Change in knee cartilage volume in individuals completing a therapeutic exercise program for knee osteoarthritis. Effects of disease severity on response to lateral wedged shoe insole for medial compartment knee osteoarthritis. The PICO project: aquatic exercise for knee osteoarthritis in overweight and obese individuals Prognostic factors in the outcome of supracondylar femoral osteotomy for lateral compartment osteoarthritis of the knee. Comparison of the efficacy of laterally wedged insoles and bespoke unloader knee orthoses in treating medial compartment knee osteoarthritis Comparing the Effectiveness of Electroacupuncture with Different Grades of Knee Osteoarthritis: A Prospective Study Gait analysis after bi-compartmental knee replacement. Foot center of pressure manipulation and gait therapy influence lower limb muscle activation in patients with osteoarthritis of the knee. Effects of foot orthoses with medial arch support and lateral wedge on knee adduction moment in patients with medial knee osteoarthritis Effects of Knee Pain Relief in Osteoarthritis on Gait and Stair-Stepping Gait metric profile of 157 patients suffering from anterior knee pain. A controlled study. Association between bone marrow lesions detected by magnetic resonance imaging and knee pain in community residents in Korea. Associations between gait and clinical parameters in patients with severe knee osteoarthritis: a multiple correspondence analysis. Effects of whole-body vibration training with quadriceps strengthening exercise on functioning and gait parameters in patients with medial compartment knee osteoarthritis: a randomised controlled preliminary study. Reduction of Medial Compartment Loads with Valgus Bracing of the Osteoarthritic Knee A biomechanical analysis of a medial unloading brace for osteoarthritis in the knee. The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain. The lateral wedged insole with subtalar strapping significantly reduces dynamic knee load in the medial compartment gait analysis on patients with medial knee osteoarthritis. Hypertonic dextrose injections (prolotherapy) for knee osteoarthritis: results of a single-arm uncontrolled study with 1-year follow-up. Association between body mass index and risk of total knee replacement, the Singapore Chinese Health Study. A comparison of knee braces during walking for the treatment of osteoarthritis of the medial compartment of the knee. Effect of a 16 weeks weight loss program on osteoarthritis biomarkers in obese patients with knee osteoarthritis: a prospective cohort study. Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocol
STUDY DESIGN Prospect i ve cohort study . OBJECTIVES To characterize knee cartilage change in individuals with knee osteoarthritis ( KOA ) who have completed a therapeutic exercise program .  BACKGROUND While therapeutic exercise is frequently used successfully to improve pain and function in individuals with KOA , no studies have reported the volume of cartilage change or individual factors that may impact volume of cartilage change in those completing an exercise program  for KOA . METHODS Thirteen individuals with KOA underwent  magnetic resonance imaging to quantify cartilage volume change in the weight-bearing regions of the medial and lateral femoral condyles and the entire surface of the tibial plateaus from baseline to 1-year follow-up . Body structure and function measures were taken for body mass index , knee axis alignment , knee motion , and knee strength . Activity limitations and activity levels were also measured prior to the therapeutic exercise program , using the Western Ontario and McMaster Universities Osteoarthritis Index and the Physical Activity Scale for the Elderly . At 6 months from baseline , follow-up clinical measurements of knee strength and motion were performed . At 1 year from baseline , imaging of the knee cartilage and knee alignment were performed , and participants completed the Western Ontario and McMaster Universities Osteoarthritis Index and Physical Activity Scale for the Elderly . RESULTS The central region of the medial femoral condyle ( cMF ) had a median volume of cartilage loss of 3.8 % . The other 3 knee tibiofemoral articular surfaces had minimal median cartilage volume change . Individuals were dichotomized into progressors ( n = 6 ) and nonprogressors ( n = 7 ) , based on the st and ard error of measurement of cartilage volume change for the cMF . Progressors were younger , had a larger body mass index , had a higher Kellgren-Lawrence grade in the medial compartment of the knee , and had a greater increase in knee varus alignment from baseline to 1-year follow-up . The progressors also had frontal plane hip and knee kinetics during baseline gait analysis that potentially increased medial knee joint loading . CONCLUSION The loss of cMF cartilage volume was highly variable and the median loss of cartilage was within the range previously reported . Seven of the 13 individuals did not have cMF cartilage volume loss greater than the st and ard error of measurement . Change in cartilage volume of the cMF may be influenced to a greater extent by personal factors than by completion of a therapeutic exercise program . Additional research is needed to decipher the interactions among therapeutic exercise and personal characteristics that impact knee cartilage loss OBJECTIVE To determine the effects of lateral wedged insoles on knee kinetics and kinematics during walking , according to radiographic severity of medial compartment knee osteoarthritis ( OA ) . DESIGN A prospect i ve case control study of patients with medial compartment OA of the knee . SETTING Gait analysis laboratory in a university hospital . PARTICIPANTS Forty-six medial compartment knees with OA of 23 patients with bilateral disease and 38 knees of 19 age-matched healthy subjects as controls . