Lateral Wedge Insoles for Reducing Biomechanical Risk Factors for Medial Knee Osteoarthritis Progression: A Systematic Review and Meta‐Analysis

Abstract

Objective. Lateral wedge insoles are intended to reduce biomechanical risk factors of medial knee osteoarthritis (OA) progression, such as increased knee joint load; however, there has been no definitive consensus on this topic. The aim of this systematic review and meta-analysis was to establish the within-subject effects of lateral wedge insoles on knee joint load in people with medial knee OA during walking. Methods. Six databases were searched from inception until February 13, 2015. Included studies reported on the immediate biomechanical effects of lateral wedge insoles during walking in people with medial knee OA. Primary outcomes of interest relating to the biomechanical risk of disease progression were the first and second peak external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI). Eligible studies were pooled using random-effects metaanalysis.Results. Eighteen studies were included with a total of 534 participants. Lateral wedge insoles resulted in a small but statistically significant reduction in the first peak EKAM (standardized mean difference [SMD] 20.19; 95% confidence interval [95% CI] 20.23, 20.15) and second peak EKAM (SMD 20.25; 95% CI 20.32, 20.19) with a low level of heterogeneity (I 2 5 5% and 30%, respectively). There was a favorable but small reduction in the KAAI with lateral wedge insoles (SMD 20.14; 95% CI 20.21, 20.07, I 2 5 31%). Risk of methodologic bias scores (quality index) ranged from 8 to 13 out of 16. Conclusion. Lateral wedge insoles cause small reductions in the EKAM and KAAI during walking in people with medial knee OA. Current evidence demonstrates that lateral wedge insoles appear ineffective at attenuating structural changes in people with medial knee OA as a whole and may be better suited to targeted use in biomechanical phenotypes associated with larger reductions in knee load.

A systematic review and meta-analysis into the effect of lateral wedge arch support insoles for reducing knee joint load in patients with medial knee osteoarthritis

“…[47,59] The reported effects of the neutral insole are not consistent in recent studies. [38,65] Although meta-analysis pooling of all studies showed statistically significant associations between the use of LWAS and reductions of the first peak EKAM, second peak EKAM and KAAI during walking for people with medial knee OA, different results were observed when comparing with various control conditions.…”

“…[47,59] Publication bias was assessed using funnel plots with Begg and Egger regression test using STATA (version 12).…”

“…[47] However, the LWAS played an important role and became more common in the conservative treatment of knee OA. The objective of this review was to assess the effects of LWAS on reductions of knee load in patients with knee OA by measuring biomechanical outcomes during gait analysis.…”

The Efficacy of a Lateral Wedge Insole for Painful Medial Knee Osteoarthritis After Prescreening: A Randomized Clinical Trial

“…They reduce the load across the medial knee, where most affected individuals have either isolated disease or disease combined with involvement of the patellofemoral (PF) joint. Lateral wedge insoles reduce the external knee adduction moment (KAM), a measure of the load across the medial versus lateral compartments, by 5–6% . Unfortunately, in trials, lateral wedges have not demonstrated a reduction in knee pain, compared to neutral insoles.…”

Longitudinal Changes in the Total Knee Joint Moment After Anterior Cruciate Ligament Reconstruction Correlate With Cartilage Thickness Changes

“…The associations between changes in KFM and KAM contributions to the TJM and cartilage thickness ratio changes in the ACLR limb provide support for load modifying interventions to alter gait mechanics following ACLR. For example, gait retraining, bracing, lateral wedging, and specialized footwear can reduce the KAM and could be explored in the ACLR population. Furthermore, extended rehabilitation or interventions aiming to improve quadriceps function/KFM after ACLR could be investigated in future work.…”