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Meta-Analysis
. 2025 Jan 2;59(2):126-132.
doi: 10.1136/bjsports-2024-108866.

Noisy knees - knee crepitus prevalence and association with structural pathology: a systematic review and meta-analysis

Jamon L Couch  1   2   3 , Matthew G King  1   2   4 , Danilo De Oliveira Silva  1   2   4 , Jackie L Whittaker  3   5 , Andrea M Bruder  1   2   4 , Fernanda Serighelli  1   2 , Sean Kaplan  1   2 , Adam G Culvenor  6   2
Affiliations
Meta-Analysis

Noisy knees - knee crepitus prevalence and association with structural pathology: a systematic review and meta-analysis

Jamon L Couch et al. Br J Sports Med. .

Abstract

Objective: Knee crepitus, the audible crackling or grinding noise during knee movement, can be experienced across the lifespan and create concern for underlying pathology. Our systematic review aims to provide a summary estimate of knee crepitus prevalence and its association with structural pathology among the general population and across knee conditions.

Design: Systematic review and meta-analysis.

Data sources: Medline, Embase, CENTRAL, Web of Science, SPORTDiscus and CINAHL.

Eligibility criteria: Studies evaluating knee crepitus prevalence.

Results: 103 studies involving 36 439 participants (42 816 knees) were included. Based on very low certainty evidence, the pooled prevalence of knee crepitus in the general population was 41% (7609 knees; 95% CI 36% to 45%; I2=92.6%); in pain-free persons 36% (852 knees; 95% CI 23% to 50%; I2=91.9%), and in those with osteoarthritis (OA) 81% (18 821 knees; 95% CI 75% to 87%; I2=97.9%). Across other musculoskeletal knee conditions, the pooled prevalence of knee crepitus ranged from 35% (ligament injury; 2740 knees; 95% CI 27% to 44%; I2=95.6%) to 61% (cartilage pathology; 1445 knees; 95% CI 40% to 81%; I2=98.2%). There was low to very low certainty evidence of an association between knee crepitus and radiographic OA (OR 3.79, 95% CI 1.99 to 7.24; 1725 knees; I2=53.0%) and several OA-related features on magnetic resonance imaging (MRI).

Conclusion: In this review, knee crepitus was prevalent in the general population, pain-free persons, those with knee OA and other musculoskeletal knee conditions. Knee crepitus was associated with a more than threefold increased odds of radiographic OA diagnosis and several OA-related MRI features. The low to very low certainty of evidence informing our aggregated prevalence estimates and association outcomes suggest that results should be interpreted with caution.

Keywords: Cartilage; Knee; Knee injuries; Meta-analysis; Osteoarthritis.

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Conflict of interest statement

Competing interests: AGC, MGK and JLW are Associate Editors of British Journal of Sports Medicine. AGC is an Associate Editor of Osteoarthritis and Cartilage. JLW is an Editor of Journal of Orthopaedic and Sports Physical Therapy. MGK is an Associate Editor of BMC Musculoskeletal Disorders. MGK and JLW are international review board members of Journal of Orthopaedic and Sports Physical Therapy. DOS is an Associate Editor of Journal of Sport Rehabilitation. All other authors declare no competing interests.

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