MARKERLESS MOTION CAPTURE FOR ASSESSING FRONTAL PLANE LOWER LIMB ALIGNMENT DURING STATIC AND DYNAMIC TASKS

Few if any prevention strategies are available for knee osteoarthritis (OA). In those with symptomatic medial OA, the contralateral knee may be at high risk of disease, and a reduction in medial loading in that knee might prevent disease or its progression there. Our aim was to determine how often persons with medial OA on 1 side had either concurrent or later medial OA on the contralateral side, and whether an intervention known to reduce medial loading in affected knees with medial OA might reduce medial loading in the contralateral knee. Lateral wedge insoles reduce loading across an affected medial knee but their effect on the contralateral knee is unknown. To determine the proportion of persons with medial knee OA who had concurrent medial contralateral OA or developed contralateral medial OA later, we examined knee radiographs from the longitudinal Framingham Osteoarthritis Study. Then, to examine an approach to reducing medial load in the contralateral knee, 51 people from a separate study with painful medial tibiofemoral OA underwent gait analysis wearing bilateral controlled shoes with no insoles, and then with 2 types of wedge insoles laterally posted by 5°. Primary outcome was the external knee adduction moment (EKAM) in the contralateral knee. Nonparametric CI were constructed around the median differences in percentage change in the affected and contralateral sides. Of Framingham subjects with medial radiograph knee OA, 137/152 (90%) either had concurrent contralateral medial OA or developed it within 10 years. Of those with medial symptomatic knee OA, 43/67 (64%) had or developed the same disease state in the contralateral knee. Compared to a control shoe, medial loading was reduced substantially on both the affected (median percentage EKAM change -4.84%; 95% CI -11.33% to -0.65%) and contralateral sides (median percentage EKAM change -9.34%; 95% CI -10.57% to -6.45%). In persons with medial OA, the contralateral knee is also at high risk of medial OA. Bilateral reduction in medial loading in knees by use of strategies such as lateral wedge insoles might not only reduce medial load in affected knees but prevent knee OA or its progression on the contralateral side.

This study aimed to evaluate the long-term functional outcomes and survivorship of medial closing wedge high tibial osteotomy (MCWHTO) in treating lateral femorotibial osteoarthritis (OA) and factors associated. Between 1997 and 2018, 65 patients (67 knees) who underwent an MCWHTO were longitudinally assessed. Inclusion criteria were symptomatic lateral femorotibial OA in valgus knees with no signs of medial compartment OA. The primary outcome was osteotomy survivorship with a failure endpoint defined by the necessity for total knee arthroplasty (TKA). Clinical and functional outcomes, including Knee injury and Osteoarthritis Outcome Score (KOOS), University of California, Los Angeles (UCLA) activity scale and patient satisfaction, as well as radiological evaluation, including hip-knee-ankle angle (HKA), mechanical proximal tibial angle (mPTA) and mechanical lateral distal femoral angle (mLDFA), were assessed both preoperatively and at final follow-up. The mean follow-up was 11.5 ± 6.3 years [3.3-24.5]. Three patients were lost at final follow-up. Overall, 25 (39.1%) patients progressed to TKA. Median time to TKA was 12.7 years [95% CI: 10.6-17.1]. Risk of TKA conversion before 10 years was 7.4 times higher in patients with body mass index (BMI) > 30 (p = 0.004). Among the 39 remaining patients, significant postoperative improvements were observed in the KOOS from 40.8 ± 14.7 to 68.2 ± 19.2 (p < 0.0001) and the UCLA activity scale from 4.6 ± 2.1 to 7.0 ± 1.8 (p < 0.0001). Radiological evaluations showed a shift toward varus alignment (HKA: 184.5 ± 2.5 vs. 178.8 ± 2.8; p < 0.0001). There was a significant evolution of the mPTA from 89.5 ± 2.6 preoperatively to 84.0 ± 2.3 postoperatively (p < 0.0001). There was no significant difference in the measurement of mLDFA. More than 80% of patients were very satisfied or would recommend the surgery. MCWHTO offers reliable long-term outcomes in valgus knees with lateral OA. Patient selection, particularly regarding BMI, is essential to achieve optimal survivorship. Level IV, case series.