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES We measured the peak external adduction moment at the knee during the stance phase of gait and the first acceleration peak after heel strike at the lateral side of the femoral condyles .  Kellgren and Lawrence grading system was used for radiographic assessment of OA severity . RESULTS The mean value of peak external adduction moment of the knee was higher in OA knees than the control . Application of lateral wedged insoles significantly reduced the peak external adduction moment in Kellgren-Lawrence grade s I and II knee OA patients . The first acceleration peak value after heel strike in these patients was relatively high compared with the control . Application of lateral wedged insoles significantly reduced the first acceleration peak in Kellgren-Lawrence grade s I and II knee OA patients . CONCLUSIONS The kinetic and kinematic effects of wearing of lateral wedged insoles were significant in Kellgren-Lawrence grade s I and II knee OA . The results support the recommendation of use of lateral wedged insoles for patients with early and mild knee OA Background Aquatic exercise is recommended by the Osteoarthritis Research Society ( OARSI ) , by the American College of Rheumatology ( ACR ) and by the European League Against Rheumatism ( EULAR ) as a nonpharmacological method of controlling the knee osteoarthritis ( KOA ) symptoms . Moreover , given that weight loss results in a reduction of the load that is exerted upon the knee during daily activities , obesity is also considered to be a modifiable risk factor for the development and or exacerbation of KOA . The implementation of an exercise based weight loss program may , however , itself be limited by the symptoms of KOA . The aquatic program against osteoarthritis ( termed “ PICO ” in Portuguese ) prioritizes the control of symptoms and the recovery of functionality , with an attendant increase in the patient ’s physical activity level and , consequently , metabolic rate . Our laboratory is assessing the effectiveness of 3 months of PICO on the symptoms of KOA , on physical function , on quality of life and on gait . In addition , PICO shall examine the effects of said exercise intervention on inflammatory biomarkers , psychological health , life style and body composition . Methods / Design The trial is a prospect i ve , single-blinded , r and omized controlled trial , and involves 50 overweight and obese adults ( BMI = 28–43.5 kg/m2 ; age 40–65 yrs ) with radiographic KOA . The participants are r and omly allocated into either an educational attention ( control ) group or an aquatic ( exercise program ) group .  This paper describes the experimental protocol that is used in the PICO project . Discussion The PICO program shall provide insight into the effectiveness of an aquatic exercise program in the control of KOA symptoms and in the improvement of the quality of life . As such , they are likely to prove a useful reference to health professionals who intend to implement any kind of therapeutic intervention based around aquatic exercise . Trial registration NCT01832545 OBJECTIVE To identify the demographic and operative factors that determine outcome in supracondylar femoral osteotomy for lateral compartment osteoarthritis of the knee . DESIGN Clinical and radiologic review of a nonr and omized , consecutive one-surgeon series . SETTING A university-affiliated , elective surgical referral centre . PATIENTS Forty-nine consecutive patients with unicompartmental osteoarthritis of the knee , involving the lateral compartment , and of sufficient severity that the alternative surgical procedure would be total knee replacement . INTERVENTION Supracondylar varus osteotomy stabilized with a blade plate . MAIN OUTCOME MEASURES Knee function measured by the Knee Society Score and time to conversion to total knee replacement . RESULTS A Knee Society Score greater than 80 was obtained in 81 % of patients , but in the function portion of the measurement only 30 % had a similar score . After discarding the patients who died , life-table analysis demonstrated the predicted survival before conversion to total knee replacement to be 87 % at 7 years . There was no correlation with patient age or sex , femorotibial angulation , amount of correction or time after the intervention . Removal of the fixation device improved the clinical result . CONCLUSION The role of supracondylar femoral osteotomy remains poorly defined , but the procedure can delay total knee replacement for considerable time in appropriate patients Background : Patients suffering from medial compartment knee osteoarthritis ( OA ) may be treated with unloader knee orthoses or laterally wedged insoles . Objectives : The aim of this study was to identify and compare the effects of them on the gait parameters and pain in these patients . Study Design : Quasi-experimental . Methods : Volunteer subjects with medial compartment knee OA ( n = 24 , mean age 59.29 ± 2.23 years ) were r and omly assigned to two separate groups and evaluated when wearing an unloader knee orthosis or insoles incorporating a 6 ° lateral wedge . Testing was performed at baseline and after six weeks of each orthosis use . A visual analog scale score was used to assess pain and gait analysis was utilized to determine gait parameters . Results : Both orthoses improved all parameters compared to the baseline condition ( p = 0.000 ) . However , no significant differences in pain ( p = 0.649 ) , adduction moment ( p = 0.205 ) , speed of walking ( p = 0 . 