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Clinical Orthopaedics and Related Research®

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Open Access 01-07-2010 | Clinical Research

Medial Knee Osteoarthritis Treated by Insoles or Braces: A Randomized Trial

Authors: Tom M. van Raaij, MD, PhD, Max Reijman, PhD, Reinoud W. Brouwer, MD, PhD, Sita M. A. Bierma-Zeinstra, PhD, Jan A. N. Verhaar, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 7/2010

Abstract

Background

There is controversial evidence regarding whether foot orthoses or knee braces improve pain and function or correct malalignment in selected patients with osteoarthritis (OA) of the medial knee compartment. However, insoles are safe and less costly than knee bracing if they relieve pain or improve function.

Questions/purposes

We therefore asked whether laterally wedged insoles or valgus braces would reduce pain, enhance functional scores, and correct varus malalignment comparable to knee braces.

Patients and Methods

We prospectively enrolled 91 patients with symptomatic medial compartmental knee OA and randomized to treatment with either a 10-mm laterally wedged insole (index group, n = 45) or a valgus brace (control group, n = 46). All patients were assessed at 6 months. The primary outcome measure was pain severity as measured on a visual analog scale. Secondary outcome measures were knee function score using WOMAC and correction of varus alignment on AP whole-leg radiographs taken with the patient in the standing position. Additionally, we compared the percentage of responders according to the OMERACT-OARSI criteria for both groups.

Results

We observed no differences in pain or WOMAC scores between the two groups. Neither device achieved correction of knee varus malalignment in the frontal plane. According to the OMERACT-OARSI criteria, 17% of our patients responded to the allocated intervention. Patients in the insole group complied better with their intervention. Although subgroup analysis results should be translated into practice cautiously, we observed a slightly higher percentage of responders for the insole compared with bracing for patients with mild medial OA.

Conclusions

Our data suggest a laterally wedged insole may be an alternative to valgus bracing for noninvasively treating symptoms of medial knee OA.

Level of Evidence

Level I, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

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Title: Medial Knee Osteoarthritis Treated by Insoles or Braces: A Randomized Trial
Authors: Tom M. van Raaij, MD, PhD
Max Reijman, PhD
Reinoud W. Brouwer, MD, PhD
Sita M. A. Bierma-Zeinstra, PhD
Jan A. N. Verhaar, MD, PhD
Publication date: 01-07-2010
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 7/2010
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-010-1274-z

At a glance: The STEP trials

Springer Medicine

Medial Knee Osteoarthritis Treated by Insoles or Braces: A Randomized Trial

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

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