Using time-driven activity-based costing (TDABC), we sought to compare the total facility costs, comprising supply and personnel costs during the episode of care for the index procedure, in patients with isolated medial compartmental knee osteoarthritis (OA) undergoing unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA). We conducted a retrospective analysis of 100 UKAs and 100 TKAs from 2019 to 2022. From a larger sample of 4899 TKAs and 137 UKAs, patients with isolated medial OA (Kellgren-Lawrence Grade <2 in other compartments) were radiographically identified. Demographic data included age, sex and body mass index, with comorbidities controlled using the Charlson comorbidity index. Facility costs were calculated using TDABC and standardized in cost units (CUs), a metric for comparing costs across procedures. Multiple regression analysis was used to assess the independent effect of TKA versus UKA on facility costs. TKA patients had similar operative times (TKA vs. UKA: 1.01×, p = 0.783) and supply costs (1.00×, p = 0.866), where 'x' denotes the relative cost ratio. However, TKA was associated with higher personnel costs (260.0 vs. 222.5 CUs [1.17×], p < 0.001) and total facility costs, both including (706.3 vs. 667.5 CUs [1.06×], p = 0.007) and excluding implants (353.8 vs. 312.5 CUs [1.13×], p < 0.001). Adjusted for demographics and comorbidities, TKA had increased facility costs, including (32.2 CUs, 95% confidence interval [CI]: 2.9-61.5, p = 0.031) and excluding implants (37.8 CUs, 95% CI: 15.2-60.3, p = 0.001). TDABC analysis revealed higher total facility costs for the index procedure in TKA, suggesting UKA may be a cost-saving alternative for isolated medial compartment knee OA. Level III, retrospective comparative study.

Lateral knee osteoarthritis (OA) is common after anterior cruciate ligament reconstruction (ACLR), yet gait characteristics associated with lateral knee OA after ACLR are not well understood. This cross-sectional study aimed to compare knee, trunk, pelvis, hip, and ankle kinematics and moments between people with predominant lateral knee OA after ACLR and healthy controls. Nineteen post-ACLR people with lateral knee OA and 25 healthy controls were recruited. Quantitative gait analysis was conducted during walking, and knee pain, confidence, and kinesiophobia were assessed. Between-group differences in peak kinematics and moments were evaluated, and Pearson correlations evaluated relations between biomechanical and patient-reported measures (P < 0.05). Participants with lateral knee OA after ACLR had greater peak knee flexion (mean difference, 3.5°; 95% confidence interval, 0.9-6.1) and lower knee internal rotation angles (-3.3°; -6.2 to -0.5) than the controls. Those with lateral knee OA also had greater peak pelvic anterior tilt (3.1°, 0.4-5.9), hip flexion angles (5.1°, 1.9-8.3), and peak ankle dorsiflexion moment (0.1 N·m·kg(-1), 0.0-0.2). In the lateral knee OA group, worse knee confidence and kinesiophobia were significantly correlated with greater peak trunk flexion angle (r = 0.654 and r = 0.535, respectively) and greater knee pain was significantly correlated with greater peak knee flexion angle (r = 0.535). Gait characteristics associated with lateral knee OA after ACLR differ from those in healthy individuals, predominantly in the sagittal plane. Increased sagittal plane knee and trunk kinematics seem to be related to worse knee pain, confidence, and kinesiophobia. These findings will assist the development of compartment-specific interventions for individuals with posttraumatic lateral knee OA.