056 ) or step length ( p = 0.687 ) were demonstrated between them . The knee range of motion ( p = 0.000 ) were significantly different between the two interventions . Conclusion : Both orthoses reduced knee pain . Maximum knee range of motion was increased by both interventions although it was 3 degrees less when wearing the knee orthosis . Clinical relevance Both orthoses reduce pain and improve gait anomalies in medial compartment knee OA . Our results suggest a laterally wedged insole can be an alternative conservative approach to unloader knee orthosis for treating symptoms of medial compartment knee OA Background : The electroacupuncture ( EA ) with different number of points significantly affected its efficacy on  knee osteoarthritis ( KOA ) , and the severity of KOA also influenced its response to treatments . Hence , we prospect ively compared the clinical efficacy of EA on KOA with different severities . Methods : A total of 132 KOA patients recruited from 181st Central Hospital of The Chinese People 's Liberation Army between March 2014 and March 2015 were classified into 4 KOA stages according to Kellgren Lawrence grading scale . They were allocated into three treatment groups , including two-point group , four-point group and six-point group . Patients in the six-point group received treatment at six-points including ST34 , SP10 , SP9 , ST36 , ST35 and EX-LE4 . Patients in the four-point group received treatment at ST34 , SP10 , ST35 and EX-LE5 , while patients in the two-point group received treatment at ST35 and EX-LE4 . Visual Analog Scale ( VAS ) , McMaster Universities Osteoarthritis Index ( WOMAC ) and self- assessment question naire of patients were assessed after treatment . Results : Three kinds of EA treatments all have significant clinical effects on  KOA  patients with down-regulated scores of VAS and WOMAC . Regarding post-treatment efficacy , the six point group exhibited lower VAS score and higher WOMAC score compared with the other two groups . For patients with different KOA grade s , patients with higher KOA grade s were associated with lower grade of treatment efficacy . Conclusions : Patients with KOA , especially those with lower KOA stages , could gain beneficial efficacies from EA treatments with two , four and six points , respectively BACKGROUND It is reported that a majority of the patients with knee osteoarthritis have cartilage degeneration in medial and patellofemoral compartments . A bi-compartmental knee replacement system was design ed to treat osteoarthritis at medial and patellofemoral compartments . To date , there is very little information regarding the knee mechanics during gait after bi-compartmental knee replacement . The purpose of the study was to evaluate knee strength and mechanics during level walking after knee replacement . METHODS Ten healthy control subjects and eight patients with unilateral bi-compartmental knee replacement participated in the study .  Maximal isokinetic concentric knee extension strength was evaluated . 3D kinematic and kinetic analyses were conducted for level walking . Paired Student t-test was used to determine difference between surgical and non-involved limbs . One way MANOVA was used to determine difference between surgical and control groups . FINDINGS The surgical knee exhibited less peak torque and initial abduction moment than both the non-involved and control limbs ( P<0.05 ) . The non-involved limb had less knee extension at stance and greater knee extensor moment during push-off than both the surgical and control limbs ( P<0.05 ) . No differences were found for other typical knee mechanics among the surgical , non-involved , and control limbs during walking ( P>0.05 ) . INTERPRETATIONS Patients with bi-compartmental knee replacement exhibited good frontal plane knee mechanics and were able to produce the same level of knee extensor moment as healthy control limbs during walking . While showing some compensatory patterns during walking , patients with bi-compartmental knee replacement largely exhibited normal gait patterns and knee mechanics BACKGROUND Foot center of pressure ( COP ) manipulation has been associated with improved gait patterns . The purpose of this study was to determine lower limb muscle activation changes in knee osteoarthritis patients , both immediately after COP manipulation and when COP manipulation was combined with continuous gait therapy ( AposTherapy ) . METHODS Fourteen females with medial compartment knee osteoarthritis underwent EMG analyzes of key muscles of the leg . In the initial stage , trials were carried out at four COP positions . Following this , gait therapy was initiated for 3 months . The  barefoot EMG  was compared before and after therapy . RESULTS The average EMG varied significantly