School of Science and Technology, Physical Therapy Department, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil.
School of Science and Technology, Physical Therapy Department, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil.
J Sport Health Sci. 2024 Jul;13(4):521-536. doi: 10.1016/j.jshs.2023.08.004. Epub 2023 Sep 3.
Impairments in hamstring strength, flexibility, and morphology have been associated with altered knee biomechanics, pain, and function. Determining the presence of these impairments in individuals with gradual-onset knee disorders is important and may indicate targets for assessment and rehabilitation. This systematic review aimed to synthesize the literature to determine the presence of impairments in hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders.
Five databases (MEDLINE, Embase, CINAHL, SPORTDiscus, and Web of Science) were searched from inception to September 2022. Only studies comparing hamstring outcomes (e.g., strength, flexibility, and/or morphology) between individuals with gradual-onset knee disorders and their unaffected limbs or pain-free controls were included. Meta-analyses for each knee disorder were performed. Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation, and evidence gap maps were created.
Seventy-nine studies across 4 different gradual-onset knee disorders (i.e., knee osteoarthritis (OA), patellofemoral pain (PFP), chondromalacia patellae, and patellar tendinopathy) were included. Individuals with knee OA presented with reduced hamstring strength compared to pain-free controls during isometric (standard mean difference (SMD) = -0.76, 95% confidence interval (95%CI) : -1.32 to -0.21) and concentric contractions (SMD = -0.97, 95%CI : -1.49 to -0.45). Individuals with PFP presented with reduced hamstring strength compared to pain-free controls during isometric (SMD = -0.48, 95%CI : -0.82 to -0.14), concentric (SMD = -1.07, 95%CI : -2.08 to -0.06), and eccentric contractions (SMD = -0.59, 95%CI : -0.97 to -0.21). No differences were observed in individuals with patellar tendinopathy. Individuals with PFP presented with reduced hamstring flexibility when compared to pain-free controls (SMD = -0.76, 95%CI : -1.15 to -0.36). Evidence gap maps identified insufficient evidence for chondromalacia patellae and hamstring morphology across all gradual-onset knee disorders.
Our findings suggest that assessing and targeting impairments in hamstring strength and flexibility during rehabilitation may be recommended for individuals with knee OA or PFP.
腘绳肌力量、柔韧性和形态的损伤与膝关节生物力学改变、疼痛和功能有关。在逐渐发作的膝关节疾病患者中确定这些损伤的存在很重要，这可能表明需要进行评估和康复的目标。本系统评价旨在综合文献，确定逐渐发作的膝关节疾病患者的腘绳肌力量、柔韧性和形态存在损伤的情况。
从成立到 2022 年 9 月，检索了五个数据库（MEDLINE、Embase、CINAHL、SPORTDiscus 和 Web of Science）。仅纳入比较逐渐发作的膝关节疾病患者与未受影响的肢体或无疼痛对照者的腘绳肌结果（如力量、柔韧性和/或形态）的研究。对每种膝关节疾病进行了荟萃分析。使用推荐评估、制定和评估（Grading of Recommendations Assessment, Development, and Evaluation）评估结果水平的确定性，并创建证据差距图。
共纳入 4 种不同的逐渐发作的膝关节疾病（即膝骨关节炎（OA）、髌股疼痛综合征（PFP）、髌骨软化症和髌腱病）的 79 项研究。与无疼痛对照者相比，膝骨关节炎患者在等长（标准均数差（SMD）=-0.76，95%置信区间（95%CI）：-1.32 至-0.21）和向心收缩（SMD=-0.97，95%CI：-1.49 至-0.45）时表现出较弱的腘绳肌力量。与无疼痛对照者相比，PFP 患者在等长（SMD=-0.48，95%CI：-0.82 至-0.14）、向心（SMD=-1.07，95%CI：-2.08 至-0.06）和离心收缩（SMD=-0.59，95%CI：-0.97 至-0.21）时表现出较弱的腘绳肌力量。髌腱病患者则无差异。与无疼痛对照者相比，PFP 患者的腘绳肌柔韧性降低（SMD=-0.76，95%CI：-1.15 至-0.36）。证据差距图显示，对于所有逐渐发作的膝关节疾病，髌骨软化症和腘绳肌形态的证据不足。
我们的研究结果表明，在康复过程中评估和针对膝关节骨关节炎或髌股疼痛综合征患者的腘绳肌力量和柔韧性损伤进行治疗可能是有益的。
