Elsevier

Gait & Posture

Volume 49, September 2016, Pages 315-328
Gait & Posture

Review
Gender differences in knee abduction during weight-bearing activities: A systematic review and meta-analysis

https://doi.org/10.1016/j.gaitpost.2016.07.107Get rights and content

Highlights

  • Women exhibit greater knee abduction compared to men during activity.

  • Gender differences in knee abduction were present during Jump landings, running and cutting.

  • Gender-specific prevention and treatment strategies for knee injury are needed.

Abstract

Background

Increased knee abduction during weight-bearing activities is suggested to be a contributing factor for the high knee injury risk reported in women. However, studies investigating gender difference in knee abduction are inconclusive.

Objective

To systematically review gender-differences in knee abduction during weight-bearing activities in individuals with or without knee injury.

Methods

A systematic review and meta-analysis were conducted according to the PRISMA guidelines. A search in the databases Medline, CINAHL and EMBASE was performed until September 2015. Inclusion criteria were studies that reported (1) gender differences, (2) healthy individuals and/or those with anterior cruciate ligament (ACL) deficiency or reconstruction or patellofemoral pain PFP, and (3) knee abduction assessed with either motion analysis or visual observation during weight-bearing activity.

Results

Fifty-eight articles met the inclusion criteria. Women with PFP had greater peak knee abduction compared to men (Std diff in mean; −1.34, 95%CI; −1.83 to −0.84). In healthy individuals, women performed weight-bearing tasks with greater knee abduction throughout the movement (initial contact, peak abduction, excursion) (Std diff in mean; −0.68 to −0.79, 95%CI; −1.04 to −0.37). In subgroup analyses by task, differences in knee abduction between genders were present for most tasks, including running, jump landings and cutting movements. There were too few studies in individuals with ACL injury to perform meta-analysis.

Conclusion

The gender difference in knee abduction during weight-bearing activities should be considered in training programs aimed at preventing or treating knee injury.

Section snippets

Background

Anterior cruciate ligament (ACL) injury and patellofemoral pain (PFP) are common sports-related injuries [1], [2]. Such injuries are more frequent in women than in men [1], [2]. Although the evidence is limited, it is suggested that increased knee abduction may be a contributing factor for this gender difference [3]. Indeed, greater knee abduction is consistently reported to form part of the mechanism of non-contact ACL injury [4], [5], [6], [7], and is associated with greater strain on the ACL

Methods

A systematic review and meta-analyses were conducted according to the PRISMA guidelines. The study protocol was pre-registered (PROSPERO 2013: CRD42013005415).

Study selection

A total of 4987 abstracts were screened against the inclusion criteria. Sixty-seven articles proceeded to quality assessment. One author reported on the same subjects in three studies [37], [38], [39]; the article with the highest quality score was included [39]. Another author reported on the same subjects in two studies [40], [41]. Of these articles, the one that reported data for more than one functional task was included [41]. Seven articles did not reach the predefined limit of a 50% score

Discussion

The results from this systematic review and meta-analysis report that women without knee injury or with PFP, execute functional tasks with greater knee abduction than their male counterparts. In healthy individuals, the specific tasks in which differences were apparent between women and men were jump landings, cutting and running. Limited data were available in individuals with a history of ACL injury or PFP; findings indicate greater peak knee abduction in women in some weight-bearing tasks.

Conclusions

This systematic review and meta-analyses reveal that women, with or without knee injury, exhibit increased knee abduction during the execution of several different weight-bearing functional tasks compared to men. Given the reported gender-difference in knee abduction during functional tasks, there may need to be a greater focus on this movement pattern during prevention and rehabilitation training in women, whereas other factors may be more relevant in men. The majority of studies included

Authors’ contribution

AC contributed to the design of the study, was responsible for collecting the data, was responsible for the analysis and interpretation of the data, and drafted the manuscript. MWC contributed to the conception and design of the study, contributed in analysis and interpretation of data, and provided feedback on drafts of the manuscript. JN contributed in collecting the data, and provided feedback on drafts of the manuscript. EA contributed to the conception and design of the study, contributed

Conflict of interest

Anna Cronström, Mark W Creaby, Jenny Nae and Eva Ageberg declare that they have no competing interests.

Acknowledgements

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.

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