There is evidence that valgus knee orthosis improves clinical and biomechanical outcomes in individuals with medial knee osteoarthritis (MKOA). It is unclear whether variations in pressure application by orthosis straps can affect the biomechanical outcomes. This study aimed to determine the dose–response relationship between different orthosis straps tensions and changes in knee adduction moment (KAM) parameters in individuals with MKOA.
Twenty-four individuals with symptomatic MKOA were enrolled in this quasi-experimental study. Five tension conditions in orthosis straps were tested in 20-mmHg increments, from 0 (no pressure) to 100 (maximal pressure) mmHg. Patients were asked to adjust the orthosis strap tension based on their perceived comfort. After each condition, a 3D gait analysis was performed, and KAM parameters were calculated. The participants also reported their satisfaction with knee orthosis adjustment for each pressure condition.
With successive increases in strap tension from 40 to 80 mmHg, the first peak, second peak, and angular impulse of KAM decreased nonlinearly (from 6 % to 25 %). Increasing the orthosis strap tension to 100 mmHg significantly decreased (P < 0.05) the participants’ satisfaction level. The effective dosages (IC50) of pressure for the first peak, second peak, and angular impulse of KAM as responses were 58, 65, and 69 mmHg, respectively.
The KAM decline was not linear as the strap pressure increased. Patients were dissatisfied with orthosis adjustment when strap tension was above 80 mmHg. The optimum dosage of pressure on the knee joint's lateral side for adjusting an orthosis' strap tension is approximately 69 mmHg.
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- A new biomechanical model for the functional assessment of knee osteoarthritis.Knee. 2004; 11: 225-231
- Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity: reduced walking speed.Arthritis Rheum. 2004; 50: 1172-1178
- External knee adduction and flexion moments during gait and medial tibiofemoral disease progression in knee osteoarthritis.Osteoarthritis and cartilage. 2015; 23: 1099-1106
- Treatment of osteoarthritis of the knee with bracing: a scoping review.Orthopedic Reviews. 2016; 8
- A preliminary assessment of a novel pneumatic unloading knee brace on the gait mechanics of patients with knee osteoarthritis.PM&R. 2013; 5: 816-824
- Gait and clinical improvements with a novel knee brace for knee OA.The journal of knee surgery. 2013; 26: 173-178
- Valgus bracing in patients with medial compartment osteoarthritis of the knee: a gait analysis study of a new brace.Gait & posture. 2007; 26: 3-10
- Reduction of medial compartment loads with valgus bracing of the osteoarthritic knee.The American journal of sports medicine. 2002; 30: 414-421
- The effectiveness of self-adjustable custom and off-the-shelf bracing in the treatment of varus gonarthrosis.Jbjs. 2006; 88: 2645-2652
- Biomechanical effects of valgus knee bracing: a systematic review and meta-analysis.Osteoarthritis and cartilage. 2015; 23: 178-188
- Design evaluation in novel orthoses for patients with medial knee osteoarthritis.Journal of Biomedical Physics & Engineering. 2019; 9: 719
- The emergence of the dose–response concept in biology and medicine.Int J Mol Sci. 2016; 17: 2034
- Effect of knee braces and insoles on clinical outcomes of individuals with medial knee osteoarthritis: A systematic review and meta-analysis.Assistive Technol. 2021; : 1-17
- The dose–response relationship between lateral foot wedging and the reduction of knee adduction moment.Clin Biomech. 2014; 29: 984-989
- Number of Persons With Symptomatic Knee Osteoarthritis in the US: Impact of Race and Ethnicity, Age, Sex, and Obesity.Arthritis Care Res (Hoboken). 2016; 68: 1743-1750
- Prospective study on the effects of orthotic treatment for medial knee osteoarthritis in Chinese patients: clinical outcome and gait analysis.Hong Kong Medical Journal. 2015;
- Unloader knee braces for osteoarthritis: do patients actually wear them?.Clinical Orthopaedics and Related Research®. 2013; 471: 1982-1991
- On the reliability and validity of manual muscle testing: a literature review.Chiropractic & osteopathy. 2007; 15: 1-23
- Knee osteoarthritis and obesity.International journal of obesity. 2001; 25: 622-627
- Knee flexion contracture will lead to mechanical overload in both limbs: a simulation study using gait analysis.Knee. 2008; 15: 467-472
- Neuromuscular dose-response studies: determining sample size.Br J Anaesth. 2011; 106: 194-198
- Kinematic Analysis of a Six-Degrees-of-Freedom Model Based on ISB Recommendation: A Repeatability Analysis and Comparison with Conventional Gait Model.Appl Bionics Biomech. 2015; 2015503713
- Viscoelastic properties of human cornea.Exp Mech. 1973; 13: 497-503
- Valgus bracing for knee osteoarthritis: a meta-analysis of randomized trials.Arthritis care & research. 2015; 67: 493-501
- Efficacy of knee braces and foot orthoses in conservative management of knee osteoarthritis: a systematic review.Am J Phys Med Rehabil. 2011; 90: 247-262
- Biomechanical effectiveness of a distraction–rotation knee brace in medial knee osteoarthritis: Preliminary results.Knee. 2014; 21: 710-716
- Kinetic and kinematic changes with the use of valgus knee brace and lateral wedge insoles in patients with medial knee osteoarthritis.J Orthop Res. 2012; 30: 1125-1132
- The effect of valgus bracing on the knee adduction moment during gait and running in male subjects with varus alignment.Clin Biomech. 2010; 25: 70-76
- Analysis of biomechanical effectiveness of valgus-inducing knee brace for osteoarthritis of knee.J Rehabil Res Dev. 2010; 47: 419-429
- Dose—Response Relationships.in: Toxic Substances and Human Risk. Springer, 1987: 29-46
- Dose–response effects of customised foot orthoses on lower limb muscle activity and plantar pressures in pronated foot type.Gait & posture. 2013; 38: 443-449
- Dose–response effects of customised foot orthoses on lower limb kinematics and kinetics in pronated foot type.J Biomech. 2013; 46: 1489-1495
- Is there a dose response for valgus unloader brace usage on knee pain, function, and muscle strength?.Arch Phys Med Rehabil. 2012; 93: 496-502
- Dose-response effects of forefoot and arch orthotic components on the center of pressure trajectory during running in pronated feet.Gait & Posture. 2021;
- Is there a dose-response of medial wedge insoles on lower limb biomechanics in people with pronated feet during walking and running?.Gait & Posture. 2021; 90: 190-196
- Identifying key gait features associated with the radiological grade of knee osteoarthritis.Osteoarthritis and Cartilage. 2019; 27: 1755-1760
- A comparison of rearfoot motion control and comfort between custom and semicustom foot orthotic devices.J Am Podiatr Med Assoc. 2008; 98: 394-403
Published online: December 01, 2022
Accepted: November 3, 2022
Received in revised form: September 23, 2022
Received: March 21, 2022
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