The purpose of this study was to evaluate the role of medial opening wedge high tibial osteotomy (HTO) in medial unicompartmental osteoarthritis (MCOA) of knee and to compare between the two methods of osteotomy using either dynamic axial fixator (DAF) or locking compression plate (LCP). A total of 20 patients with medial osteoarthritis of knee were enrolled in this prospective study who were divided into two groups of 10 each. First group comprising of two males and eight females were treated by HTO using DAF. Second group comprising of five males and five females were treated by HTO using LCP. We assessed various radiological parameters including hip knee ankle angle (HKA), tibiofemoral angle (TFA), weight-bearing line on tibia, Insall Salvati index and tibial slope. Functional outcome of knee at final follow-up was assessed by Oxford knee score (OKS) and visual analogue scale. In first group, mean HKA angle changed from 187° to 178.30° (p = 0.006), mean TFA from 182.40° to 172° (p = 0.003), average position of weight-bearing line from 11.24 to 59.54 % (p = 0.004), and mean OKS 43.3-16.9 (p = 0.004). In second group, mean HKA angle changed from 186° to 178.80° (p = 0.004), mean TFA from 180.90° to 173.60° (p = 0.004), average position of weight-bearing line from 14 to 61.3 % (p = 0.004), and mean OKS 43.2-16.5 (p = 0.002). HTO is an established treatment for patients with symptomatic MCOA knee with significant improvement in the clinical and radiographic parameters. There is no significant difference between the two methods; however, external fixator has the complication of pin tract infections. II.

The medial compartment osteoarthritis (OA) of knee joint has various surgical options such as high tibial osteotomy (HTO), hemiarthroplasty, and total knee arthroplasty. In the early stages of medial OA, there are no intra-articular deformities. Thus HTO, which is an extra-articular osteotomy, is recommended for the treatment of mild OA, but in moderate and severe medial OA, there are intra-articular deformities. HTO cannot correct these intra-articular deformities. Thus, an intra-articular osteotomy like the Tibial condylar valgus osteotomy (TCVO) is required in cases of moderate to severe medial OA knee. The contact area of the articular surface of the knee joint after TCVO is broader than it is after HTO in cases of moderate/severe OA. TCVO also improves the bony stability, eliminates the lateral thrust and surely corrects the alignment of the lower limb. To conclude, in cases of medial OA knee, the type of deformity must be evaluated and corrected accordingly. Intra-articular deformity must be corrected first. If the correction of varus and the mechanical axis is not enough, then extra-articular deformity must also be corrected, with a simultaneous or subsequent HTO.

Background: Lateral knee osteoarthritis is notably common after anterior cruciate ligament reconstruction (ACLR). While valgus bracing has been investigated as an intervention for medial knee osteoarthritis (OA), little is known about the effectiveness of varus bracing for lateral knee OA after ACLR. Purpose: To determine the immediate effects of a varus unloader knee brace on gait biomechanics in people with lateral knee OA and valgus malalignment after ACLR. Study Design: Controlled laboratory study. Methods: Nineteen participants who had undergone primary ACLR 5 to 20 years previously and had symptomatic and radiographic lateral knee OA as well as valgus malalignment were included. Three-dimensional gait analyses were conducted during walking under 3 test conditions: (1) no brace, (2) unadjusted brace (sagittal plane support with neutral frontal plane adjustment), and (3) adjusted brace (sagittal plane support with varus adjustment). Knee, pelvis, hip, and ankle kinematics and moments data were statistically analyzed using repeated-measures analysis of variance (α = 0.05). Results: Compared with walking with no brace, the adjusted brace significantly increased peak knee flexion angle (mean difference [95% CI]: 3.2° [1.3° to 5.0°]) and adduction angle (1.7° [0.8° to 2.6°]) and reduced peak internal rotation angle (−3.0° [−4.0° to −2.0°]). Significant increases in peak knee flexion moment (0.14 N·m/kg [0.06 to 0.20 N·m/kg]), adduction moment (0.10 N·m/kg [0.07 to 0.14 N·m/kg]), and external rotation moment (0.01 N·m/kg [0.00 to 0.02 N·m/kg]) were observed with the adjusted brace. The adjusted brace also reduced peak hip adduction angle (−1.29° [−2.12 to −0.47]) and increased peak hip adduction (0.17 N·m/kg [0.04 to 0.31 N·m/kg]) and external rotation moments (0.09 N·m/kg [0.03 to 0.14 N·m/kg]). There were no significant differences between the adjusted and unadjusted brace conditions, except for knee internal rotation angle, where the adjusted brace produced significantly greater reductions relative to the unadjusted brace (−1.46° [−1.98 to −0.95]). Conclusion: Irrespective of frontal plane adjustment, the varus unloader brace produced immediate modulations in sagittal, frontal, and transverse plane joint angles and moments in younger individuals with lateral knee OA and valgus malalignment after ACLR. Clinical Relevance: The varus unloader brace may have the potential to mitigate abnormal knee joint mechanics associated with the development and progression of lateral knee OA after ACLR.

