Baert Isabel A C, Nijs Jo, Meeus Mira, Lluch Enrique, Struyf Filip
Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2560, Wilrijk, Antwerp, Belgium,
Clin Rheumatol. 2014 Nov;33(11):1529-38. doi: 10.1007/s10067-014-2668-1. Epub 2014 May 21.
Results on the effects of lateral wedge insoles (LWIs) in patients with medial knee osteoarthritis (OA) are ambiguous and not fully understood. Because of the low cost of this intervention and its clinical utility, attention to LWIs is worth considering. Current insights on the efficacy of LWIs are mainly focused on changing biomechanical aspects, such as the external knee adduction moment, in an attempt to influence pain, functional ability and structural progression. It is however appropriate to interpret the effectiveness of LWIs in a broader concept than the pure biomechanical approach. Given our current understanding of OA-related pain, including the involvement of the central nervous system and nociception-motor interactions, concepts of pain neuroscience should be taken into account. The purpose of this review is to summarize the current state of knowledge regarding the biomechanical effect of LWIs. It aims to discuss the degree to which such biomechanical effect translates to clinical effects (symptom relief, function recovery and reduction of structural progression). In order to explain these clinical effects, this paper balances biomechanics with pain neuroscience. A literature search was performed and reviewed using a narrative approach. Many studies investigated the effect of LWIs on dynamic knee joint loading, and beneficial biomechanical effects (reduction in knee adduction moment) were observed in patients with mild to moderate medial knee OA, in particular when using full-length LWIs. However, despite beneficial biomechanical effects, there is insufficient evidence for clinically important effects or significant reductions in disease progression. Evaluating the effects of LWIs, our current understanding of OA pain should be taken into account, as LWIs may be part of a comprehensive biopsychosocial treatment. Future work on all of the variables that could influence clinical outcomes in order to decide in which subgroups of patients LWIs are (most) effective is necessary.
关于外侧楔形鞋垫（LWIs）对膝关节内侧骨关节炎（OA）患者的影响，研究结果尚不明确，尚未完全了解。由于这种干预措施成本低且具有临床实用性，因此值得关注LWIs。目前对LWIs疗效的认识主要集中在改变生物力学方面，如膝关节外展力矩，试图影响疼痛、功能能力和结构进展。然而，用比单纯生物力学方法更广泛的概念来解释LWIs的有效性是合适的。鉴于我们目前对OA相关疼痛的理解，包括中枢神经系统的参与和伤害感受-运动相互作用，应考虑疼痛神经科学的概念。本综述的目的是总结关于LWIs生物力学效应的当前知识状态。它旨在讨论这种生物力学效应转化为临床效果（症状缓解、功能恢复和结构进展减少）的程度。为了解释这些临床效果，本文将生物力学与疼痛神经科学进行了平衡。采用叙述性方法进行了文献检索和综述。许多研究调查了LWIs对膝关节动态负荷的影响，在轻度至中度膝关节内侧OA患者中观察到了有益的生物力学效应（膝关节内收力矩降低），特别是使用全长LWIs时。然而，尽管有有益的生物力学效应，但缺乏临床重要效果或疾病进展显著降低的证据。评估LWIs的效果时，应考虑我们目前对OA疼痛的理解，因为LWIs可能是综合生物心理社会治疗的一部分。未来有必要研究所有可能影响临床结果的变量，以确定LWIs在哪些亚组患者中（最）有效。
