Does gait retraining have the potential to reduce medial compartmental loading in individuals with knee osteoarthritis whilst not adversely affecting the other lower limb joints? A systematic review

Abstract Objectives To review the literature regarding gait retraining to reduce knee adduction moments and its 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 two individuals against a pre-defined criterion. Data synthesis Out 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 12/25 to 18/28. 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 and assessed gait retraining during one laboratory visit, whilst 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, as well as a lack of understanding for the ease of application of the gait retraining styles.