This case series analyzes the outcomes of high tibial osteotomy in five middle-aged patients with medial knee osteoarthritis. The study focuses on the procedures efficacy in addressing varus deformity and pain relief, including detailed preoperative and postoperative assessments. The results indicate significant improvement in symptoms and alignment, highlighting the procedure's potential as a treatment modality for this patient demographic. Introduction: Osteoarthritis of knee is a chronic debilitating disease causing considerable disability. Osteoarthritis commonly affect the medial compartment of knee giving rise to varus deformity in majority of cases. Significant varus deformity further aggravates pathology due to medialisation of load bearing axis. High tibial osteotomy is a valuable treatment modality for correcting malalignment. Thus producing postoperative valgus alignment of the limb with shifting of load bearing axis of lower limb laterally and thereby relieving the symptoms associated with medial unicompartmental knee osteoarthritis. Materials and Methods: We reported total of 5 cases who were of middle aged(33 -55 years) presented with knee pain(VAS 7-8) and isolated medial osteoarthritis with good range of motion and without ligamentous instability. All these patients were diagnosed with medial compartment of knee osteoarthritis based on radiological assessment, Ahlback's grade I and II .We performed medial opening wedge high tibial osteotomy with iliac crest graft using tomofix plates in all five patients. Results: This procedure resulted in significant pain relief (two patients -VAS 3, two patients -VAS 2, one patient-VAS 1) and correction of deformity in all the patients. Conclusion: Medial opening wedge High tibial osteotomy is a good option in the treatment of uni-compartmental osteoarthritis knee.It relieves pain and improves functional outcome and prevents further progression of osteoarthritis.

We have previously demonstrated that laterally wedged orthotics can alleviate knee pain in subjects with medial compartment knee osteoarthritis. However, this effect has not yet been demonstrated in subjects with lateral knee osteoarthritis (LKOA) using a medially wedged orthotic. PURPOSE: To determine the effect of medially wedged orthotics on knee pain and function in subjects with LKOA. METHODS: As part of a larger study, ten subjects aged 65± 7 years with LKOA (K-L grades II-IV) were chosen for evaluation. Subjects were given an orthotic with an individually determined amount of wedging (range 5–15 degrees, average 9 ± 3 degrees) based on maximum pain reduction during a lateral step-down test. Subjects returned for testing following two weeks of accommodation to the orthotic. Two functional tests were performed: a walking test to see how far the subject could walk in six minutes, followed by a stair test to determine how long the subject took to ascend and descend a twelve step flight of stairs. No wedge (NW) and wedge (W) conditions were tested in random order. Subjects were asked to rate their knee pain before and after each test on a 100mm visual analog scale, 0 being no pain and 100 being the worst pain imaginable. Dependent t-tests (p≤0.05) were used to assess changes in walking distance, stair test time, and knee pain between the NW and W conditions. RESULTS: There were no differences between the NW and W conditions for six minute walk distance (p=0.57) or stair test time (p=0.12). For the stair test, knee pain significantly increased in the NW condition (pre-test pain 14.9±18.7mm, post-test pain 22.6±21.3mm; p=0.02) while there was no change in pain for the W condition (pre pain 11±12.3mm, post pain 13.8±15.5mm; p=0.16). Similar results were found for the six minute walk, with pain increasing significantly in the NW condition (pre pain 13.4±15.5mm, post pain 22.9±17.8mm; p=0.005) but not in the W condition (pre pain 11±15.6mm, post pain 17±18.7mm; p=0.25). CONCLUSION: Short term accommodation to medially wedged orthotics, while not affecting objective measures of functional ability, appear to prevent increases in knee pain associated with walking and stair climbing in patients with lateral knee OA. Support from NIH-RR16548 (Thomas Buchanan, PI) is acknowledged.

