Farrokhi Shawn, Voycheck Carrie A, Tashman Scott, Fitzgerald G Kelley
Department of Physical Therapy and Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA.
J Orthop Sports Phys Ther. 2013 Sep;43(9):600-19. doi: 10.2519/jospt.2013.4121.
Altered knee joint biomechanics and excessive joint loading have long been considered as important contributors to the development and progression of knee osteoarthritis. Therefore, a better understanding of how various treatment options influence the loading environment of the knee joint could have practical implications for devising more effective physical therapy management strategies. The aim of this clinical commentary was to review the pertinent biomechanical evidence supporting the use of treatment options intended to provide protection against excessive joint loading while offering symptomatic relief and functional improvements for better long-term management of patients with knee osteoarthritis. The biomechanical and clinical evidence regarding the effectiveness of knee joint offloading strategies, including contralateral cane use, laterally wedged shoe insoles, variable-stiffness shoes, valgus knee bracing, and gait-modification strategies, within the context of effective disease management is discussed. In addition, the potential role of therapeutic exercise and neuromuscular training to improve the mechanical environment of the knee joint is considered. Management strategies for treatment of joint instability and patellofemoral compartment disease are also mentioned. Based on the evidence presented as part of this clinical commentary, it is argued that special considerations for the role of knee joint biomechanics and excessive joint loading are necessary in designing effective short- and long-term management strategies for treatment of patients with knee osteoarthritis.
Therapy, level 5.
膝关节生物力学改变和关节负荷过重长期以来一直被认为是膝关节骨关节炎发生和发展的重要因素。因此，更好地了解各种治疗方案如何影响膝关节的负荷环境，对于制定更有效的物理治疗管理策略可能具有实际意义。本临床评论的目的是回顾相关生物力学证据，这些证据支持使用旨在防止关节负荷过重、缓解症状并改善功能，以实现对膝关节骨关节炎患者更好的长期管理的治疗方案。讨论了在有效疾病管理背景下，包括使用对侧手杖、外侧楔形鞋垫、可变刚度鞋、外翻膝关节支具和步态修正策略等膝关节卸载策略有效性的生物力学和临床证据。此外，还考虑了治疗性运动和神经肌肉训练对改善膝关节力学环境的潜在作用。还提到了治疗关节不稳定和髌股关节疾病的管理策略。基于作为本临床评论一部分所呈现的证据，有人认为在设计治疗膝关节骨关节炎患者的有效短期和长期管理策略时，有必要特别考虑膝关节生物力学和关节负荷过重的作用。
治疗，5级。
