Non-operative treatment of unicompartmental osteoarthritis of the knee: a prospective randomized trial with two different braces—ankle–foot orthosis versus knee unloader brace

Petersen, Wolf; Ellermann, Andree; Henning, Joerg; Nehrer, Stefan; Rembitzki, Ingo Volker; Fritz, Jürgen; Albasini, Alfio; Zinser, Wolfgang; Laute, Volker; Ruhnau, Klaus; Stinus, Hartmut; Liebau, Christian

doi:10.1007/s00402-018-3040-8

Cited by 26 publications

(21 citation statements)

References 29 publications

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“…So far, only a few and partly controversial results have been obtained on ankle-foot orthoses in the context of knee osteoarthritis. Studies by Petersen et al 21 and Menger et al 22 reported positive influences on pain and functional outcomes., On the contrary, the study by Sliepen et al 23 described a clinically relevant deterioration of the same measures after a six-week intervention with an ankle-foot orthosis. Our results complement this spectrum: Health-related quality of life was improved by the ankle-foot orthosis and even by the lateral wedge insole despite the only marginal biomechanical effects of the latter.…”

Section: Discussionmentioning

confidence: 98%

A comparison between laterally wedged insoles and ankle-foot orthoses for the treatment of medial osteoarthritis of the knee: A randomized cross-over trial

et al. 2021

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Objective: To compare biomechanical and clinical outcome of laterally wedged insoles (LWI) and an ankle-foot orthosis (AFO) in patients with medial knee osteoarthritis. Design: Single-centre, block-randomized, cross-over controlled trial. Setting: Outpatient clinic. Subjects: About 39 patients with symptomatic medial knee osteoarthritis. Interventions: Patients started with either LWI or AFO, determined randomly, and six weeks later changed to the alternative. Main measures: Change in the 1st maximum of external knee adduction moment (eKAM) was assessed with gait analysis. Additional outcomes were other kinetic and kinematic changes and the patient-reported outcomes EQ-5D-5L, Oxford Knee Score (OKS), American Knee Society Clinical Rating System (AKSS), Hannover Functional Ability Questionnaire – Osteoarthritis and knee pain. Results: Mean age (SD) of the study population was 58 (8) years, mean BMI 30 (5). Both aids significantly improved OKS (LWI P = 0.003, AFO P = 0.001), AKSS Knee Score (LWI P = 0.01, AFO P = 0.004) and EQ-5D-5L Index (LWI P = 0.001, AFO P = 0.002). AFO reduced the 1st maximum of eKAM by 18% ( P < 0.001). The LWI reduced both maxima by 6% ( P = 0.02, P = 0.03). Both AFO and LWI reduced the knee adduction angular impulse (KAAI) by 11% ( P < 0.001) and 5% ( P = 0.05) respectively. The eKAM (1st maximum) and KAAI reduction was significantly larger with AFO than with LWI ( P = 0.001, P = 0.004). Conclusions: AFO reduces medial knee load more than LWI. Nevertheless, no clinical superiority of either of the two aids could be shown.

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Section: Discussionmentioning

confidence: 98%

A comparison between laterally wedged insoles and ankle-foot orthoses for the treatment of medial osteoarthritis of the knee: A randomized cross-over trial

et al. 2021

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“…In addition, some studies validated the effectiveness of ankle–foot orthoses (AFOs) for improving the stability of the knee and ankle during gait 7–9. Hence, many independent ambulant hemiplegic patients use AFOs 8–12…”

Section: Introductionmentioning

confidence: 99%

<p>Kinematic on Ankle and Knee Joint of Post-Stroke Elderly Patients by Wearing Newly Elastic Band-Type Ankle–Foot Orthosis in Gait</p>