with COP in at least one phase of stance in all examined muscles of the less symptomatic leg and in three muscles of the more symptomatic leg . After training , a significant increase in average EMG was observed in most muscles . Most muscles of the less symptomatic leg showed significantly increased peak EMG . Activity duration was shorter for all muscles of the less symptomatic leg ( significant in the lateral gastrocnemius ) and three muscles of the more symptomatic leg ( significant in the biceps femoris ) . These results were associated with reduced pain , increased function and improved spatiotemporal parameters . CONCLUSIONS COP manipulation influences the muscle activation patterns of the leg in patients with knee osteoarthritis . When combined with a therapy program , muscle activity increases and activity duration decreases Background : There is contradictory evidence regarding whether the addition of medial arch supports to laterally wedged insoles reduces knee adduction moment , improves comfort , and reduces knee pain during the late stance phase of gait . Objectives : To verify if such effects occur in participants with medial knee osteoarthritis . Study design : R and omized single-blinded study . Methods : Gait analysis was performed on 18 patients affected by medial knee osteoarthritis . Pain and comfort scores , frontal plane kinematics and kinetics of ankle , knee , and hip were compared in four conditions : without foot orthosis , with foot orthoses , with medial arch support , and with foot orthoses with medial arch support and lateral wedge insoles with 6 ° and 10 ° inclination . Results : Lower-extremity gait kinetics were characterized by a significant decrease , greater than 6 % , in second peak knee adduction moment in laterally wedged insole conditions compared to the other conditions ( p < 0.001 ; effect size = 0.6 ) . No significant difference in knee adduction moment was observed between laterally wedged insole conditions . In contrast , a significant increase of 7 % in knee adduction moment during the loading response was observed in the customized foot orthoses without lateral inclination condition ( p < 0.001 ; effect size = 0.3 ) . No difference was found in comfort or pain ratings between conditions . Conclusion : Our study suggests that customized foot orthoses with a medial arch support may only be suitable for the management of medial knee osteoarthritis when a lateral wedge is included . Clinical relevance Our data suggest that customized foot orthoses with medial arch support and a lateral wedge reduce knee loading in patients with medial knee osteoarthritis ( KOA ) . We also found evidence that medial arch support may increase knee loading , which could potentially be detrimental in KOA patients Osteoarthritic knee pain affects patient mobility . Relief of knee pain in osteoarthritis has been reported to increase loading of the knee during gait , but it is unknown whether such pain relief enhances knee loading during more dem and ing activities such as stair-stepping . The gait of 19 patients and stair-stepping of 14 patients with painful medial compartment osteoarthritis of the knee was assessed before and after pain-relieving intraarticular injection of the knee and compared with those of 21 healthy control subjects . There were significant increases in gait velocity , cadence , maximum external knee adduction moment ( indicating increased loading in the medial compartment of the knee ) , and maximum external hip adduction and ankle abduction moments immediately after the injection . With the exception of velocity and ankle abduction moment , these variables were returned to levels that were not statistically different from those of the control subjects . However , no significant differences were found during stair-stepping in the external adduction-abduction moments about the knee , hip , or ankle after injection . Furthermore , the postinjection magnitudes of these variables during stair-stepping were significantly less than those of the controls . Therefore , although the relief of knee pain is sufficient to enhance gait function in osteoarthritis of the knee , it is insufficient to enhance stair-stepping function PURPOSE Gait metric alterations have been previously reported in patients suffering from anterior knee pain ( AKP ) . Characterization of simple and measureable gait parameters in these patients may be valuable for assessing disease severity as well as for follow-up . Previous gait studies in this population have been comprised of relatively small cohorts and the findings of these studies are not uniform . The objective of the present study was to examine spatio-temporal gait parameters in patients with AKP in comparison to symptom-free controls . Furthermore , the study aim ed to examine the relationship between self-reported disease severity and the magnitude of gait abnormalities . METHODS 157 patients with AKP were identified and compared to 31 healthy controls . Patients were evaluated with a spatiotemporal gait analysis via a computerized mat , the Western Ontario and McMaster Osteoarthritis Index ( WOMAC )  question naire and the Short Form (SF)-36 health surveys . RESULTS AKP patients walked with significantly lower velocity ( 15.9 % ) and cadence ( 5.9 % ) , shorter step length ( 9.5 % ) , stride length ( 9.6 % ) , and showed significant differences in all gait