May the force be with you: understanding how patellofemoral joint reaction force compares across different activities and physical interventions—a systematic review and meta-analysis

Abstract

ObjectiveTo systematically review and synthesise patellofemoral joint reaction force (PFJRF) in healthy individuals and those with patellofemoral pain and osteoarthritis (OA), during everyday activities, therapeutic exercises and with physical interventions (eg, foot orthotics, footwear, taping, bracing).DesignA systematic review with meta-analysis.Data sourcesMedline, Embase, Scopus, CINAHL, SportDiscus and Cochrane Library databases were searched.Eligibility criteriaObservational and interventional studies reporting PFJRF during everyday activities, therapeutic exercises, and physical interventions.ResultsIn healthy individuals, the weighted average of mean (±SD) peak PFJRF for everyday activities were: walking 0.9±0.4 body weight (BW), stair ascent 3.2±0.7 BW, stair descent 2.8±0.5 BW and running 5.2±1.2 BW. In those with patellofemoral pain, peak PFJRF were: walking 0.8±0.2 BW, stair ascent 2.5±0.5 BW, stair descent 2.6±0.5 BW, running 4.1±0.9 BW. Only single studies reported peak PFJRF during everyday activities in individuals with patellofemoral OA/articular cartilage defects (walking 1.3±0.5 BW, stair ascent 1.6±0.4 BW, stair descent 1.0±0.5 BW). The PFJRF was reported for many different exercises and physical interventions; however, considerable variability precluded any pooled estimates.SummaryEveryday activities and exercises involving larger knee flexion (eg, squatting) expose the patellofemoral joint to higher PFJRF than those involving smaller knee flexion (eg, walking). There were no discernable differences in peak PFJRF during everyday activities between healthy individuals and those with patellofemoral pain/OA. The information on PFJRF may be used to select appropriate variations of exercises and physical interventions.

Do biomechanical foot-based interventions reduce patellofemoral joint loads in adults with and without patellofemoral pain or osteoarthritis? A systematic review and meta-analysis

“…With assistance from an academic librarian, one reviewer (SAK) conducted the search that combined relevant terms for population, intervention and outcome. These relevant terms were based on other similar reviews 15 27. We searched the following databases from inception to 4 October 2022: Medline, the Cumulative Index to Nursing and Allied Health Literature, The Cochrane Central Register of Controlled Trials, SPORTdiscus and Embase and screened the reference lists of included studies and relevant systematic reviews 15 16.…”

“…Despite the biomechanical rationale and widespread use of these interventions, no study has systematically reviewed research investigating the effects of biomechanical foot-based interventions on patellofemoral joint loads. Although one recent systematic review included some studies that evaluated foot-based interventions,15 its focus was on comparing patellofemoral joint reaction force across everyday activities, and it did not conduct a subgroup analysis of intervention effects. Thus, the specific effect(s) of biomechanical foot-based interventions on patellofemoral joint loads remains unclear.…”

“…Patellofemoral joint loads may be quantified using direct (reaction force and pressure)16 or surrogate (external flexion or internal extension moment)17 measures. Although three-dimensional models are considered more accurate,18 the majority of researchers have estimated patellofemoral joint reaction force using sagittal plane two-dimensional (2D) models that combine the knee flexion angle and moment with mathematical representations of the extensor mechanism 15 16. To calculate pressure, the reaction force is divided by the contact area obtained from previous studies 16.…”

The effect of biomechanical foot-based interventions on patellofemoral joint loads during gait in adults with and without patellofemoral pain or osteoarthritis: a systematic review protocol.

“…The search strategy for MEDLINE (Ovid) is presented in Additional le 2, and we will adapt this strategy for the remaining databases with the help of an academic librarian from The University of Melbourne. The search terms used are based on other similar reviews [20,21,26]. We will not apply any limits on the type or publication date of the studies.…”

“…To date, there has been no systematic review speci cally evaluating the effects of biomechanical footbased interventions on patellofemoral joint loads. Although one systematic review [20] included some studies that evaluated foot-based interventions, its focus was on comparing patellofemoral joint reaction force (only) across everyday activities and it did not conduct a sub-group analysis of intervention effects. As a result, the speci c effect(s) of biomechanical foot-based interventions on patellofemoral joint loads remains unclear.…”