OBJECTIVE: To determine whether knee sleeves can significantly improve the biomechanical variables for knee problems.

METHOD: Systematic literature search was conducted on four online databases - PubMed, Web of Science, ScienceDirect and Springer Link - to find peer-reviewed and relevant scientific papers on knee sleeves published from January 2005 to January 2015. Study quality was assessed using the Structured Effectiveness Quality Evaluation Scale (SEQES).

RESULTS: Twenty studies on knee sleeves usage identified from the search were included in the review because of their heterogeneous scope of coverage. Twelve studies found significant improvement in gait parameters (3) and functional parameters (9), while eight studies did not find any significant effects of knee sleeves usage.

METHODS: This study will include only RCTs published in peer-reviewed journals. A systematic search will be conducted in several electronic databases and other relevant online resources. No limitations are imposed on language or publication date. Participants must be explicitly identified by authors as having OA. Interventions that involved exercise or comparators in any form will be included. Pain is the primary outcome of interest; secondary outcomes will include function and quality of life measures. Quality assessment of studies will be based on the modified Cochrane's risk of bias assessment tool. At least two investigators will be involved throughout all stages of screening and data acquisition. Conflicts will be resolved through discussion. Conventional meta-analysis will be performed based on random effects model and network meta-analysis on a Bayesian model. Subgroup analysis will also be conducted based on study, patient and disease characteristics.

DISCUSSION: This study will provide for the first time comprehensive research evidence for the relative efficacy of different exercise regimens for treatment of OA. We will use network meta-analysis of existing RCT data to answer this question.

METHODS: A parallel-group unblinded randomized controlled trial involving 300 patients was conducted in two hospital orthopedics clinics in Malaysia. Patients were randomly assigned to receive cognitive behavioral-based group therapy (n = 150) or no further intervention (n = 150). The primary outcome was the change from baseline in knee pain as determined by the Knee injury and Osteoarthritis Outcome Score (KOOS) at 6 months. The data collected were analyzed by covariate-adjusted mixed design repeated measures analysis of variance. All analyses were performed under the terms of intention-to-treat.

RESULTS: At 6 months, mean change from baseline in the KOOS knee pain score was 0.6 points (95% CI -1.73 to 2.94) in the control group and 8.9 points (95% CI 6.62 to 11.23) (denoting less knee pain intensity) in the intervention group (significant treatment effect p < 0.0001). Patients treated with such an approach also experienced significant improvement in functional ability when performing activities of daily living and had improved ability to cope with depression, anxiety and pain catastrophizing.

OBJECTIVES:: To test the hypothesis that toe-out gait will reduce second peak knee adduction moment further and increase fall risk when combined with knee brace and laterally wedged insole in knee osteoarthritis patients.

STUDY DESIGN:: Single visit study with repeated measures.

METHODS:: First and second peak knee adduction moments, fall risk and comfort level. First and second peak knee adduction moments were determined from three-dimensional gait analysis, completed under six randomized conditions: (1) natural, (2) knee brace, (3) knee brace + toe-out gait, (4) laterally wedged insole, (5) laterally wedged insole + toe-out gait, and (6) knee brace + laterally wedged insole + toe-out gait. Fall risk was assessed by Biodex Balance System using three randomized stability settings: (1) static, (2) moderate dynamic setting (FR12), and (3) high dynamic setting (FR8).

RESULTS:: The reduction in first peak knee adduction moment and second peak knee adduction moment was greatest (7.16% and 25.55%, respectively) when toe-out gait combine with knee brace and laterally wedged insole. Significant increase in fall risk was observed with knee brace + laterally wedged insole + toe-out gait (42.85%) at FR12. Similar significant balance reductions were found at FR8 condition for knee brace + toe-out gait (35.71%), laterally wedged insole + toe-out gait (28.57%), and knee brace + laterally wedged insole + toe-out gait (50%) as compared to natural. However, knee brace decreased fall risk at FR12 by 28.57%.

CONCLUSION:: There is a synergistic effect of toe-out when combined with knee brace and laterally wedged insole concurrently in second peak knee adduction moment reduction but with a greater degree of fall risk. Simultaneous use of conservative treatments also decreases comfort level.

METHODS: Osteoarthritis was induced at the right knee of sheep by complete resection of ACL and medial meniscus. Stem cells from sheep were induced to chondrogenic lineage. Test sheep received 5 mls single doses of 2 × 107 autologous PKH26-labelled ADSCs or BMSCs, while controls received basal medium. Functional recovery of the knees was evaluated via electromyography.

RESULTS: Induced ADSCs had 625, 255, 393, 908, 409, 157 and 1062 folds increases of collagen I, collagen II, aggrecan, SOX9, cartilage oligomeric protein, chondroadherin and fibromodullin compare to uninduced cells, while BMSCs had 702, 657, 321, 276, 337, 233 and 1163 respectively; p = .001. Immunocytochemistry was positive for these chondrogenic markers. 12 months post-treatment, controls scored 4 in most regions using ICRS, while the treated had 8; P = .001. Regenerated cartilages were positive to PKH26 and demonstrated the presence of condensing cartilages on haematoxylin and eosin; and Safranin O. OA degenerations caused significant amplitude shift from right to left hind limb. After treatments, controls persisted with significant decreases; while treated samples regained balance.