cycle phases ( P<0.05 for all ) . Study group reported higher levels of pain ( 96 % ) , functional limitation ( 94 % ) , and poorer perception of mental quality of life ( 30 % ) ( P<0.05 for all ) . CONCLUSION Significant differences were found between the spatiotemporal gait profile of AKP patients and symptom-free matched controls . In addition , an association was found between subjective disease severity and gait abnormalities . These findings suggest the usefulness of gait parameters , alongside with the use of self-evaluation question naires , in identifying deviations of these patients from healthy population OBJECTIVE To describe the frequency of bone marrow lesions ( BMLs ) detected by magnetic resonance imaging ( MRI ) , and to examine the association of BMLs with knee pain severity in community residents in Korea . METHODS Participants were r and omly chosen from the population -based Hallym Aging Study , irrespective of whether they had knee osteoarthritis ( OA ) or pain . Demographic and knee pain data were obtained by question naire . Radiographic evaluations consisted of weight-bearing knee anteroposterior radiographs and 1.5-T MRI scans . MRI was performed in the dominant knees of subjects without knee pain and in the more symptomatic knees of subjects with knee pain . BMLs were grade d according to the whole-organ MRI score . RESULTS The mean age of the 358 study subjects was 71.8 years , and 34.5 % of subjects had radiographically detected knee OA . The prevalences of BMLs and large BMLs in the tibiofemoral compartments were 80.3 % and 40.4 % , respectively . After adjusting for age , sex , and body mass index , total and medial compartment BML scores were significantly associated with the presence of knee pain , and the association was stronger as the summary score for BML increased . In proportional regression analysis , knee pain severity increased with BML severity in any compartment and in the medial compartment . CONCLUSION BMLs detected by MRI were highly prevalent in this elderly Asian population . BMLs were significantly linked to knee pain , and BML severity correlated with knee pain severity . BMLs may be important surrogate targets for monitoring pain and structure modification in OA therapeutics BACKGROUND Given the complexity of the gait of patients with knee osteoarthritis , a multiple correspondence analysis may be helpful to optimise the extraction of relevant gait and clinical information . Therefore , the aims of this study are to identify the main associations with clinical and gait biomechanical parameters and to evaluate whether there are more specific knee osteoarthritis groups with different gait profiles . METHODS Ninety patients with severe knee osteoarthritis and twenty-six healthy individuals participated in this study .  Pain and function were assessed with the WOMAC Index  ;  knee joint deformity was assessed by the hip-knee-ankle angle on full-limb radiography ; and full body gait analysis was performed with a motion analysis system and force plates . FINDINGS Using multiple correspondence analysis , two categories of gait parameters that best explain the gait variance of patients with knee osteoarthritis were highlighted . The forward displacement category is composed of the parameters speed , stride length , hip flexion and knee flexion . The frontal category is composed of the parameters thorax obliquity and knee adductor moments . Moreover , based on these parameters , four distinct gait profiles were identified : two gait profiles were associated with knee varus deformities , increased thorax obliquity and different forward displacements , while two gait profiles were associated with valgus deformities and different forward displacements . INTERPRETATION These gait parameters can be used to simplify the characterisation of the gait of the knee osteoarthritis population . Patients in varus profiles increase thorax obliquity on the stance limb and may reduce forward displacement . Patients in valgus profiles , however , only reduce forward displacement OBJECTIVE To compare the effects of whole-body vibration training ( WBVT ) with quadriceps strengthening exercise ( QSE ) with QSE alone on functioning and gait parameters in patients with medial compartment knee osteoarthritis . DESIGN R and omised controlled preliminary study . SETTING Department of Rehabilitation Medicine , West China Hospital , Chengdu , Sichuan , People 's Republic of China . SUBJECTS Thirty-nine patients with medial compartment knee osteoarthritis . INTERVENTIONS Participants were assigned at r and om to one of two groups . MAIN MEASURES Visual analogue scale ( VAS ) for pain , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , timed up and go test ( TUG ) , 6-minute walk distance test ( 6MWD ) , and three-dimensional gait analysis during level walking at baseline , 12 weeks and 16 weeks ( follow-up ) . RESULTS Compared with baseline , significant improvements in VAS , all WOMAC scales , TUG , 6MWD and all spatiotemporal parameters were seen in both the WBVT+QSE group and the QSE alone group at 12 and 16 weeks . However , the WBVT+QSE group showed greater improvements than the QSE alone group in WOMAC scales ( physical function ) , TUG , 6MWD and cadence at 12 weeks . No differences were found between the WBVT+QSE and QSE alone groups in VAS , WOMAC scales ( pain , stiffness ) , kinematic and kinetic gait