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Meta-Analysis
. 2023 May;12(3):333-342.
doi: 10.1016/j.jshs.2022.12.002. Epub 2022 Dec 5.

Biomechanics associated with tibial stress fracture in runners: A systematic review and meta-analysis

Clare E Milner  1 , Eric Foch  2 , Joseph M Gonzales  3 , Drew Petersen  3
Affiliations
Meta-Analysis

Biomechanics associated with tibial stress fracture in runners: A systematic review and meta-analysis

Clare E Milner et al. J Sport Health Sci. 2023 May.

Erratum in

Abstract

Background: Tibial stress fracture (TSF) is an overuse running injury with a long recovery period. While many running studies refer to biomechanical risk factors for TSF, only a few have compared biomechanics in runners with TSF to controls. The aim of this systematic review and meta-analysis was to evaluate biomechanics in runners with TSF compared to controls.

Methods: Electronic databases PubMed, Web of Science, SPORTDiscus, Scopus, Cochrane, and CINAHL were searched. Risk of bias was assessed and meta-analysis conducted for variables reported in 3 or more studies.

Results: The search retrieved 359 unique records, but only the 14 that compared runners with TSF to controls were included in the review. Most studies were retrospective, 2 were prospective, and most had a small sample size (5-30 per group). Many variables were not significantly different between groups. Meta-analysis of peak impact, active, and braking ground reaction forces found no significant differences between groups. Individual studies found larger tibial peak anterior tensile stress, peak posterior compressive stress, peak axial acceleration, peak rearfoot eversion, and hip adduction in the TSF group.

Conclusion: Meta-analysis indicated that discrete ground reaction force variables were not statistically significantly different in runners with TSF compared to controls. In individual included studies, many biomechanical variables were not statistically significantly different between groups. However, many were reported by only a single study, and sample sizes were small. We encourage additional studies with larger sample sizes of runners with TSF and controls and adequate statistical power to confirm or refute these findings.

Keywords: Bone stress injury; Gait; Kinematics; Kinetics; Tibial acceleration.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Image, graphical abstract
Graphical abstract
Fig 1
Fig. 1
Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 flow diagram. TSF = tibial stress fracture.
Fig 2
Fig. 2
Forest plot of vertical impact peak during running showing no difference between groups. Normalized to body weight. 95%CI = 95% confidence interval; IV = inverse variance; TSF = tibial stress fracture.
Fig 3
Fig. 3
Forest plot of peak vertical active force during running showing no difference between groups. Normalized to body weight. 95%CI = 95% confidence interval; IV = inverse variance; TSF = tibial stress fracture.
Fig 4
Fig. 4
Forest plot of peak braking force during running showing no difference between groups. Normalized to body weight. 95%CI = 95% confidence interval; IV = inverse variance; TSF = tibial stress fracture.
See this image and copyright information in PMC

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