For an overview of the options available to people with unicompartmental and bicompartmental knee osteoarthritis, see the July 2005 article What's New in Adult Reconstructive Knee Surgery, by Archibeck et al., in the Total Knee Replacement/Arthroplasty (TKR/TKA) Subsection.

The Effect of Wedged Insoles on the Lateral Thrust of Anterior Cruciate Ligament-Insufficient Knees, Ichiro Yoshimura et al.; The American Journal of Sports Medicine, Baltimore; November 2003, Vol 31, p. 999-1002.Comments: This article describes an intriguing concept: instead of costly OA braces, simply put a wedge-shaped insole (in this case, a lateral-wedge one) in the shoe. The Discussion section of this article is absolutely superb and very insightful, since it describes the effect of ACL rupture on knee biomechanics -- and thus it enunciates points which are highly relevant to anyone with any ACL-injury history (irrespective of whether accompanied by osteoarthritic changes). The authors note that, when the ACL is fully torn, the tensile stresses in the lateral structures increase five-fold. This causes them to stretch out, and is a major reason why prompt reconstruction of a fully torn ACL is very wise. The abnormal stress distribution also means osteoarthritic changes in the articular cartilage can be expected, particularly if meniscal damage is also present. Keep in mind that ACL-tearing incidents are almost invariably accompanied by ancillary damage such as meniscal tearing, articular-cartilage damage via bone-bruising, or both. So, clearly, delaying the reconstruction means more long-term problems. The authors also note that the ACL functions as a secondary restraint to varus-valgus torque, and thus assists the collateral ligaments (MCL and LCL), especially at full extension. With all these aspects in mind, using lateral-wedge-shaped insoles to redistribute these loadings in an ACL-deficient-and-subsequently-osteoarthritic knee intuitively makes sense, and the authors describe their findings. Note that similar biomechanical advantages can be obtained by using a sideways-forcing osteoarthritis-type knee brace. Additionally, such a brace, if well-designed, would provide protection against injurious sideways forcing and hyperextension (just like a standard functional brace does). Such protection is extremely desirable for an ACL-deficient knees in particular, but is not available with shoe-insert wedges. Also, keep in mind that shoe-insert wedges must act through the ankle; such forcing could eventually result in problems in the ankle joints. Keep in mind that shoe-insert wedges might increase the risk of ankle injuries. These wedges would also cause accelerated wear at the edges of one's shoe soles, which could result in the user having to repair or replace his/her shoes frequently.

Women's shoes and knee osteoarthritis, D. Casey Kerrigan; The Lancet; April 2001, Vol 357, p.1097-1098.Kerrigan et al., in following up on their 1998 study, found that wider high heels do not decrease the worrisomely high forces across the knee. While a wider heel does decrease the risk of ankle inversion and eversion injuries, it does not reduce the osteoarthritis concerns of high heels in general. Once again, it is clear that high-heeled footwear is extremely anathematical to the knee, and therefore is wholly incompatible with long-term orthopedic health. Concerns are amplified if the knee harbours any history of ligamentous injuries, articular-cartilage damage, or meniscal injuries (even if surgical rectification and diligent rehabilitation of said injuries has been pursued).

Lower-limb function among former elite male athletes, Jyrki A. Kettunen; The American Journal of Sports Medicine, Baltimore; Jan/Feb 2001, Vol 29/1, p. 2.Comments: This article provides a good overview of the long-term consequences of orthopedic injuries, in particular knee injuries.

Knee Joint Torques: A Comparison Between Women and Men During Barefoot Walking, D. Casey Kerrigan; Archives of Physical Medicine and Rehabilitation; September 2000, Vol 81, p.1162-1165.Comments: Kerrigan et al. found that women and men have very similar intrinsic biomechanical risks for knee osteoarthritis (where "intrinsic" is defined as being an inherent function of anatomy and physiology, and in practice is measured via barefoot walking). The authors astutely note that women are nearly twice as likely to develop knee osteoarthritis, and end up undergoing twice as many total knee replacement surgeries (arthroplasties). The major cause of this staggeringly huge spike in female osteoarthritis appears to be the widespread wearing of high-heeled footwear. However, the authors note, in the discussion section, that myriad other factors should also be borne in mind. (Note that females are also 2-8 times as likely to incur ACL tearing, in particular in the context of cutting-type [plant-and-twist] sports such as soccer and basketball. These factors are separate from the high-heeled footwear issue, since the female-ACL issue become apparent only rather recently, as female participation in knee-demanding sports skyrocketed starting in about the 1980s. Therefore, osteoarthritis in females arising as a direct consequence of ACL injuries has, as of 2000, not started to generate a pronounced need for total knee replacements. For this reason, it is unlikely that any of the total knee replacements referred to by Kerrigan in this 2000 study would be attributable to ACL injuries. This leaves high-heeled footwear as the most logical explanation for the markedly higher rate of total knee replacements in females, as compared to males. Further discussion on the effects of high heels can be found in two other articles by Kerrigan et al.: Kerrigan-TL-May98.shtml and Kerrigan-TL-Apr01.shtml.)

Knee osteoarthritis and high-heeled shoes, D Casey Kerrigan et al.; The Lancet; May 1998, Vol 351, p.1399-1401.Comments: This article shows that the use of high-heeled footwear predisposes the person to knee osteoarthritis. Kerrigan et al. found that the torque (twisting force) at the knee, in particular varus-directed (i.e. outwards in the coronal/frontal plane), increases when high heels are worn. So, the forces across the knee are higher when the fashion-minded person is teetering around on high heels. Additionally, note that the use of high heels tends to disable the arch of the foot; and the arch serves to absorb the shock of each footfall. The result is that the shock of each step is transmitted directly to the knee. (The strident "clop-clop-clop" sound of walking around in high heels is mechanically very similar to the "bang-bang-bang" of a carpenter's hammer. A person walking around in high heels is literally pounding on her knees in much the same way as a carpenter pounds in a nail.) These concerns are in addition to all the other biomechanical concerns generated by high-heeled footwear use, including the medial-compartment pressure increase resulting from the aforementioned varus torquing of the knee. Additionally, if the knee harbours any existing ligament-injury or cartilage-injury history, for example acute sports injuries or acute work injuries, then the concerns will be even greater.

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