Systematic Review and Meta-Analysis
Does Gait Retraining Have the Potential to Reduce Medial Compartmental Loading in Individuals With Knee Osteoarthritis While Not Adversely Affecting the Other Lower Limb Joints? A Systematic Review

https://doi.org/10.1016/j.arrct.2019.100022Get rights and content
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Abstract

Objectives

To review the literature regarding gait retraining to reduce knee adduction moments and their effects on hip and ankle biomechanics.

Data Sources

Twelve academic databases were searched from inception to January 2019. Key words “walk*” OR “gait,” “knee” OR “adduction moment,” “osteoarthriti*” OR “arthriti*” OR “osteo arthriti*” OR “OA,” and “hip” OR “ankle” were combined with conjunction “and” in all fields.

Study Selection

Abstracts and full-text articles were assessed by 2 individuals against a predefined criterion.

Data Synthesis

Of the 11 studies, sample sizes varied from 8-40 participants. Eight different gait retraining styles were evaluated: hip internal rotation, lateral trunk lean, toe-in, toe-out, increased step width, medial thrust, contralateral pelvic drop, and medial foot weight transfer. Using the Black and Downs tool, the methodological quality of the included studies was fair to moderate ranging between 12 of 25 to 18 of 28. Trunk lean and medial thrust produced the biggest reductions in first peak knee adduction moment. Studies lacked collective sagittal and frontal plane hip and ankle joint biomechanics. Generally, studies had a low sample size of healthy participants with no osteoarthritis and assessed gait retraining during 1 laboratory visit while not documenting the difficulty of the gait retraining style.

Conclusions

Gait retraining techniques may reduce knee joint loading; however, the biomechanical effects to the pelvis, hip, and ankle is unknown, and there is a lack of understanding for the ease of application of the gait retraining styles.

Keywords

Gait
Osteoarthritis, knee
Rehabilitation
Systematic review

List of abbreviations

EHAM
external hip adduction moment
EKAM
external knee adduction moment
OA
osteoarthritis
SMD
standardized mean difference

Cited by (0)

Supported by the School of Engineering at Cardiff University in their commitment to the Biomechanics and Bioengineering Research Centre Versus Arthritis (BBRC VA) (Versus Arthritis [20781]) (PhD funding for Bowd). Funders were not involved with design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Disclosures: none

Clinical Trial Registration No.: CRD42018085738.