Lateral wedges in knee osteoarthritis: What are their immediate clinical and biomechanical effects and can these predict a three-month clinical outcome?
Lateral wedges in knee osteoarthritis: What are their immediate clinical and biomechanical effects and can these predict a three-month clinical outcome?
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DOI：
10.1002/art.23326
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发表时间：
2008-03-15
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影响因子：
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通讯作者：
Bennell, Kim L.
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文献类型：
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作者：
Hinman, Rana S.;Payne, Craig;Bennell, Kim L.
Objective.评估外侧楔形鞋垫对行走疼痛、膝关节外收力矩、静态和对线的即时影响，以及这些即时影响与年龄、体重指数和疾病严重程度一起是否可预测内侧膝关节骨关节炎患者穿着鞋垫3个月后的临床结果。40名志愿者（平均年龄64.7岁，16名男性）在使用和不使用一对5度全长侧向楔形物的情况下随机接受测试。通过放射学机械轴测量静态对线的即时变化，通过三维步态分析测量内收力矩的变化。使用鞋垫治疗3个月后，通过西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和患者感知的整体变化评分评估疼痛和身体功能的变化。内收力矩减少发生在鞋垫（第一峰值平均值[95%置信区间（95% CI）] -0.22 [0.28，-0.15] Nm/体重x身高%），伴随着步行疼痛减少24%（平均值[95% CI] -1.0 [-4.0，2.0]）。鞋垫对静态对齐没有平均影响。在3个月时观察到WOMAC疼痛（P = 0.004）和身体功能（平均值[95% CI] -6 [-11，-1]）的平均改善，36例患者中分别有25例（69%）和26例（72%）报告疼痛和功能总体改善。回归分析表明，疾病严重程度、基线功能、行走疼痛的即刻变化幅度和鞋垫的第一峰值内收力矩可预测3个月时的临床结局。外侧楔形垫立即减少膝关节内收力矩和行走疼痛，但对静态对线没有影响。尽管一些参数预测了临床结果，但这些参数仅解释了三分之一的方差，这表明其他未知因素也很重要。
Objective. To assess immediate effects of laterally wedged insoles on walking pain, external knee adduction moment, and static, alignment, and whether these immediate effects together with age, body mass index, and disease severity predict clinical outcome after 3 months of wearing insoles in medial knee osteoarthritis.Methods. Forty volunteers (mean age 64.7 years, 16 men) were tested in random order with and without a pair of 5 degrees full-length lateral wedges. Immediate changes in static alignment were measured via radiographic mechanical axis and changes in adduction moment via 3-dimensional gait analysis. After 3 months of treatment with insoles, changes in pain and physical functioning were assessed via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and patient-perceived global change scores.Results. Reductions in the adduction moment occurred with insoles (first peak mean [95% confidence intervals (95% CI)] -0.22 [0.28, -0.15] Nm/body weight x height %), accompanied by a reduction in walking pain of similar to 24% (mean [95% CI] -1.0 [-4.0, 2.0]). Insoles had no mean effect on static alignment. Mean improvement in WOMAC pain (P = 0.004) and physical functioning (mean [95% CI] -6 [-11, -1]) was observed at 3 months, with 25 (69%) and 26 (72%) of 36 individuals reporting global improvement in pain and functioning, respectively. Regression analyses demonstrated that disease severity, baseline functioning, and magnitude of immediate change in walking pain and the first peak adduction moment with insoles were predictive of clinical outcome at 3 months.Conclusion. Lateral wedges immediately reduced knee adduction moment and walking pain but had no effect on static alignment. Although some parameters predicted clinical outcome, these explained only one-third of the variance, suggesting that other unknown factors are also important.