Kim¹,

Won²

2019

CIA

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PurposeThe post-stroke elderly was increased caused by increasing stroke and advanced medical. However, ankle–foot orthoses (AFOs) can be uncomfortable for hemiplegic patients; therefore, the usability is not good. In this study, we analyzed ankle and knee joint angles in post-stroke elderly patients to assess the functional effectiveness (specifically prevention of back knee and drop-foot) of a new elastic band-type AFO (New Product: NP) during gait.Patients and methodsNine elderly post-stroke patients (eight males, one female; 55.7±8.4 years; 165.8±9.2 cm; 68.8±11.5 kg; five with right hemiplegia, four with left hemiplegia; onset period: 6.6 years) were selected for participation in this study. We captured gait motion using 12 cameras (MX-T20, Vicon, Inc., Oxford, UK) under three different conditions [wearing nothing (WI), using existing ordinary AFOs made from hard plastic material (EP), and using NP]. The angle variation and maximum–minimum angle of the lower body joints were analyzed during dorsi-plantar flexion of the ankle joint and flexion–extension of knee joint. A one-way ANOVA test for multiple comparisons was performed, followed by a Tukey’s b test to identify statistical significance, which was set at 0.005.ResultsRegarding the ankle joint, the maximum plantar flexion (drop-foot) value decreased with the NP, and the maximum dorsiflexion value increased. Regarding the knee joint, the maximum extension (back knee) value decreased, and the maximum flexion value increased (p < 0.005).ConclusionUsing analysis of the kinematics of the ankles and knees during walking, this research confirmed the effectiveness of the NP, an elastic band-type AFO, for use in ordinary post-stroke elderly patients.

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“…The reported estimate for bracing appears high (ie, 67%), but this was just from 1 study and the nature of adverse effects related to the device are likely not severe, largely being associated with superficial skin irritation and patient discomfort while wearing the device. 35 Glucosamine and chondroitin have been shown to be generally well-tolerated 102,103 ; however, certain patients may be allergic, some may experience minor gastrointestinal effects and they are usually administered with a salt, which would increase daily sodium intake. [103][104][105] In addition, there is some uncertainty regarding glucosamine's effect on glucose metabolism.…”

Section: Discussionmentioning

confidence: 99%

Can Medical Cannabis Therapies be Cost-Effective in the Non-Surgical Management of Chronic Knee Pain?

Vannabouathong¹,

Meng²,

Chang³

et al. 2021

Clin Med�Insights�Arthritis�Musculoskelet Disord

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Introduction: Chronic knee pain is a common musculoskeletal condition, which usually leads to decreased quality of life and a substantial financial burden. Various non-surgical treatments have been developed to relieve pain, restore function and delay surgical intervention. Research on the benefits of medical cannabis (MC) is emerging supporting its use for chronic pain conditions. The purpose of this study was to evaluate the cost-effectiveness of MC compared to current non-surgical therapies for chronic knee pain conditions. Methods: We conducted a cost-utility analysis from a Canadian, single payer perspective and compared various MC therapies (oils, soft gels and dried flowers at different daily doses) to bracing, glucosamine, pharmaceutical-grade chondroitin oral non-steroidal anti-inflammatory drugs (NSAIDs), and opioids. We estimated the quality-adjusted life years (QALYs) gained with each treatment over 1 year and calculated incremental cost-utility ratios (ICURs) using both the mean and median estimates for costs and utilities gained across the range of reported values. The final ICURs were compared to willingness-to-pay (WTP) thresholds of $66 714, $133 428 and $200 141 Canadian dollars (CAD) per QALY gained. Results: Regardless of the estimates used (mean or median), both MC oils and soft gels at both the minimal and maximal recommended daily doses were cost-effective compared to all current knee pain therapies at the lowest WTP threshold. Dried flowers were only cost-effective up to a certain dosage (0.75 and 1 g/day based on mean and median estimates, respectively), but all dosages were cost-effective when the WTP was increased to $133 428/QALY gained. Conclusion: Our study showed that MC may be a cost-effective strategy in the management of chronic knee pain; however, the evidence on the medical use of cannabis is limited and predominantly low-quality. Additional trials on MC are definitely needed, specifically in patients with chronic knee pain.

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Non-operative treatment of unicompartmental osteoarthritis of the knee: a prospective randomized trial with two different braces—ankle–foot orthosis versus knee unloader brace

Cited by 26 publications

References 29 publications

A comparison between laterally wedged insoles and ankle-foot orthoses for the treatment of medial osteoarthritis of the knee: A randomized cross-over trial

A comparison between laterally wedged insoles and ankle-foot orthoses for the treatment of medial osteoarthritis of the knee: A randomized cross-over trial

<p>Kinematic on Ankle and Knee Joint of Post-Stroke Elderly Patients by Wearing Newly Elastic Band-Type Ankle–Foot Orthosis in Gait</p>

Can Medical Cannabis Therapies be Cost-Effective in the Non-Surgical Management of Chronic Knee Pain?

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