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Lateral Wedge Insoles for Reducing Biomechanical Risk Factors for Medial Knee Osteoarthritis Progression: A Systematic Review and Meta‐Analysis
Author(s) -
Arnold John B.,
Wong Daniel X.,
Jones Richard K.,
Hill Catherine L.,
Thewlis Dominic
Publication year - 2016
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.22797
Subject(s) - medicine , osteoarthritis , meta analysis , confidence interval , physical therapy , wedge (geometry) , relative risk , strictly standardized mean difference , knee joint , orthodontics , surgery , pathology , physics , alternative medicine , optics
Objective Lateral wedge insoles are intended to reduce biomechanical risk factors of medial knee osteoarthritis (OA) progression, such as increased knee joint load; however, there has been no definitive consensus on this topic. The aim of this systematic review and meta‐analysis was to establish the within‐subject effects of lateral wedge insoles on knee joint load in people with medial knee OA during walking. Methods Six databases were searched from inception until February 13, 2015. Included studies reported on the immediate biomechanical effects of lateral wedge insoles during walking in people with medial knee OA. Primary outcomes of interest relating to the biomechanical risk of disease progression were the first and second peak external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI). Eligible studies were pooled using random‐effects meta‐analysis. Results Eighteen studies were included with a total of 534 participants. Lateral wedge insoles resulted in a small but statistically significant reduction in the first peak EKAM (standardized mean difference [SMD] −0.19; 95% confidence interval [95% CI] −0.23, −0.15) and second peak EKAM (SMD −0.25; 95% CI −0.32, −0.19) with a low level of heterogeneity (I 2 = 5% and 30%, respectively). There was a favorable but small reduction in the KAAI with lateral wedge insoles (SMD −0.14; 95% CI −0.21, −0.07, I 2 = 31%). Risk of methodologic bias scores (quality index) ranged from 8 to 13 out of 16. Conclusion Lateral wedge insoles cause small reductions in the EKAM and KAAI during walking in people with medial knee OA. Current evidence demonstrates that lateral wedge insoles appear ineffective at attenuating structural changes in people with medial knee OA as a whole and may be better suited to targeted use in biomechanical phenotypes associated with larger reductions in knee load.