Does Gait Retraining Have the Potential to Reduce Medial Compartmental Loading in Individuals With Knee Osteoarthritis While Not Adversely Affecting the Other Lower Limb Joints? A Systematic Review

Objectives: To review the literature regarding gait retraining to reduce knee adduc-tion moments and their 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 2 individuals against a pre-defined criterion. Data Synthesis: 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 of 25 to 18 of 28. Trunk lean and medial thrust pro-duced 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 with no osteoarthritis and assessed gait retraining during 1 laboratory visit while not documenting the difficulty of the gait retraining style. Conclusions: Gait retraining techniques may reduce knee joint loading; however, the biome-chanical effects to the pelvis, hip, and ankle is unknown, and there is a lack of understanding for the ease of application of the gait retraining styles. Crown Copyright 2019 Published by Elsevier Inc on behalf of the American Congress of Reha-bilitation Medicine. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).