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

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Kinematic and Kinetic Gait Characteristics in People with Patellofemoral Pain: A Systematic Review and Meta-analysis
Sports Medicine ( IF 9.3 ) Pub Date : 2022-11-05 , DOI: 10.1007/s40279-022-01781-1
David M Bazett-Jones ₁ , Bradley S Neal _{2,

3} , Christopher Legg ₄ , Harvi F Hart ₅ , Natalie J Collins _{6,

7} , Christian J Barton _{7,

8}

Affiliation

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.

中文翻译：

髌股关节疼痛患者的运动学和动力学步态特征：系统评价和荟萃分析

背景

髌股关节疼痛 (PFP) 是一种普遍存在的膝关节疾病，有许多生物力学导向的病因和治疗方法。

客观的

我们的目的是系统地审查和综合 PFP 患者与无痛对照组相比在步行和跑步期间的生物力学变量（时空、运动学、动力学）的证据，并确定生物力学变量是否有助于 PFP 的发展。

设计

系统评价和荟萃分析。

数据源

我们搜索了 Medline、CINAHL、SPORTDiscus、Embase 和 Web of Science 从成立到 2021 年 10 月。

选择研究的资格标准

所有研究设计（前瞻性、病例对照 [± 干预成分，提供两组报告的干预前数据]、横断面研究）比较患有和/或患有糖尿病的人在步行和/或跑步期间的时空、运动学和/或动力学变量没有 PFP。

结果

我们确定了 55 项研究，涉及 1300 名 PFP 患者和 1393 名无痛对照者。总体汇总分析发现，PFP 患者的步态速度较慢 [中等证据，标准化均值差 (SMD) - 0.50，95% 置信区间 (CI) - 0.72，- 0.27]，节奏较低（有限证据，SMD - 0.43，95 % CI − 0.74, − 0.12)，和更短的步幅（有限证据，SMD − 0.46, 95% CI − 0.80, − 0.12）。PFP 患者的对侧骨盆下降峰值也更大（中等证据，SMD - 0.46，95% CI - 0.90，- 0.03），膝关节屈曲角度峰值较小（中等证据，SMD - 0.30，95% CI - 0.52，- 0.08）和更小的峰值膝关节伸展力矩（有限证据，SMD - 0.41, 95% CI - 0.75, - 0.07）与对照组相比。患有 PFP 的女性具有更大的髋关节屈曲峰值（中等证据，SMD 0.83, 95% CI 0.30, 1. 36) 和后足外翻（有限证据，SMD 0.59，95% CI 0.03，1.14）角度与无痛女性相比。对于所有其他生物力学变量，未发现显着的组间差异。前瞻性研究无法合并数据。