To investigate the accuracy of split three-dimensional (3D) printing patient-specific instrumentation (PSI) in medial open-wedge high tibial osteotomy (MOWHTO) and its effectiveness in treating medial knee osteoarthritis. Clinical data of 14 patients with medial knee osteoarthritis and treated with split 3D printing PSI-assisted MOWHTO between August 2019 and August 2020 were retrospectively analyzed. There were 5 males and 9 females with an average age of 61 years (range, 43-68 years). The disease duration ranged from 1 to 16 years, with an average of 4.7 years. Preoperative Kellgren-Lawrence grading of knee osteoarthritis included grade Ⅰ in 2 cases, grade Ⅱ in 6 cases, and grade Ⅲ in 6 cases. The Hospital for Special Surgery (HSS) score was 59.1±4.9. The weight bearing line ratio (WBL), hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), and actual correction angle of the lower limbs were measured on postoperative imaging data, and compared with the preoperative measurements and the designed target values to evaluate the accuracy of the PSI-assisted surgery. The patients' knee function were evaluated with the HSS score at 3 and 6 months postoperatively, and at last follow-up. One patient suffered from an incision exudation at 2 weeks postoperatively, and the incision healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 7-19 months (mean, 14.8 months). There was no neural injuries, hinge fracture, plate or screw fractures, loosening, or other complications. The WBL was maintained at the postoperative level according to the X-ray examination during the follow-up period. The WBL, HKA, MPTA, and PTSA were all within a satisfactory range after operation. The WBL, HKA, and MPTA were significantly improved when compared with the preoperative measurements ( P<0.05). There was no significant difference between preoperative and postoperative PTSA ( P>0.05). The differences in postoperative WBL, HKA, MPTA, and correction angle compared with the preoperative designed target values were not significant ( P>0.05). The HSS scores were 69.2±4.7, 77.7±4.3, and 88.1±5.4 at 3 and 6 months postoperatively, and last follow-up, respectively. The differences between time points were significant ( P<0.05). For patients with medial knee osteoarthritis, the split 3D printing PSI can assist the surgeon in MOWHTO with accurate osteotomy orthopedics and achieve favorable effectiveness.

Introduction:Medial compartment knee osteoarthritis (OA) with varus alignment is a common degenerative condition leading to pain, functional limitation, and reduced quality of life. High tibial osteotomy (HTO) by the open wedge technique is a joint-preserving option aimed at realigning the mechanical axis.Objectives:This study aims to evaluate the functional and radiological outcomes of medial open wedge HTO in patients with medial knee OA and varus deformity.Material and Methods:We conducted a prospective study at Hamidia Hospital, Bhopal, for 2 years with 6 months follow-up of each patient. Twenty-five patients of symptomatic medial compartment OA diagnosed by standing X-rays and Scannogram, underwent medial open wedge HTO using TomoFix plate. Outcome was assessed using standing X-rays, visual analog scale (VAS), and Western Ontario and McMaster Universities OA Index (WOMAC) scores. All patients were classified by the Kellgren–Lawrence (KL) system. We excluded patients with secondary knee OA.Results:In our patients, 72% of patients were elderly women, and the mean age was 62.76 years. Most had KL Grade 3 OA (72%), with the left knee more commonly affected (62.5%). Although we have not found a significant improvement at 4 weeks, theVAS score improved from 6 weeks onward (P < 0.001), with mean VAS 4.48 at 12 weeks and 3.44 at 18 weeks, respectively. WOMAC score also improved at 6 weeks (mean change: 2.32, P = 0.022) and at 12, 18, and 24 weeks (mean changes: 11.64, 21.92, and 35.56, respectively; all P < 0.001). Radiologically, a mean correction of 9.72° (±0.89) was achieved, with successful restoration of mechanical alignment for a mean varus of 2.40 ± 0.65°.Conclusion:Medial open wedge HTO is an effective treatment modality for selected patients with medial compartment OA and varus alignment. It provides significant pain relief and functional improvement. Proper patient selection, pre-operative planning, surgical technique, and rehabilitation are critical for optimal outcomes.

