University of Groningen, University Medical Center Groningen, Department of Sports and Exercise Medicine, The Netherlands.
University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands.
Gait Posture. 2019 Mar;69:13-24. doi: 10.1016/j.gaitpost.2019.01.011. Epub 2019 Jan 11.
Abnormal kinematics have been implicated as one of the major risk factors for lower limb tendinopathy (LLT).
To systematically review evidence for kinematic risk factors for LLT in runners.
Individual electronic searches in PubMed, EMBASE and Web of Science were conducted. Two reviewers screened studies to identify observational studies reporting kinematic risk factors in runners with LLT compared to healthy controls. The Down and Black appraisal scale was applied to assess quality. A meta-analysis was performed provided that at least two studies with similar methodology reported the same factor.
Twenty-eight studies were included: Achilles tendinopathy (AT) (9), iliotibial band syndrome (ITBS) (17), plantar fasciopathy (PF) (2), patellar tendinopathy (PT) (1), posterior tibial tendon dysfunction (PTTD) (1). Eighteen studies were rated high-quality and ten medium-quality. The meta-analyses revealed strong evidence of higher peak knee internal rotation, moderate evidence of lower peak rearfoot eversion and knee flexion at heel strike and greater peak hip adduction in runners with ITBS. Very limited evidence revealed higher peak ankle eversion in runners with PF and PTTD or higher peak hip adduction in PT.
Peak rearfoot eversion was the only factor reported in all included LLTs; it is a significant factor in ITBS, PT and PTTD but not in AT and PF. More prospective studies are needed to accurately evaluate the role of kinematic risk factors as a cause of LLT. Taken together, addressing rearfoot kinematic and kinematic chain movements accompanied by peak eversion should be considered in the prevention and management of LLT.
异常运动学已被认为是下肢腱病（LLT）的主要危险因素之一。
系统回顾跑步者 LLT 的运动学危险因素的证据。
在 PubMed、EMBASE 和 Web of Science 中进行了个体电子检索。两名审查员筛选研究，以确定与健康对照组相比报告 LLT 跑步者运动学危险因素的观察性研究。应用 Down 和 Black 评估量表评估质量。如果至少有两项具有相似方法的研究报告了相同的因素，则进行荟萃分析。
共纳入 28 项研究：跟腱腱病（AT）（9 项）、髂胫束综合征（ITBS）（17 项）、足底筋膜炎（PF）（2 项）、髌腱病（PT）（1 项）、胫骨后肌腱功能障碍（PTTD）（1 项）。18 项研究被评为高质量，10 项为中等质量。荟萃分析显示，ITBS 患者的膝关节内旋峰值较大、跟骨着地时后足外翻和膝关节屈曲较小、髋关节内收峰值较大，证据较强；PF 和 PTTD 患者的踝关节外翻峰值较高，或 PT 患者的髋关节内收峰值较高，证据有限。
后足外翻峰值是所有纳入的 LLT 中唯一报告的因素；它是 ITBS、PT 和 PTTD 的重要因素，但不是 AT 和 PF 的重要因素。需要更多的前瞻性研究来准确评估运动学危险因素作为 LLT 病因的作用。综上所述，在 LLT 的预防和管理中，应考虑后足运动学和运动链运动以及峰值外翻。