parameters , and other spatiotemporal parameters at 12 weeks and 16 weeks . CONCLUSION Over a 3-month period , WBVT in combination with QSE improved symptoms , physical function and spatiotemporal parameters in patients with medial compartment knee osteoarthritis , and led to greater improvement than QSE alone in WOMAC scales ( physical function ) , TUG , 6MWD and cadence Background Patients with medial compartment osteoarthritis of the knee may be treated nonoperatively with adjustable valgus bracing . Hypothesis Valgus bracing reduces load on the medial compartment through the application of an external valgus moment about the knee , result ing in pain relief . Study Design Prospect i ve cohort study . Methods Eleven patients were tested using an instrumented brace and three-dimensional gait analysis . We measured the valgus moment applied by the adjustable valgus brace and determined the compressive load in the medial compartment . We also documented the effects of increased valgus alignment of the brace and increased strap tension on load sharing . Pain and activity levels were also recorded . Results Pain and activity level improved in all subjects with valgus bracing . During gait , valgus bracing reduced the net varus moment about the knee by an average of 13 % ( 7.1 N•m ) and the medial compartment load at the knee by an average of 11 % ( 114 N ) in the calibrated 4 ° valgus brace setting . Increasing valgus alignment with the adjustable brace had a greater effect on the medial compartment load than did increasing strap tension . Conclusion Adjustable valgus bracing was effective in reducing medial compartment load and subsequent pain while also improving knee function in a group of patients with osteoarthritis OBJECTIVES The goals of the study were to measure the force applied to the lateral side of the knee by a valgus loading brace design ed for patients with medial compartment osteoarthritis ( OA ) and to compare the varus moment at the knee during level gait with and without the brace . METHODS Five subjects diagnosed with medial compartment OA were fitted with a custom Monarch valgus loading knee brace . A 3-dimensional videobased motion analysis system and force plate information were used to calculate forces and moments at the knee . An instrumented condylar bladder was used to determine the force applied to the knee by the brace . The varus moments for the braced and unbraced trials were compared during gait at 15 % , 20 % , 25 % , and 30 % of stance . RESULTS The Monarch brace significantly reduced the varus moment at 20 % and 25 % of stance . The valgus force measured with the custom condylar bladder remained fairly constant throughout the first 80 % of the stance phase . CONCLUSIONS The reduced various moment observed for the braced condition demonstrates the biomechanical function of the brace in 5 subjects and may contribute to a reduction of pain for patients with medial compartment OA This study tested whether the peak external knee adduction moments during walking in subjects with knee osteoarthritis ( OA ) were correlated with the mechanical axis of the leg , radiographic measures of OA severity , toe out angle or clinical assessment s of pain , stiffness or function .  Gait analysis was performed on 62 subjects with knee OA and 49 asymptomatic control subjects ( normal subjects ) . The subjects with OA walked with a greater than normal peak adduction moment during early stance ( p = 0.027 ) . In the OA group , the mechanical axis was the best single predictor of the peak adduction moment during both early and late stance ( R = 0.74 , p < 0.001 ) . The radiographic measures of OA severity in the medial compartment were also predictive of both peak adduction moments ( R = 0.43 to 0.48 , p < 0.001 ) along with the sum of the WOMAC subscales ( R = -0.33 to -0.31 , p < 0.017 ) . The toe out angle was predictive of the peak adduction moment only during late stance ( R = -0.45 , p < 0.001 ) . Once mechanical axis was accounted for , other factors only increased the ability to predict the peak knee adduction moments by 10 18 % . While the mechanical axis was indicative of the peak adduction moments , it only accounted for about 50 % of its variation , emphasizing the need for a dynamic evaluation of the knee joint loading environment . Underst and ing which clinical measures of OA are most closely associated with the dynamic knee joint loads may ultimately result in a better underst and ing of the disease process and the development of therapeutic interventions OBJECTIVE Two lateral wedged insoles were compared : one with , and the other without , subtalar strapping . METHODS Twenty-one patients ( age 58 - 83 , mean 72 ) with medial knee osteoarthritis ( OA ) were enrolled . Thirty-seven knees in the patients were divided into three groups based on the Kellgren and Lawrence OA grading system ; grade s 2 ( cases=20 ) , 3 ( cases=11 ) , and 4 ( cases=6 ) . The subjects were tested during walking barefoot and during walking with a silicon rubber lateral wedged insole with elevation of 10 mm attached to a barefoot .  Gait analysis was performed on a 10 m walkway for each subject under three different walking conditions ; barefoot , wearing a conventional insole , and a subtalar strapping insole .  