Methods for Improving Ability to Investigate the Effectiveness of Non-Invasive Treatment Strategies for Medial Knee OA

Osteoarthritis (OA) is the most common form of arthritis, occurring frequently in the medial compartment of the knee. As the onset and progression of medial knee OA has been associated with abnormal and excessive loading of the joint, non-invasive treatment options often focus on joint load reduction to slow the progression of the disease. However, a need persists for further development of methods for analysing the effectiveness of existing and potential treatment strategies.

Unloader braces are one common form of treatment for knee OA, which primarily function by applying a moment at the knee to reduce loading and increase joint separation in the medial compartment. We developed a novel method based on measuring brace deflection using motion capture techniques to estimate the mechanical effect of valgus braces. Brace moments computed using the motion capture method for three subjects during static and walking trials were validated using strain gauge instrumentation.

A second, promising treatment option we explored was biofeedback-assisted gait retraining, which uses live feedback to guide subjects towards an optimal and novel gait pattern that lessens medial compartment loads. We developed a biofeedback system that uses real-time kinematic and kinetic input measures to provide a live estimate of knee joint loading using a statistical regression model. By using a large group of training subjects with a variety of gait styles to generate the regression model, the system that was developed can provide feedback of an estimate of the joint contact forces in the knee for a variety of gait patterns.

In summary, we developed (1) a method for measuring the mechanical effect of valgus bracing and (2) a biofeedback system that can be used in gait retraining to provide live feedback of an estimate of knee joint loads. These developments will provide us with the ability to further investigate the effectiveness of these non-invasive strategies for treating medial knee osteoarthritis. In doing so, we will be able to continue developing these treatment options towards providing more pain relief and improvements in function for a larger group of individuals with knee OA, potentially delaying or preventing the need for surgical interventions.

Year	Entry
1977	Andriacchi TP, Ogle IJA, Galante JO. Walking speed as a basis for normal and abnormal gait measurements. J Biomech. 1977;10(4):261-268.
2007	Delp SL, Anderson FC, Arnold AS, Loan P, Habib A, John CT, Guendelman E, Thelen DG. OpenSim: open-source software to create and analyze dynamic simulations of movement. IEEE Trans Biomed Eng. November 2007;54(11):1940-1950.
2010	Arnold EM, Ward SR, Lieber RL, Delp SL. A model of the lower limb for analysis of human movement. Ann Biomed Eng. February 2010;38(2):269-279.
2005	Wu G, van der Helm FCT, Veeger HEJ, Makhsous M, Van Roy P, Anglin C, Nagels J, Karduna AR, McQuade K, Wang X, Werner FW, Buchholz B. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion, II: shoulder, elbow, wrist and hand. J Biomech. May 2005;38(5):981-992.
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Year

Entry

1977

Andriacchi TP, Ogle IJA, Galante JO. Walking speed as a basis for normal and abnormal gait measurements. J Biomech. 1977;10(4):261-268.

2007

Delp SL, Anderson FC, Arnold AS, Loan P, Habib A, John CT, Guendelman E, Thelen DG. OpenSim: open-source software to create and analyze dynamic simulations of movement. IEEE Trans Biomed Eng. November 2007;54(11):1940-1950.

2010

Arnold EM, Ward SR, Lieber RL, Delp SL. A model of the lower limb for analysis of human movement. Ann Biomed Eng. February 2010;38(2):269-279.

2005

Wu G, van der Helm FCT, Veeger HEJ, Makhsous M, Van Roy P, Anglin C, Nagels J, Karduna AR, McQuade K, Wang X, Werner FW, Buchholz B. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion, II: shoulder, elbow, wrist and hand. J Biomech. May 2005;38(5):981-992.

1990

Hoy MG, Zajac FE, Gordon ME. A musculoskeletal model of the human lower extremity: the effect of muscle, tendon, and moment arm on the moment-angle relationship of musculotendon actuators at the hip, knee, and ankle. J Biomech. 1990;23(2):157-169.