The Effect of Commercially Available Footwear Interventions in Meniscectomy Patients
Condition: Meniscus Injury; Osteoarthritis, Knee; Footwear
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      Injuries to the meniscus are common in sport. A meniscectomy is often performed to manage
      symptoms associated with the meniscal injury. Following a meniscectomy individuals are highly
      likely to develop knee osteoarthritis (OA). Footwear interventions have demonstrated
      biomechanical changes during walking and running, in healthy and individuals with
      osteoarthritis. With the increased risk of developing OA associated with meniscectomy
      patients, understanding biomechanical changes with footwear when compared to healthy
      individuals, may provide a conservative approach to delaying or minimising the development of
      (OA). There is no current literature assessing the effect footwear has post meniscectomy, so
      this is a very novel approach and can yield important results for the management of future
      risks. Current evidence supports the use of footwear interventions aiming to minimise OA
      progression in older adults during walking. Yet, meniscectomy patients who have sustained an
      injury during sport are likely to continue to participate in sport following treatment in
      their usual footwear. Further evidence is required to better understand the effect of
      footwear interventions during dynamic movements often performed in sport. Previous studies
      have assessed customised footwear interventions, however these interventions are not
      representative of commercially available interventions that could be widely used by the
      general population. Therefore assessing commercially available footwear will give a more
      realistic approach to conservative treatment for meniscectomy patients. This project aims to
      examine biomechanical differences between commercially available footwear conditions in
      healthy individuals and individuals who have had a meniscal injury. Three-dimensional kinetic
      and kinematic measures will be assessed during five tasks (walking, running, 90 degrees side
      cut, single leg landing, and small knee bend squat), for different footwear conditions.
    

Detailed description: 
      Injuries to the meniscus are common in sport, often as a result of a traumatic event.
      Mitchell et al. (2016) reported 5.1 meniscal injuries per 100 000 athletic exposures, with a
      greater proportion reported during competition (11.9 injuries per 100 000 athletic
      exposures), compared to practice (2.7 injuries per 100 000 athletic exposures). Rotation
      around a planted/ inverted foot has been cited as a common mechanism for meniscal injuries,
      followed by landing and jumping movements. The meniscus aids in stabilising the knee, acting
      as a shock absorber and transmitting load. Damage to the meniscus is suggest to lead to
      altered knee mechanics leading to the initiation or acceleration of osteoarthritis (OA)
      development. Prior meniscal tears are commonly reported in OA patients, in addition, reports
      suggest 4 to 14 times increased risk of developing OA following a meniscal injury.

      Altered knee mechanics have been reported following a meniscal injury, which have been
      associated with increased likelihood of developing OA. These changes include reduced contact
      area within the joint and increased contact pressure, resulting in reduced ability to
      transmit load. Indirect measures of knee loading, such as external knee adductor moments
      (EKAM) and knee adduction angular impulses (KAAI), have been associated with increased risk
      of developing OA. Knee joint loading is also determined by the coordination of muscle
      activity. Greater and longer co-contractions of the medial muscles at the knee have
      demonstrated faster development of OA in individuals diagnosed with medial knee OA.

      Meniscectomies are widely used to manage the symptoms associated with meniscus injuries.
      Whilst, non-operative therapies have demonstrated improvements in knee pain three years post
      intervention. However, following these interventions, alter mechanics of the knee have been
      observed. For instance, following a medial meniscectomy, increases in contact area and
      pressure at the knee have been observed and suggested to increase the likelihood of
      developing OA. Increases in EKAM in meniscectomy patients have been associated with changes
      in tibia alignment and GRF lever arm. Non-invasive interventions such as footwear, could
      alter biomechanics to lower EKAM and reduce the progression of OA. Following a meniscectomy
      procedure, most patients tend to go back to wearing their old trainers. Due to the changes in
      the biomechanics of the knee, it can be assumed that they support and cushioning they need
      would change too.

      Typical sports movements such as landing and cutting require dynamic control of the knee
      which is very under-researched. Muscle strength recovery is also considered to be important
      for young individuals after an arthroscopic surgery in order to regain capacity to
      participate in sports or other activities as both pre- and post-operative knee extensor
      strength have been reported to predict better functional outcome of knee surgery. The
      co-contraction between the quadriceps and hamstrings are also important in this as muscle
      weakness creates a less stable base. Muscle strength is also essential to control movements
      such as stair descent which is essential for everyday living. This is closely linked with
      balance and the risk of falling. Having extra support or cushioning in footwear can help aid
      this control needed for static and dynamic exercises especially post-surgical intervention.

      Different footwear interventions have been used in OA patients to reduce knee loading and
      pain. Lateral wedges have demonstrated reduced medial knee loading in both affected and
      contralateral limbs. In addition, mobility shoes and lateral wedges which provide additional
      medial support have been shown to reduce pain in OA patients. However, it is unclear whether
      footwear interventions are able to alleviate the risk factors associated with the progression
      of OA following a meniscal injury. For effective self-management, post operation the
      appropriate footwear is recommended, however there is little evidence to inform what the
      appropriate footwear is for patient after surgery or with knee OA.

      Current evidence on footwear interventions on minimising OA development relies on assessment
      of linear movements such as walking and running. Yet, it is likely that athletes who sustain
      a meniscal injury would return to sport and therefore be required to perform movements that
      require a greater demand and muscular control then reported during walking. It is unclear
      whether footwear interventions are able to alleviate the risk factors associated with the
      progression of OA following a meniscal injury in a younger athletic population. Understanding
      knee loading during sport-specific movements and between sports footwear can provide a
      greater insight to the risk of OA development for athletic populations. Therefore
      understanding the effect of commercially available footwear interventions knee loading during
      sport-specific movements could provide a greater insight to the use conservative
      interventions to reducing the risk of OA development for athletic populations.
    

Intervention name(s): Footwear; Gait analysis
Intervention type(s): Device; Procedure
Intervention description(s): Different types of footwear will be tested to see if these can be used to help slow the progression of osteoarthritis in meniscectomy patients or even stop it from occurring.; Gait analysis will be done during several different tasks wear the footwear
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Testing meniscus patients for several different shoes
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Meniscectomy; Footwear; Osteoarthritis