Department of Exercise and Rehabilitation Sciences, The University of Toledo, Toledo, OH, USA.
School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, Essex, UK.
Sports Med. 2023 Feb;53(2):519-547. doi: 10.1007/s40279-022-01781-1. Epub 2022 Nov 5.
Patellofemoral pain (PFP) is a prevalent knee condition with many proposed biomechanically orientated etiological factors and treatments.
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.
Systematic review and meta-analysis.
We searched Medline, CINAHL, SPORTDiscus, Embase, and Web of Science from inception to October 2021.
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.
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.
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.
PROSPERO # CRD42019080241.
髌股疼痛（PFP）是一种常见的膝关节疾病，有许多提出的生物力学导向的病因和治疗方法。
我们旨在系统地回顾和综合比较患有 PFP 的人与无痛对照者在行走和跑步时的生物力学变量（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。
系统回顾和荟萃分析。
我们从开始到 2021 年 10 月检索了 Medline、CINAHL、SPORTDiscus、Embase 和 Web of Science。
所有研究设计（前瞻性、病例对照[±干预成分，只要报告了两组的干预前数据]、横断面）比较了患有和不患有 PFP 的人在行走和/或跑步期间的时空、运动学和/或动力学变量。
我们确定了 55 项研究，涉及 1300 名患有 PFP 的人和 1393 名无痛对照者。总体汇总分析表明，患有 PFP 的人步行速度较慢[中等证据，标准化均数差（SMD）-0.50，95%置信区间（CI）-0.72，-0.27]，步频较低（有限证据，SMD-0.43，95%CI-0.74，-0.12），步长较短（有限证据，SMD-0.46，95%CI-0.80，-0.12）。与对照组相比，患有 PFP 的人还具有更大的对侧骨盆下降峰值（中度证据，SMD-0.46，95%CI-0.90，-0.03）、更小的峰值膝关节屈曲角度（中度证据，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）。与无痛女性相比，患有 PFP 的女性具有更大的峰值髋关节屈曲角度（中度证据，SMD 0.83，95%CI 0.30，1.36）和后足外翻角度（有限证据，SMD 0.59，95%CI 0.03，1.14）。对于所有其他生物力学变量，没有发现组间存在显著差异。由于前瞻性研究的数据缺乏，无法对前瞻性研究进行数据汇总。
在比较患有和不患有 PFP 的人时，存在一些生物力学差异，主要表现为小到中等的效应大小。患有 PFP 的人步行速度较慢，步频较低，步长较短，对侧骨盆下降幅度较大，膝关节屈曲角度和伸展力矩较小。由于缺乏前瞻性数据，目前尚不清楚这些特征是在 PFP 发病前存在还是作为疼痛补偿运动策略出现的。
PROSPERO#CRD42019080241。
