Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany.
Clin Rehabil. 2021 Jul;35(7):1032-1043. doi: 10.1177/0269215521993636. Epub 2021 Mar 29.
To compare biomechanical and clinical outcome of laterally wedged insoles (LWI) and an ankle-foot orthosis (AFO) in patients with medial knee osteoarthritis.
Single-centre, block-randomized, cross-over controlled trial.
Outpatient clinic.
About 39 patients with symptomatic medial knee osteoarthritis.
Patients started with either LWI or AFO, determined randomly, and six weeks later changed to the alternative.
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.
Mean age (SD) of the study population was 58 (8) years, mean BMI 30 (5). Both aids significantly improved OKS (LWI = 0.003, AFO = 0.001), AKSS Knee Score (LWI = 0.01, AFO = 0.004) and EQ-5D-5L Index (LWI = 0.001, AFO = 0.002). AFO reduced the 1st maximum of eKAM by 18% ( < 0.001). The LWI reduced both maxima by 6% ( = 0.02, = 0.03). Both AFO and LWI reduced the knee adduction angular impulse (KAAI) by 11% ( < 0.001) and 5% ( = 0.05) respectively. The eKAM (1st maximum) and KAAI reduction was significantly larger with AFO than with LWI ( = 0.001, = 0.004).
AFO reduces medial knee load more than LWI. Nevertheless, no clinical superiority of either of the two aids could be shown.
比较外侧楔形鞋垫（LWI）和踝足矫形器（AFO）在治疗内侧膝关节骨关节炎患者中的生物力学和临床效果。
单中心、块随机、交叉对照临床试验。
门诊。
约 39 名有症状的内侧膝关节骨关节炎患者。
患者随机开始使用 LWI 或 AFO，六周后更换为另一种。
步态分析评估第 1 大的膝关节外展力矩（eKAM）变化。其他的运动学和运动学变化以及患者报告的结果 EQ-5D-5L、牛津膝关节评分（OKS）、美国膝关节协会临床评分系统（AKSS）、汉诺威功能能力问卷-骨关节炎和膝关节疼痛也被评估。
研究人群的平均年龄（SD）为 58（8）岁，平均 BMI 为 30（5）。两种辅助器具均显著改善了 OKS（LWI = 0.003，AFO = 0.001）、AKSS 膝关节评分（LWI = 0.01，AFO = 0.004）和 EQ-5D-5L 指数（LWI = 0.001，AFO = 0.002）。AFO 降低了第 1 大的 eKAM 18%（ < 0.001）。LWI 降低了两个最大值 6%（ = 0.02， = 0.03）。AFO 和 LWI 均降低了膝关节内收角动量（KAAI）11%（ < 0.001）和 5%（ = 0.05）。AFO 比 LWI 更能显著降低 eKAM（第 1 大）和 KAAI（ = 0.001， = 0.004）。
AFO 比 LWI 更能减轻内侧膝关节的负荷。然而，两种辅助器具都没有显示出明显的临床优势。
