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Kinematic and Kinetic Gait Characteristics in People with Patellofemoral Pain: A Systematic Review and Meta-analysis

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Abstract

Background

Patellofemoral pain (PFP) is a prevalent knee condition with many proposed biomechanically orientated etiological factors and treatments.

Objective

We aimed to systematically review and synthesize the evidence for biomechanical variables (spatiotemporal, kinematic, kinetic) during walking and running in people with PFP compared with pain-free controls, and determine if biomechanical variables contribute to the development of PFP.

Design

Systematic review and meta-analysis.

Data sources

We searched Medline, CINAHL, SPORTDiscus, Embase, and Web of Science from inception to October 2021.

Eligibility criteria for selecting studies

All study designs (prospective, case–control [± interventional component, provided pre-intervention data were reported for both groups], cross-sectional) comparing spatiotemporal, kinematic, and/or kinetic variables during walking and/or running between people with and without PFP.

Results

We identified 55 studies involving 1300 people with PFP and 1393 pain-free controls. Overall pooled analysis identified that people with PFP had slower gait velocity [moderate evidence, standardized mean difference (SMD) − 0.50, 95% confidence interval (CI) − 0.72, − 0.27], lower cadence (limited evidence, SMD − 0.43, 95% CI − 0.74, − 0.12), and shorter stride length (limited evidence, SMD − 0.46, 95% CI − 0.80, − 0.12). People with PFP also had greater peak contralateral pelvic drop (moderate evidence, SMD − 0.46, 95% CI − 0.90, − 0.03), smaller peak knee flexion angles (moderate evidence, SMD − 0.30, 95% CI − 0.52, − 0.08), and smaller peak knee extension moments (limited evidence, SMD − 0.41, 95% CI − 0.75, − 0.07) compared with controls. Females with PFP had greater peak hip flexion (moderate evidence, SMD 0.83, 95% CI 0.30, 1.36) and rearfoot eversion (limited evidence, SMD 0.59, 95% CI 0.03, 1.14) angles compared to pain-free females. No significant between-group differences were identified for all other biomechanical variables. Data pooling was not possible for prospective studies.

Conclusion

A limited number of biomechanical differences exist when comparing people with and without PFP, mostly characterized by small-to-moderate effect sizes. People with PFP ambulate slower, with lower cadence and a shortened stride length, greater contralateral pelvic drop, and lower knee flexion angles and knee extension moments. It is unclear whether these features are present prior to PFP onset or occur as pain-compensatory movement strategies given the lack of prospective data.

Trial Registration

PROSPERO # CRD42019080241.

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Acknowledgements

The authors would like to thank the following contributors: Gerald Natal, MLIS, AHIP, and Jodi Jameson, MLIS, AHIP, Librarians at the University of Toledo, for performing the literature search for this systematic review; Ms. Marina Waiteman, MS, PT, for her assistance with data management; and Drs. Michael Rainbow, PhD, Mitchell Wheatley, PhD, and Paul DeVita, PhD, for their review of the biomechanics reporting checklist.

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Authors and Affiliations

  1. Department of Exercise and Rehabilitation Sciences, The University of Toledo, Toledo, OH, USA

    David M. Bazett-Jones

  2. School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, Essex, UK

    Bradley S. Neal

  3. Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK

    Bradley S. Neal

  4. Physiotherapy Department, Prince of Wales Hospital, Sydney, NSW, Australia

    Christopher Legg

  5. School of Physical Therapy and Bone and Joint Institute, Western University, London, ON, Canada

    Harvi F. Hart

  6. School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia

    Natalie J. Collins

  7. La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, VIC, Australia

    Natalie J. Collins & Christian J. Barton

  8. Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia

    Christian J. Barton

Authors
  1. David M. Bazett-Jones
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  2. Bradley S. Neal
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  3. Christopher Legg
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  4. Harvi F. Hart
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  5. Natalie J. Collins
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  6. Christian J. Barton
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Corresponding author

Correspondence to David M. Bazett-Jones.

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Funding

This study was not funded.

Conflicts of interest/competing interests

David Bazett-Jones, Bradley Neal, Christopher Legg, Harvi Hart, Natalie Collins and Christian Barton have no conflicts of interest to report.

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Data are available upon request.

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Author contributions

According to the definition given by the International Committee of Medical Journal Editors (ICMJE), the authors listed qualify for authorship based on making one or more of the substantial contributions to the intellectual content of: conception and design (DBJ, BN, CB); and/or acquisition of data (CL); and/or analysis and interpretation of data (DBJ, BN, CL, HH, NC, CB); and/or participated in drafting of the manuscript (DBJ, BN); and/or critical revision of the manuscript for important intellectual content (DBJ, BN, HH, NC, CB); and all authors read and approved the final manuscript.

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Bazett-Jones, D.M., Neal, B.S., Legg, C. et al. Kinematic and Kinetic Gait Characteristics in People with Patellofemoral Pain: A Systematic Review and Meta-analysis. Sports Med 53, 519–547 (2023). https://doi.org/10.1007/s40279-022-01781-1

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