Browsing by Author "Hildebrand, Kevin"

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    Prescription of Specialized Footwear for Individuals with Knee Osteoarthritis
    (2016-02-02) Lewinson, Ryan; Stefanyshyn, Darren; Worobets, Jay; Herzog, Walter; Wiley, Preston; Schmidt, Tannin; Hildebrand, Kevin; Messier, Stephen
    Wedged footwear insoles can reduce peak knee adduction moments during gait, which are associated with knee osteoarthritis development and progression; however, randomized trials have been mixed in terms of wedged insole clinical efficacy. To address methodological and technical limitations of past studies, the purposes of this thesis were to (1) identify the most suitable footwear control condition, from a biomechanical perspective, (2) identify a method that can predict the effect of wedged insoles on resultant knee adduction moments, and (3) evaluate the effects of a reduced knee adduction moment intervention on clinical outcomes for individuals with knee osteoarthritis. In fifteen healthy individuals, three sham footwear conditions were compared against participant’s own footwear to determine if sham footwear were biomechanically inert. It was found that all three sham footwear conditions significantly altered biomechanical variables during gait, including the knee adduction moment, and thus participant’s own footwear was recommended as the best control condition, from a biomechanical perspective, for future clinical studies. In fifteen healthy and nineteen knee osteoarthritis participants, a method was discovered that utilizes two dimensional video data from a single stepping motion to predict the change in knee adduction moment induced by wedged insoles during walking. When compared to actual walking data, the method successfully identified the correct insole intervention for 12/15 healthy and 17/19 knee osteoarthritis individuals. It is hoped this method may be implemented into clinical settings for improved footwear prescription capability for individuals with knee osteoarthritis. Finally, a three month randomized trial was conducted. Biomechanical and clinical data were collected from 48 individuals with knee osteoarthritis at baseline, and participants were randomized to either an insole (knee adduction moment reduction) group, or a waitlist control group. At follow-up, no significant differences were noted between groups in terms of change in pain. Knee adduction moment reduction was not associated with reduced pain for the insole group. These data suggest that reduction of knee adduction moments do not confer a clinical benefit in the short term, but do not rule out the possibility that reduced moments are beneficial from a prevention standpoint, or for long term management.
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    Systematic review of economic evaluations investigating education, exercise, and dietary weight management to manage hip and knee osteoarthritis: protocol
    (2020-10-06) Mazzei, Darren R; Ademola, Ayoola; Abbott, J. H; Sajobi, Tolulpe; Hildebrand, Kevin; Marshall, Deborah A
    Abstract Background International guidelines recommend education, exercise, and dietary weight management as core treatments to manage osteoarthritis (OA) regardless of disease severity or co-morbidity. Evidence supports the clinical effectiveness of OA management programs, but the cost-effectiveness of core treatments remains unclear. We will systematically review, synthesize, and assess the literature in economic evaluations of core treatments (education, exercise, and dietary weight management) for the management of hip and/or knee OA. Methods We will search the following elecftronic databases (from inception onwards): MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), National Health Services Economic Evaluation Database, and EconLit. Economic evaluations alongside randomized or nonrandomized clinical trials investigating OA education, exercise, and dietary weight management interventions will be included. Title, abstract, and full text of relevant publications will be screened independently by two reviewers. A content matter expert will resolve any conflicts between two reviewers. Key information from relevant papers will be extracted and tabulated to provide an overview of the published literature. Methodological quality will be evaluated using the Consensus on Health Economic Criteria list. A narrative synthesis without meta-analysis will be conducted. Subgroup analysis will attempt to find trends between research methods, intervention characteristics, and results. Discussion The findings of this review will evaluate the breadth and quality of economic evaluations conducted alongside clinical trials for core treatments in OA management. Systematic review registration PROSPERO CRD42020155964
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    Use of a Glucocorticoid to Mitigate Post-Traumatic Osteoarthritis Development in the Ovine Knee
    (2017) Barton, Kristen; Hart, David; Shrive, Nigel; Fritzler, Marvin; Hildebrand, Kevin
    After knee ligament injury, specifically anterior cruciate ligament (ACL) injury, the articular surface frequently becomes damaged and can lead to post-traumatic osteoarthritis (PTOA). PTOA is a common joint disease and involves the breakdown of the cartilage that covers the ends of the articular joint-bone interface. PTOA development can be attributed to many factors, two of which may be altered kinematics and joint inflammation. Presently, no treatment options are effective in slowing PTOA progression. Therefore, it is crucial to better understand both joint biomechanics and inflammation. Further, studying interventions that have the potential to mitigate inflammation is necessary to find strategies that may prevent the damage from setting in. Therefore, the rationale for this thesis was to 1) determine if partial ACL (p-ACL) transection (Tx) model leads to PTOA (Project A), 2) determine if p-ACL Tx leads to kinematic alterations (Project B), and 3) determine if p-ACL Tx induced joint inflammation can be modified by glucocorticoid (GC) treatment (Project C). We hypothesized that early inflammation following p-ACL Tx in an ovine model would initiate degeneration of the knee joint and that methylprednisolone acetate (MPA; Depo-Medrol®) treatment would mitigate injury-related PTOA development. Furthermore, MPA would provide a mechanism of long-term prevention to joint damage by suppressing acute inflammation. The results showed that p-ACL Tx led to significantly more combined gross damage at 40 weeks post p-ACL Tx than the control group. There was considerable inter-subject variability following p-ACL knee injury within animals. There were consistent changes in medial-lateral, posterior-anterior, and inferior-superior translations at 40 weeks from intact to after p-ACL Tx. In normal explants, MPA treatment suppressed IL-1β induced mRNA levels for matrix metalloproteinases (MMPs) in articular cartilage, synovium, and infrapatellar fat pad (IPFP) and was found to be tissue-, location-, and gene-specific. Although the gross damage was not significant at 20 weeks post p-ACL Tx compared to the control group, there were trends indicating that the damage was progressive over time and that MPA mitigated gross damage at 20 weeks post p-ACL Tx. The in vivo 20 week studies provided efficacy to determine if we could detect changes early. However, perhaps a greater differential in PTOA damage is necessary to see an impact of GC treatment in a long- term model, comparable to that observed in the 40 weeks post p-ACL Tx group. Last, there were no significant bone changes at either the early 20 weeks post p-ACL Tx or the advanced 40 weeks post p-ACL Tx, compared to non-operative control tibias in any of the subchondral bone layers, thus suggesting the degree of joint instability (full ACL Tx vs. p-ACL Tx) appears to influence the response in bone microarchitecture.