Peak knee varus moment during gait was measured under each condition , and compared between the three conditions and between the OA grade s. RESULTS On the whole ( cases=37 ) , the peak varus moment was significantly reduced by wearing either of the insoles , compared to walking barefoot . The reduction was more obvious with the strapping insole ( -13 % , P<0.01 ) , compared with the conventional insole ( -8 % , P<0.05 ) . In moderate OA patients ( grade s 2 and 3 ) , the moments were significantly lower with the strapping insole , compared with the conventional insole ( P=0.0048 and 0.005 , respectively ) . However , no significant difference was detected in severe OA patients ( grade 4 ) between the two types of insoles ( P=0.4 ) . CONCLUSIONS Both lateral wedged insoles significantly reduced the peak medial compartment load during gait . The subtalar strapping insole had a greater effect than the conventional insole , particularly in patients with moderate medial knee OA OBJECTIVE The objective of this study was to determine whether prolotherapy , an injection-based complementary treatment for chronic musculoskeletal conditions , improves pain , stiffness , and function in adults with symptomatic knee osteoarthritis ( KOA ) compared to baseline status . DESIGN This was a prospect i ve , uncontrolled study with 1-year follow-up . SETTING The study was conducted in an outpatient setting . PARTICIPANTS Adults with at least 3 months of symptomatic KOA , recruited from clinical and community setting s , participated in the study . INTERVENTIONS Participants received extra-articular injections of 15 % dextrose and intra-articular prolotherapy injections of 25 % dextrose at 1 , 5 , and 9 weeks , with as-needed treatments at weeks 13 and 17 . OUTCOME MEASURES Primary outcome measure was the vali date d Western Ontario McMaster University Osteoarthritis Index ( WOMAC ) . Secondary outcome measure was the vali date d Knee Pain Scale ( KPS ) . Tertiary outcome measure was procedure-related pain severity and participant satisfaction . RESULTS Thirty-six ( 36 ) participants ( 60 ± 8.7 years old , 21 female ) with moderate-to-severe KOA received an average of 4.3 ± 0.7 prolotherapy injection sessions over a 17-week treatment period and reported progressively improved scores during the 52-week study on WOMAC and KPS measures . Participants reported overall WOMAC score improvement 4 weeks after the first injection session ( 7.6 ± 2.4 points , 17.2 % ) , and continued to improve through the 52-week follow-up ( 15.9 ± 2.5 points , p<0.001 , 36.1 % ) . KPS scores improved in both injected ( p<0.001 ) and uninjected knees ( p<0.05 ) . Prescribed low-dose opioid analgesia effectively treated procedure-related pain . Satisfaction was high and there were no adverse events . Female gender , age 46 - 65 years old , and body-mass index of 25 kg/m(2 ) or less were associated with greater improvement on the WOMAC instrument . CONCLUSIONS In adults with moderate to severe KOA  , dextrose prolotherapy may result in safe , significant , sustained improvement of knee pain , function , and stiffness scores . R and omized multidisciplinary effectiveness trials including evaluation of potential disease modification are warranted to further assess the effects of prolotherapy for KOA PURPOSE Data on the association between body mass index ( BMI ) and risk of knee osteoarthritis ( KOA ) are sparse for Asian population s who are leaner than Western population s. We evaluated the association between BMI and risk of  total knee replacement ( TKR ) due to severe KOA among Chinese in Singapore . METHODS We used data from the Singapore Chinese Health Study ( SCHS ) , a population -based prospect i ve cohort of 63,257 Chinese men and women , aged 45 - 74 years at enrollment from 1993 to 1998 . Information on  height , weight , diet and lifestyle factors  were obtained via in-person interviews . TKR cases for severe KOA were identified via linkage with the nationwide hospital discharge data base through 2011 . Cox regression and weighted least squares regression were used in the analysis . RESULTS The mean BMI among cohort participants was 23.1 kg/m(2 ) , and more than two-thirds had BMI below 25 kg/m(2 ) . A total of 1649 had TKR attributable to severe KOA . Risk of TKR increased in a strong dose-dependent manner with increasing BMI throughout the 15 - 32 kg/m(2 ) range and became less clear at BMI > 32 kg/m(2 ) . In the BMI range 16 - 27 kg/m(2 ) , there was a 27 % increase in TKR risk for each unit increase in BMI ( P for trend < 0.001 ) . Compared to BMI 19 - 20 kg/m(2 ) , the risk estimates of TKR were all statistically significant with increasing unit of BMI ≥21 kg/m(2 ) . Results were similar for men and women . CONCLUSION Our results provided evidence for a constant mechanical mechanism underlying BMI and KOA initiation and /or progression In this cross-over study , we evaluated two types of knee brace commonly used in the conservative treatment of osteoarthritis of the medial compartment . Twelve patients confirmed radiologically as having unilateral osteoarthritis of the medial compartment ( Larsen grade 2 to grade 4 ) were studied . Treatment with a simple hinged brace was compared with that using a valgus corrective brace .  