A valgus stress radiograph, in addition to the weight-bearing fixed flexion posteroanterior radiograph (e.g., Rosenberg), is deemed useful to assess lateral cartilage wear by measuring lateral joint space width (JSW) in patients with medial knee osteoarthritis. This study aimed to assess: (1) the difference in measured lateral JSW between the Rosenberg and the valgus stress radiograph, and (2) the ability of the valgus stress radiograph to detect lateral cartilage wear (indicated by joint space narrowing) in patients where the Rosenberg radiograph showed full thickness cartilage (i.e., the additional value). The Rosenberg and valgus stress radiographs, obtained between January 1st 2018 and December 31st 2018, of 137 patients with medial knee osteoarthritis prior to total or partial knee replacement were retrospectively collected. The lateral JSW was measured at its midpoint (midJSW) and minimum (minJSW). The differences were tested with a paired-sample t test. The valgus stress radiograph was considered to have an additional value if: (1) JSW ≥ 5mm on the Rosenberg radiograph, (2) JSW < 5mm on valgus stress radiograph, and (3) > 2mm less JSW on the valgus stress than on the Rosenberg radiograph. The mean differences in lateral JSW between the Rosenberg and valgus stress radiographs were 0.53mm (SD = 1.0mm, p < 0.001) for midJSW and 0.66mm (SD = 1.1mm, p < 0.001) for minJSW with both values being lower on the valgus stress radiograph. The valgus stress radiograph was of additional value in 4-6% of the patients. Although the valgus stress radiograph shows more lateral JSW narrowing compared to Rosenberg radiograph, it only has an additional value in 1 out of 17-25 patients with medial osteoarthritis. We, therefore, recommend a Rosenberg radiograph as routine radiographic assessment and only use an additional valgus stress radiograph in case of discrepancy between clinical and radiological findings.

Total knee arthroplasty (TKA) is used for tricompartmental knee osteoarthritis, while unicompartmental knee arthroplasty (UKA) is preferred for unicompartmental knee osteoarthritis. Bicompartmental knee arthroplasty (BKA) aims to address 2 knee compartments by combining 2 UKA's or 1 UKA with a patellofemoral replacement. This study examines the clinical outcomes of BKA, focusing on pain alleviation and knee function. The aim of this study is to report the functional outcome of BKA and see if this aligns with BKA outcomes from literature in terms of patient reported outcome measurements (PROMs) and range of motion (ROM) after a 2-year follow-up. Additionally, radiographic alignment, implant survivorship, adverse events and length of stay are secondary outcomes. This is a cohort study of 21 patients who underwent BKA for medial and patellofemoral osteoarthritis. The patients had follow-up for at least 2 years postoperatively. PROMs were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), Oxford Knee Score, Western Ontario and McMaster University Osteoarthritis index (WOMAC) and the Visual Analogue Scale (VAS). ROM was measured using a goniometer. Pre- and postoperative radiographic coronal alignment was measured using standard full leg radiographs. Patient demographics, implant survivorship, length of stay and adverse events were recorded. Twenty-one patients (23 knees) were included, with a mean follow-up of 41 months (standard deviation [SD] 12 months; range 24-59 months). Patient-reported outcome measures (PROMs) demonstrated significant improvements, with 80% achieving good to excellent OKS and KSS scores. KOOS scores were similar to scores found in literature. The WOMAC score was higher in our results compared to other authors. Which indicates worse outcome. The mean preoperative hip-knee-ankle angle (HKAA) was 2.4 degrees varus (SD 1.9 degrees; range 1.2 degrees valgus - 6.1 degrees varus), while the mean postoperative HKAA was 0.3 degrees valgus (SD 2.8 degrees; range 4.6 degrees valgus - 5.6 degrees varus) (p < 0.001). Postoperative range of motion averaged 117 degrees (SD 10 degrees; range 98-132). BKA shows promise in alleviating pain and improving knee function in patients with medial and patellofemoral osteoarthritis. Challenges include the risk of revision and technical difficulties during surgery. Comparative studies suggest similar outcomes between BKA and TKA, with potential advantages for younger, more active patients. Further research, particularly randomized trials with larger cohorts, is necessary to elucidate the long-term benefits and drawbacks of BKA compared to other knee arthroplasty options.

