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Modifiable Factors Associated with Knee Abduction During Weight-Bearing Activities: A Systematic Review and Meta-Analysis

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Abstract

Background

Increased knee abduction angle during activity is suggested to be a risk factor for sustaining an anterior cruciate ligament (ACL) injury or developing patellofemoral pain syndrome (PFPS). Knowledge of the modifiable mechanisms that are associated with increased knee abduction will aid in the appropriate design of preventive and rehabilitative strategies for these injuries.

Objective

Our objective was to systematically review modifiable mechanisms contributing to increased knee abduction in healthy people and in individuals with an ACL injury or PFPS.

Methods

We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the databases MEDLINE, CINAHL, and Embase until September 2015. Inclusion criteria were studies in healthy individuals and/or those with ACL injury or PFPS reporting (1) muscle strength, muscle activation, proprioception, and/or range of motion (ROM) and (2) knee abduction angle assessed with either motion analysis or visual observation during weight-bearing activity.

Results

In total, 33 articles were included. Reduced trunk strength, reduced gluteus maximus amplitude, decreased ankle ROM, and increased hip external rotation ROM were moderately associated with increased knee abduction angle (r −0.34 or higher, standardized difference in means (SDM) greater than −0.39, p < 0.05, articles n = 3, total sample size n = 101–114) in healthy individuals. Decreased strength of hip abductors, external rotators, and extensors and knee flexors were at most weakly associated with increased knee abduction angle (r ≤ 0.21, p = 0.013–0.426, articles n = 2–9, total sample size n = 80–311). Too few articles included patients with knee injury to be included in any meta-analysis.

Conclusion

The associations identified in this review indicate that investigation of strengthening of the trunk muscles, and improvement of gluteus maximus activation and ankle ROM to change knee kinematics is merited. Studies on modifiable factors associated with increased knee abduction angle in people with knee injury are needed.

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Authors and Affiliations

  1. Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden

    Anna Cronström, Jenny Nae & Eva Ageberg

  2. School of Exercise Science, Australian Catholic University, Brisbane, QLD, Australia

    Mark W. Creaby

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  1. Anna Cronström
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Correspondence to Anna Cronström.

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Funding

This research was funded by the Swedish Research Council (2009–1447), the Crafoord Foundation, the Swedish Rheumatism Association, the Swedish National Centre for Research in Sports, and the Faculty of Medicine of Lund University.

Author contributions

Anna Cronström contributed to the design of the study, was responsible for collecting the data, was responsible for the analysis and interpretation of the data, and was in charge of writing the manuscript. Mark Creaby contributed to the conception and design of the study, contributed to the analysis and interpretation of the data, and provided feedback on drafts of this paper. Jenny Nae contributed to collection of the data and provided feedback on drafts of this paper. Eva Ageberg contributed to the conception and design of the study, contributed to the analysis and interpretation of the data, contributed to the writing of the manuscript, and provided feedback on drafts of this paper. All authors read and approved the final manuscript.

Conflict of interest

Anna Cronström, Mark W. Creaby, Jenny Nae, and Eva Ageberg declare that they have no competing interests relevant to the content of this review.

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Cronström, A., Creaby, M.W., Nae, J. et al. Modifiable Factors Associated with Knee Abduction During Weight-Bearing Activities: A Systematic Review and Meta-Analysis. Sports Med 46, 1647–1662 (2016). https://doi.org/10.1007/s40279-016-0519-8

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