Knee kinematics , ground reaction forces , pain and function were assessed during walking and the Hospital for Special Surgery scores were also determined . Significant improvements in pain , function , and loading and propulsive forces were seen with the valgus brace . Treatment with a simple brace showed only significant improvements in loading forces . Our findings suggest that although both braces improved confidence and function during gait , the valgus brace showed greater benefit OBJECTIVE Changes in biomarkers for bone and cartilage in knee osteoarthritis ( KOA ) may reflect changes in tissue turnover induced by interventions . The aim of this study was to assess the effect on osteoarthritis biomarkers of an intensive weight loss intervention in obese KOA patients . METHODS 192 obese KOA patients followed a 16 weeks weight loss intervention ( Clinical Trials.gov : NCT00655941 ) . Serum Cartilage Oligomeric Matrix Protein ( sCOMP ) , Urine C-terminal telopeptide of collagen type II ( uCTX-II ) and type I ( uCTX-I )  were determined by enzyme-linked immunoassay ( ELISA ) at baseline and after 16 weeks . Patient-reported symptoms were assessed by the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) Question naire without the sports and recreation score ( KOOS-4 ) . Change from baseline was analyzed using Analysis of CoVariance ( ANCOVA ) adjusting for sex , age , and body mass index ( BMI ) . Bivariate associations were analyzed using Spearman 's test of rank correlation . RESULTS 175 patients completed the treatment and lost mean 13.4 ( 95 % CI : 12.5 - 14.4 )  kg . sCOMP concentration decreased on average 1.1 ( 95 % CI : -1.5 to -0.8 ) U/L with a correlation to weight loss ( r = -0.17 , P = 0.028 ) , but not to change in KOOS-4 ( r = -0.13 , P = 0.091 ) . uCTX-II increased significantly , mean 69 ( 95 % CI : 31 - 106 ) ng/mmol creatinine , with no relation to weight loss ( P = 0.14 ) . Change in uCTX-II was reversely related to change in KOOS-4 ( r = -0.28 , P = 0.0003 ) . uCTX-I increased , mean 67 ( 95 % CI : 47 - 87 ) μg/mmol creatinine , and correlated to weight loss ( r = 0.22 , P = 0.0007 ) , while not to KOOS-4 ( P = 0.93 ) . CONCLUSION A rapid substantial weight loss in obese KOA patients was weakly , while significantly associated with a reduction in sCOMP , and increases in both uCTX-II and Background Osteoarthritis of the knee involving predominantly the medial tibiofemoral compartment is common in older people , giving rise to pain and loss of function . Many people experience progressive worsening of the disease over time , particularly those with varus malalignment and increased medial knee joint load . Therefore , interventions that can reduce excessive medial knee loading may be beneficial in reducing the risk of structural progression . Traditional quadriceps strengthening can improve pain and function in people with knee osteoarthritis but does not appear to reduce medial knee load . A neuromuscular exercise program , emphasising optimal alignment of the trunk and lower limb joints relative to one another , as well as quality of movement performance , while dynamically and functionally strengthening the lower limb muscles , may be able to reduce medial knee load . Such a program may also be superior to traditional quadriceps strengthening with respect to improved pain and physical function because of the functional and dynamic nature . This r and omised controlled trial will investigate the effect of a neuromuscular exercise program on medial knee joint loading , pain and function in individuals with medial knee joint osteoarthritis . We hypothesise that the neuromuscular program will reduce medial knee load as well as pain and functional limitations to a greater extent than a traditional quadriceps strengthening program . Methods / Design 100 people with medial knee pain , radiographic medial compartment osteoarthritis and varus malalignment will be recruited and r and omly allocated to one of two 12-week exercise programs : quadriceps strengthening or neuromuscular exercise . Each program will involve 14 supervised exercise sessions with a physiotherapist plus four unsupervised sessions per week at home . The primary outcomes are medial knee load during walking ( the peak external knee adduction moment from 3D gait analysis ) , pain , and self-reported physical function measured at baseline and immediately following the program . Secondary outcomes include the external knee adduction moment angular impulse , electromyographic muscle activation patterns , knee and hip muscle strength , balance , functional ability , and quality -of-life . Discussion The findings will help determine whether neuromuscular exercise is superior to traditional quadriceps strengthening regarding effects on knee load , pain and physical function in people with medial knee osteoarthritis and varus malalignment . Trial Registration Australian New Zeal and Clinical Trials Registry reference :
The majority of consistent gait deviations associated with KOA were exhibited by those with severe disease in the temporospatial domain .
There was a lack of evidence for alterations in the external knee adduction moment .
Individuals with KOA exhibit a range of gait deviations compared with controls .
Despite its common usage in KOA gait studies , we did not find consistent evidence that knee adduction moment differs between those with and without KOA or between disease severity levels .
OBJECTIVE To identify which gait deviations are consistently associated with knee osteoarthritis ( KOA ) and how these are influenced by disease severity , the involved compartment , and sex .