Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Sep 21;17(9):e0274874.
doi: 10.1371/journal.pone.0274874. eCollection 2022.

Effects of neuromuscular gait modification strategies on indicators of knee joint load in people with medial knee osteoarthritis: A systematic review and meta-analysis

M Denika C Silva  1   2   3 , Diana M Perriman  1   2   4 , Angela M Fearon  1   2   5 , Daniel Tait  1   5 , Trevor J Spencer  1   5 , Dianne Walton-Sonda  6 , Milena Simic  7 , Rana S Hinman  8 , Kim L Bennell  8 , Jennie M Scarvell  1   2
Affiliations
Meta-Analysis

Effects of neuromuscular gait modification strategies on indicators of knee joint load in people with medial knee osteoarthritis: A systematic review and meta-analysis

M Denika C Silva et al. PLoS One. .

Abstract

Objectives: This systematic review aimed to determine the effects of neuromuscular gait modification strategies on indicators of medial knee joint load in people with medial knee osteoarthritis.

Methods: Databases (Embase, MEDLINE, Cochrane Central, CINAHL and PubMed) were searched for studies of gait interventions aimed at reducing medial knee joint load indicators for adults with medial knee osteoarthritis. Studies evaluating gait aids or orthoses were excluded. Hedges' g effect sizes (ES) before and after gait retraining were estimated for inclusion in quality-adjusted meta-analysis models. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results: Seventeen studies (k = 17; n = 362) included two randomised placebo-controlled trials (RCT), four randomised cross-over trials, two case studies and nine cohort studies. The studies consisted of gait strategies of ipsilateral trunk lean (k = 4, n = 73), toe-out (k = 6, n = 104), toe-in (k = 5, n = 89), medial knee thrust (k = 3, n = 61), medial weight transfer at the foot (k = 1, n = 10), wider steps (k = 1, n = 15) and external knee adduction moment (KAM) biofeedback (k = 3, n = 84). Meta-analyses found that ipsilateral trunk lean reduced early stance peak KAM (KAM1, ES and 95%CI: -0.67, -1.01 to -0.33) with a dose-response effect and reduced KAM impulse (-0.37, -0.70 to -0.04) immediately after single-session training. Toe-out had no effect on KAM1 but reduced late stance peak KAM (KAM2; -0.42, -0.73 to -0.11) immediately post-training for single-session, 10 or 16-week interventions. Toe-in reduced KAM1 (-0.51, -0.81 to -0.20) and increased KAM2 (0.44, 0.04 to 0.85) immediately post-training for single-session to 6-week interventions. Visual, verbal and haptic feedback was used to train gait strategies. Certainty of evidence was very-low to low according to the GRADE approach.

Conclusion: Very-low to low certainty of evidence suggests that there is a potential that ipsilateral trunk lean, toe-out, and toe-in to be clinically helpful to reduce indicators of medial knee joint load. There is yet little evidence for interventions over several weeks.

PubMed Disclaimer

Conflict of interest statement

There are no further conflicts of interest to disclose. All the competing interests are included. This does not alter our adherence to all PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. PRISMA flow diagram of study selection.
Fig 2
Fig 2
A. Effects of trunk lean on KAM1, B. KAM impulse. (TL: Trunk lean, KAM1: early stance phase peak external knee adduction moment, KAM impulse: external knee adduction moment impulse).
Fig 3
Fig 3
A. Effects of toe-out on KAM1, B. KAM impulse, C. KAM2, D. KFM1 (TO: Toe-out; KAM1: early stance phase peak external knee adduction moment, KAM impulse: external knee adduction moment impulse, KAM2: late stance phase peak external knee adduction moment, KFM1: early stance phase peak external knee flexion moment).
Fig 4
Fig 4
A. Effects of toe-in on KAM1, B. KAM2, C. KFM1 (TI: Toe-in, KAM1: early stance phase peak external knee adduction moment, KAM2: late stance phase peak external knee adduction moment, KFM1: early stance phase peak external knee flexion moment).
See this image and copyright information in PMC

References

    1. Ackerman IN, Pratt C, Gorelik A, Liew D. Projected Burden of Osteoarthritis and Rheumatoid Arthritis in Australia: A Population-Level Analysis. Arthritis Care Res (Hoboken). 2018;70(6):877–83. doi: 10.1002/acr.23414 - DOI - PubMed
    1. Hunter DJ, Nicolson PJA, Little CB, Robbins SR, Wang X, Bennell KL. Developing strategic priorities in osteoarthritis research: Proceedings and recommendations arising from the 2017 Australian Osteoarthritis Summit. BMC Musculoskelet Disord. 2019;20(1):74. doi: 10.1186/s12891-019-2455-x - DOI - PMC - PubMed
    1. Wise BL, Niu J, Yang M, Lane NE, Harvey W, Felson DT, et al. Patterns of compartment involvement in tibiofemoral osteoarthritis in men and women and whites and African Americans. Arthritis Care Res. 2012;64(6):847–52. - PMC - PubMed
    1. Hinman RS, Hunt MA, Simic M, Bennell KL. Exercise, Gait Retraining, Footwear and Insoles for Knee Osteoarthritis. Current Physical Medicine and Rehabilitation Reports. 2013;1(1):21–8.
    1. Miyazaki T, Wada M, Kawahara H, Sato M, Baba H, Shimada S. Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis. 2002;61(7):617–22. doi: 10.1136/ard.61.7.617 - DOI - PMC - PubMed