In Brief The purpose of this review is to determine the effectiveness of knee orthoses in the treatment of pain in unilateral compartment osteoarthritis (OA). OA is the most common disorder affecting synovial joints, with structural changes of OA present in approximately half of the adults. The knee is the most commonly affected joint. Many treatments have been developed for OA, including the unloader knee orthosis. The principle of the unloader knee orthosis is to create a varus or valgus moment at the knee—theoretically creating additional space in the joint compartment, thus relieving pain caused by bone-on-bone contact. Several studies have been done, but none with a power or number of participants were large enough to demonstrate effective treatment of OA. Using the keywords “knee osteoarthritis” and “orthosis” or “brace,” the PubMed, CINAHL, RECAL, and ISI Web of Knowledge electronic databases were searched for randomized control trials with “orthoses” or “braces” for the knee between January 1980 and December 2010. Only studies that dealt with medial unilateral compartment knee OA and the use of a knee orthosis were selected. Of these articles, only experimental trials were selected based on the American Academy of Orthotists and Prosthetists State-of-the-Science Evidence Report Guidelines. A comparative analysis of the articles was used to determine the effectiveness of the orthoses in reducing pain. Forty-six initial articles were found. Of these, 15 articles were ultimately included and reviewed based on the inclusion guidelines. Most of these articles were either single-subject research or before-and-after studies. The majority were of moderate quality. Statistically significant pain reduction was noted by 73% of the studies reviewed, although all showed that there was pain reduction in the patients. Patient function and orthosis efficacy were also briefly examined, showing moderate increases of function. The rate of pain relief was further investigated and revealed that pain relief was almost immediate. OA knee orthoses are a cost-effective way to reduce pain in patients with medial compartment OA. The purpose of this review is to determine the effectiveness of knee orthoses in the treatment of pain in unilateral compartment osteoarthritis (OA). Only studies that dealt with medial unilateral compartment knee OA and the use of a knee orthosis were selected. Of these articles, only experimental trials were selected based on the American Academy of Orthotists and Prosthetists State-of-the-Science Evidence Report Guidelines. Statistically significant pain reduction was noted by 73% of the studies reviewed, although all showed that there was pain reduction in the patients.

In this study, we proposed for the first time the theory of "settlement phenomenon" in tibial plateau and carefully explored the role of settlement of tibial plateau in the occurrence and progression of medial compartment knee osteoarthritis (OA) through investigating the relationship between the degree of settlement and the radiographic severity of OA. One hundred twenty-seven patients with knee medial compartment OA were recruited and examined with weight-bearing radiographs of the entire lower limb. The radiographic severity of OA was evaluated using the Kellgren and Lawrence (KL) grading methods. The settlement value, hip-knee-ankle angle, minimum medial joint space width, and condylar plateau angle were measured at the same time. The settlement value increases with the upgrading of KL grades (r = 0.352, P < 0.001) and is significantly correlated with the changes of hip-knee-ankle angle, minimum medial joint space width, and condylar plateau angle (r = -0.527, -0.271, and 0.415, P < 0.001, respectively). These results suggest that the settlement of tibial plateau could be an evaluable indicator of medial compartment knee OA and be used in the early diagnosis and progression of OA.