Knee valgus braces and lateral wedge insoles in the treatment of medial tibiofemoral osteoarthritis
Osteoarthritis of the knee joint has been shown to develop in approximately 10% of adults over the age of 55, and is nearly ten times more common in the medial than the
lateral compartment. This discrepancy is speculated to be the result of increased load on the medial tibiofemoral cartilage with the external knee adduction moment being used as a surrogate measure for this medial loading. In the management of knee osteoarthritis, surgical treatments have been of great success, but conservative treatments such as
valgus braces and lateral wedge insoles to alter this loading are important before surgery is considered. No study has ever compared a valgus knee brace and lateral wedge insole against each other in the same population, and therefore the purpose of this thesis was to determine which of these is best in terms of biomechanical, clinical and user observations.
A randomised cross-over comparison study of a valgus knee brace and a lateral wedge insole was performed in 28 patients presenting with medial tibiofemoral osteoarthritis
whilst using the interventions for a two week period. Pre- and post-intervention, threedimensional kinematic and kinetic walking data, clinical outcomes and user observations were collected to characterise the difference between the interventions.
The valgus knee brace and the lateral wedge insole significantly reduced the external knee adduction moment compared to the baseline readings, with the lateral wedge insole significantly more. The valgus knee brace had a significant reduction in knee adduction angle with the lateral wedge having a significant increase in the lateral centre of pressure trajectory. It is apparent from the results in this thesis that the lateral wedged insole is
the best choice of intervention to use with medial tibiofemoral osteoarthritis given the reduced external knee adduction moment and pain, whilst having increased acceptance by patients compared to the knee brace. Further studies to understand their efficacy are needed.