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Trial of Realignment Therapy for Treatment of Medial Knee Osteoarthritis

This study has been completed.
Information provided by:
Boston University Identifier:
First received: July 26, 2005
Last updated: January 28, 2009
Last verified: January 2009

The overall objective of this 3-year project is to determine whether the provision of realignment therapy in patients with medial knee osteoarthritis (OA) relieves knee pain and improves function. The researchers will test the hypothesis that compared to control treatment, the use of realignment therapy (valgus knee brace + motion control shoes + orthosis) is effective in medial knee OA.

The specific aims are:

  • To undertake a 30 week randomized crossover clinical trial in patients with medial knee osteoarthritis to determine whether provision of realignment therapy leads to lower pain scores and improved function during the time of this treatment than during the use of a placebo treatment;
  • To perform an open label follow-up study to track use and effectiveness of treatment. This project will be co-funded by DonJoy Orthopedic, a knee bracing company.

Condition Intervention
Knee Osteoarthritis Device: Brace and Shoe Insert Device: Knee brace and shoe insert

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double Blind (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Randomized Trial of Realignment Therapy for Treatment of Medial Knee Osteoarthritis

Resource links provided by NLM:

Further study details as provided by Boston University:

Primary Outcome Measures:
  • Western Ontario and McMaster Osteoarthritis Index (WOMAC) Pain and Function Subscales (Most symptomatic treated knee) [ Time Frame: 12 weeks ]

Secondary Outcome Measures:
  • WOMAC Stiffness Subscale [ Time Frame: 12 weeks ]
  • Knee Injury and Osteoarthritis Outcome Score [ Time Frame: 12 weeks ]
  • Patient Global Assessment [ Time Frame: 12 weeks ]
  • Overall Knee Pain Visual Analogue Scale (V.A.S.) (Knee specific) [ Time Frame: 12 weeks ]
  • SF36 [ Time Frame: 12 weeks ]
  • Analgesic use (Medication log) [ Time Frame: 12 weeks ]
  • Blinded knee exam by physician [ Time Frame: 12 weeks ]
  • Physician Global Assessment [ Time Frame: 12 weeks ]
  • Functional performance measures [ Time Frame: 12 weeks ]
  • Proprioception [ Time Frame: 12 weeks ]

Enrollment: 80
Study Start Date: March 2008
Study Completion Date: November 2008
Primary Completion Date: November 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1 Device: Brace and Shoe Insert
Realigning Knee brace and custom orthodic
Placebo Comparator: 2 Device: Knee brace and shoe insert
Non realigning knee brace and flat orthodic


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Trial participants must meet American College of Rheumatology (ACR) criteria for osteoarthritis with knee pain, aching or stiffness on most of the past 30 days and evidence on radiograph of a definite osteophyte. In addition, because the researchers are interested in recruiting persons with medial knee osteoarthritis, participants will need to have evidence of disease in this compartment on their radiographs, and not have lateral compartment or patellofemoral compartment disease. Medial disease is based on definitions used in the researcher's previous publications as definite radiographic OA + at least grade 1 medial narrowing (0-3 scale) using an atlas from the Osteoarthritis Research Society International.

Exclusion Criteria:

  • Individuals with clinical evidence of patellofemoral disease or knee pathology (other than medial compartment OA) likely to be causing their knee pain.
  • Individuals who usually use an ambulation aid to walk such as a cane, crutch, walker or wheel chair.
  • Amputation of foot or previous major trauma to foot that would raise concerns about whether an insert might worsen foot pain. Persons with foot lesions such as sores or ulcers in which redistributing load in the foot might be dangerous, will be excluded.
  • Known neuropathy from diabetes or for other reasons.
  • Past history of deep venous thrombosis.
  • Pain emanating more from back or hip than from knee as determined by screening questionnaire
  • Low pain score on WOMAC, a widely used and well validated questionnaire to assess knee symptoms. To evaluate response, the researchers will require that patients have a minimal score of at least 4 out of 10 on at least 2 of 5 questions, or a total of greater than 15 out of 50 for the WOMAC pain scale in the eligible knee at pre-randomization phone call and visit, and at randomization visit. This will allow us to detect response to treatment if response occurs.
  • Planning to move from area within 9 months of study screening
  • Symptomatic comorbid disease limits walking more than knee pain (per screening questionnaire)
  • Receiving corticosteroid injections in the month prior to starting the trial. No other treatments will trigger exclusion, although for patients who have been on glucosamine +/or chondroitin +/or nonsteroidal anti-inflammatory drug (NSAID) the researchers will require that they must have taken these treatments for at least 2 months prior to onset of trial and to commit to not start a new treatment throughout the trial.
  • Bilateral total knee replacements (TKR) or plan for TKR in next 6 months for affected knee.
  • Known other causes of arthritis including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), gout, psoriatic arthritis, pseudogout.
  • Failure to pass 4 week run-in test.
  • Volunteers in a pre-contemplative state (persons who would not consider realignment therapy as a therapeutic option for their knee OA).
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00124462

United States, Massachusetts
Boston University, School of Medicine
Boston, Massachusetts, United States, 02118
Sponsors and Collaborators
Boston University
Principal Investigator: David J Hunter Boston University
  More Information

Responsible Party: David Hunter, BU School of Medicine Identifier: NCT00124462     History of Changes
Other Study ID Numbers: 84.133G-1
Study First Received: July 26, 2005
Last Updated: January 28, 2009

Additional relevant MeSH terms:
Osteoarthritis, Knee
Joint Diseases
Musculoskeletal Diseases
Rheumatic Diseases processed this record on June 22, 2017