title: Does knee malalignment predict the efficacy of realignment therapy for patients with knee osteoarthritis?
abstract: BACKGROUND
  Realignment therapies, including knee braces, foot orthoses and shoes are prescribed to patients with medial knee osteoarthritis (OA) with the goal of unloading the medial tibiofemoral (TF) compartment. It is uncertain whether realignment therapies have different effects in those with knee malalignment. We studied whether the efficacy of realignment therapy for pain and function in persons with medial TF OA is predicted by the severity of the baseline knee malalignment.
  
  
  METHODS
  The baseline characteristics of 48 participants with moderate to severe medial knee OA were collected. Participants' pain and function were measured using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale before and after 12 weeks of realignment therapy using a valgus unloader knee brace plus bilateral neutral foot orthoses and motion control shoes. Anatomical axis (AA) was measured on weight-bearing knee radiographs by a blinded reader and knee malalignment was categorized as either varus malaligned (moderate or severe) or neutral according to the AA angle. We assessed for differences in response to treatment according to alignment category. General linear statistical models were generated to determine which of the measured alignment variables and covariates predicted change in the pain outcome.
  
  
  RESULTS
  Anatomical axis knee alignment was not a significant predictor of pain or function change with active treatment. Baseline WOMAC scores were the best predictor of change in WOMAC (P < 0.01 and P = 0.06 for pain and function, respectively).
  
  
  CONCLUSIONS
  Baseline knee alignment did not predict the efficacy of 12 weeks realignment therapy in participants with medial tibiofemoral OA. [Correction added on 27 August 2015, after first online publication: 'did predict' has been corrected to 'did not predict' in the conclusions of the abstract section.].
authors.affiliation: Musculoskeletal Research Center, Department of Physical Therapy, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.|Kolling Institute, The University of Sydney, Sydney, NSW, Australia.|Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia.
authors.forename: Zahra Sadat
authors.initials: ZS
authors.lastname: Rezaeian
authors.affiliation: Raymond Purves Research Laboratories, Royal North Shore Hospital, Sydney, NSW, Australia.
authors.forename: Margaret Mary
authors.initials: MM
authors.lastname: Smith
authors.affiliation: Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Tyler L
authors.initials: TL
authors.lastname: Skaife
authors.affiliation: Tufts Medical Center, Boston, MA, USA.
authors.forename: William F
authors.initials: WF
authors.lastname: Harvey
authors.affiliation: MGH Institute of Health Professions, Boston, MA, USA.
authors.forename: Kevin Douglas
authors.initials: KD
authors.lastname: Gross
authors.affiliation: Kolling Institute, The University of Sydney, Sydney, NSW, Australia.|Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia.
authors.forename: David John
authors.initials: DJ
authors.lastname: Hunter
mesh_terms: D000368:Aged; D018771:Arthralgia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D001696:Biomechanical Phenomena; D017760:Bone Malalignment / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D001915:Braces; D016009:Chi-Square Distribution; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004867:Equipment Design; D005260:Female; D061826:Foot Orthoses; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009989:Orthotic Devices; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D010147:Pain Measurement; D020127:Recovery of Function; D012720:Severity of Illness Index; D012775:Shoes; D013997:Time Factors; D016896:Treatment Outcome; D016474:Weight-Bearing
keywords: alignment; bracing; osteoarthritis