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  • Review Article
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Conservative biomechanical strategies for knee osteoarthritis

Nature Reviews Rheumatology volume 7, pages 113–122 (2011)Cite this article

Subjects

Abstract

Knee osteoarthritis (OA) is one of the most prevalent forms of this disease, with the medial compartment most commonly affected. The direction of external forces and limb orientation during walking results in an adduction moment that acts around the knee, and this parameter is regarded as a surrogate measure of medial knee compression. The knee adduction moment is intimately linked with the development and progression of knee OA and is, therefore, a target for conservative biomechanical intervention strategies, which are the focus of this Review. We examine the evidence for walking barefoot and the use of lateral wedge insoles and thin-soled, flexible shoes to reduce the knee adduction moment in patients with OA. We review strategies that directly affect the gait, such as walking with the foot externally rotated ('toe-out gait'), using a cane, lateral trunk sway and gait retraining. Valgus knee braces and muscle strengthening are also discussed for their effect upon reducing the knee adduction moment.

Key Points

  • Knee osteoarthritis (OA) is closely associated with the development of a high external knee adduction moment, which reflects compression of the medial compartment of the knee

  • The nature of biomechanical loading at the knee joint can be altered by a number of conservative intervention strategies, which are potentially capable of slowing the progression of the disease

  • Using lateral wedge insoles or thin-soled, flexible shoes can reduce the knee adduction moment and thus contribute to retarding the progression of OA

  • Strategies that directly modify gait characteristics, such as a toe-out gait, lateral trunk lean and the use of a walking stick, can reduce the knee adduction moment

  • Intervention strategies that act either directly or indirectly upon the knee joint, such as valgus knee braces and muscle strengthening, can effectively decrease the knee adduction moment

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Figure 1: The external knee adduction moment during walking.
Figure 2: Schematic representation of the knee adduction moment profile during walking showing the characteristic double peak associated with the stance phase.
Figure 3: Schematic diagram illustrating the 'toe-out' gait.
Figure 4: Schematic diagram illustrating how valgus bracing counteracts the external adduction moment acting about the knee during walking.

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Acknowledgements

C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Institute for Biomedical Research into Human Movement & Health, School of Healthcare Science, Faculty of Science & Engineering, Manchester Metropolitan University, John Dalton Building E216, Oxford Road, Manchester, M1 5GD, UK

    Neil D. Reeves

  2. Faculty of Medical & Human Sciences, University of Manchester, Oxford Road, Manchester, M13 9WL, UK

    Frank L. Bowling

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N. D. Reeves and F. L. Bowling contributed equally to researching the data for the article, to discussions of the content and to reviewing and/or editing of the manuscript before submission. N. D. Reeves provided a substantial contribution to writing the article.

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Reeves, N., Bowling, F. Conservative biomechanical strategies for knee osteoarthritis. Nat Rev Rheumatol 7, 113–122 (2011). https://doi.org/10.1038/nrrheum.2010.212

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