acetabular orientation by radiography before surgery and after one year. The mean overall magnitude of acceleration was significantly reduced from 2.30 m/s ² (sd 0.57) before operation to 1.55 m/s ² (sd 0.31) afterwards. The mean Harris hip score improved from 78.08 (47 to 96) to 95.36 points (88 to 100). The radiographic parameters all showed significant improvements.
This study suggests that periacetabular osteotomy provides pain relief, improves acetabular cover and reduces the dynamic instability in patients with dysplastic hips.
Osteoarthritis of the knee is one of the most important degenerative joint diseases in the clinical routine. The treatment of knee osteoarthritis is not only based on the stage, symptoms and duration of the joint disease, but also depends on the existing arthrosis pattern. In the case of unicompartmental arthrosis, damage typical for osteoarthritis is limited to just one joint compartment. Both the conservative and the surgical treatment of unicompartmental osteoarthritis of the knee have to respect the individual characteristics of the respective forms of osteoarthritis. In the context of this manuscript, the genesis, the diagnostics and the guideline-based stage-adapted conservative and operative treatment of unicompartmental osteoarthritis of the knee are addressed.
Purpose:
To investigate the effect of lateral wedge insole (LWI) on medial meniscus extrusion (MME) observed during dynamic evaluation with ultrasound and its correlation with the alteration in knee pain in patients with knee osteoarthritis (OA).
Methods:
This cohort study included 25 participants with knee OA. The medial meniscus was imaged during walking in video mode using ultrasonography. The degree of increase in MME (ΔMME) was calculated as the difference in the value of the maximum and minimum MME. The intensity of knee pain was evaluated immediately after the walking trial using the visual analogue scale (VAS). These measurements were performed with and without the LWI. The participants were categorised into the responder group, which was identified by the constant reduction in the VAS, and the non-responder group.
Results:
MME, ΔMME, and knee pain during walking were significantly lower with the LWI than without the LWI (p < 0.01). The reduction in ΔMME with the LWI in the responder group was significantly higher than that in the non-responder group (p < 0.01).
Conclusions:
Our findings showed that MME and knee pain during walking decreased with LWI use, especially in patients whose reduction in knee pain was characterised by inhibition in the increase in MME observed during dynamic evaluation with ultrasound.
Introduction / Background: In the period of evidence-based medicine orthopedic insoles and orthoses require evidence of efficacy as every other form of medical therapy. Providing such evidence is in the best interest of patients as well as funders in the health care systems. This review of literature has the objective to present the current state of evidence for a prescription of insoles and foot orthoses for different indications, to identify therapies which have not been proved effective yet with scientifically qualitative and quantitative evidence and to identify promising and relevant concepts of orthoses and insoles for further clinical trials. Material and Methods: A structured research of literature was conducted in two medical databases (PubMed and Cochrane); after screening all results and applying exclusion criteria it revealed 277 clinical trials, reviews and meta-analyses as well as further scientific studies covering more than 20 different areas of indication. Before completion of this review an update was conducted. Results: In general, the number and quality of the available articles concerning orthopedic in-soles and foot orthoses presents as low and poor, especially when considering their widespread use. Ailments like diabetic foot syndrome or rheumatoid arthritis can be treated with insoles and orthoses, at least as an adjuvant therapy. For the frequently discussed unicompartimental osteoarthritis of the knee there are certain hints of efficacy for a concept of elevating the insoles’ rims, however the data situation is insufficient. Beyond that there are single trials for many indications which claim to prove efficacy, yet the number of trials and quality of designs often prevents generating scientific evidence. Superiority of customized insults over off-the-shelf insoles has not been proved yet either. Discussion / Conclusion: At large, there is a current lack of high-quality clinical trials with sufficient follow-up intervals and population sizes which are necessary to conduct for creating a base of evidence for the future.
1 Zusammenfassung 1.1 Hintergrund Aufgrund mangelnder Evidenz für die Wirksamkeit orthopädischer Einlagen wird zur Sicherung von deren Kostenübernahme durch die Krankenkassen in Zukunft die Durchführung methodisch verbesserter klinischer Studien notwendig sein. In der vorgelegten Arbeit werden die bisher verwendeten Methoden zur Bewertung des Nutzens von orthopädischen Einlagen zusammengestellt und analysiert. Darüber hinaus werden neue, bisher noch nicht verwendete Methoden aufgezeigt. Ziel ist die Identifizierung geeigneter Untersuchungsmethoden für zukünftige Studien, welche sich wissenschaftlich mit dem Effekt von orthopädischen Maßeinlagen befassen. 1.2 Methoden In den frei zugänglichen Datenbanken „PubMed“ und „Cochrane Library“ wurde in einer systematischen Literaturrecherche mit den Suchstrategien [„insoles“], [„foot AND orthoses“] und [„foot AND orthotics“] nach aussagekräftigen Publikationen zur Wirksamkeit von orthopädischen Maßeinlagen gesucht. Aus den Studien, welche die Aufnahmekriterien erfüllten, wurden die verwendeten Untersuchungsmethoden quantitativ gelistet und mit Hilfe beschreibender Sekundärliteratur qualitativ analysiert. Weitere, nicht in den eingeschlossenen Studien verwendete Verfahren, wurden unter anderem durch Expertenbefragungen identifiziert und ebenfalls bezüglich ihrer Eignung zur Generierung von Evidenz für die Wirksamkeit von Einlagen bewertet. 1.3 Ergebnisse Die Untersuchungsmethoden aus 212 Studien wurden analysiert. Dabei wurden 49 verschiedene Scores und Skalen in 114 Studien sowie neun Gruppen apparativer Methoden in 108 Studien verwendet. In 30 weiteren Studien wurden 2 verschiedene klinische Untersuchungsparameter angewandt. In 11 Studien erfolgten Prüfungen zur physischen Aktivität. 1.4 Schlussfolgerung Für bestimmte Fragestellungen (beispielsweise der positive Einfluss der Veränderung dynamischer Parameter, wie z.B. dem EKAM durch Einlagen auf den Krankheitsverlauf) scheint das aktuelle Repertoire an Methoden nicht ausreichend, sodass bisher nicht in Studien eingesetzte Techniken eingebunden, bzw. neue Techniken entwickelt werden müssen. Des Weiteren bedürfen insbesondere apparative Methoden und die damit gemessenen Parameter einer wesentlich eingehenderen Evaluation. Skalen und Scores als alleiniges Werkzeug sind wenig geeignet, jedoch als Ergänzung zu den apparativen Methoden sehr wertvoll
