Off-axis biomechanical alterations and related interventions in medial knee osteoarthritis: a mini review.

This is a narrative review, not a systematic review or meta-analysis, so the selection of studies may be subject to author bias. Most cited studies measure outcomes during gait or weight-bearing tasks without differentiating between structural malalignment and functional movement dysfunction, which limits the ability to target interventions precisely. There is a lack of high-quality, long-term randomized controlled trials confirming whether these interventions alter structural disease progression or ensure long-term adherence. The review notes that hip abductor strengthening improves symptoms, but the hypothesized biomechanical mechanism (reducing external knee loads) is not supported by current evidence.

The authors declared that financial support was received from the National Institute on Disability, Independent Living, and Rehabilitation Research.

Do not assume that hip abductor strengthening works by mechanically reducing the external knee adduction moment, as the review states this hypothesized mechanism is not supported by current evidence. Additionally, do not expect lateral wedge insoles to provide consistent pain relief, as their effectiveness is described as not affirmative and likely limited to a specific subset of patients.