Kinematic gait characteristics associated with patellofemoral pain syndrome: a systematic review

Abstract

Development of patellofemoral pain syndrome (PFPS) is considered to be multifactorial. The aims of this systematic review were to (i) summarise and critique the body of literature addressing kinematic gait characteristics associated with PFPS; and (ii) provide recommendations for future research addressing kinematic gait characteristics associated with PFPS. A comprehensive search of MEDLINE, EMBASE, CINAHL, and Current Contents revealed 561 citations for review. Each citation was assessed for inclusion and quality using a modified version of the 'Quality Index' and a novel inclusion/exclusion criteria checklist by two independent reviewers. A total of 24 studies were identified. No prospective studies with adequate data to complete effect size calculations were found. Quality of included case-control studies varied, with a number of methodological issues identified. Heterogeneity between studies made meta-analysis inappropriate. Reductions in gait velocity were indicated during walking, ramp negotiation, and stair negotiation in individuals with PFPS. Findings indicated delayed timing of peak rearfoot eversion and increased rearfoot eversion at heel strike transient during walking; and delayed timing of peak rearfoot eversion, increased rearfoot eversion at heel strike, reduced rearfoot eversion range, greater knee external rotation at peak knee extension moment, and greater hip adduction during running in individuals with PFPS. There is a clear need for prospective evaluation of kinematic gait characteristics in a PFPS population to distinguish between cause and effect. Where possible, future PFPS case-control studies should consider evaluating kinematics of the knee, hip and foot/ankle simultaneously with larger participant numbers. Completing between sex comparisons when practical and considering spatiotemporal gait characteristics during methodological design and data analysis is also recommended.