Helder S Lopes, Marina C Waiteman, Liliam B Priore, Neal R Glaviano, David M Bazett-Jones, Ronaldo V Briani, Fábio M Azevedo
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Only studies comparing hamstring outcomes (e.g., strength, flexibility, and/or morphology) between individuals with gradual-onset knee disorders and their unaffected limbs or pain-free controls were included. Meta-analyses for each knee disorder were performed. Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation, and evidence gap maps were created.</p><p><strong>Results: </strong>Seventy-nine studies across 4 different gradual-onset knee disorders (i.e., knee osteoarthritis (OA), patellofemoral pain (PFP), chondromalacia patellae, and patellar tendinopathy) were included. Individuals with knee OA presented with reduced hamstring strength compared to pain-free controls during isometric (standard mean difference (SMD) = -0.76, 95% confidence interval (95%CI) : -1.32 to -0.21) and concentric contractions (SMD = -0.97, 95%CI : -1.49 to -0.45). Individuals with PFP presented with reduced hamstring strength compared to pain-free controls during isometric (SMD = -0.48, 95%CI : -0.82 to -0.14), concentric (SMD = -1.07, 95%CI : -2.08 to -0.06), and eccentric contractions (SMD = -0.59, 95%CI : -0.97 to -0.21). No differences were observed in individuals with patellar tendinopathy. Individuals with PFP presented with reduced hamstring flexibility when compared to pain-free controls (SMD = -0.76, 95%CI : -1.15 to -0.36). Evidence gap maps identified insufficient evidence for chondromalacia patellae and hamstring morphology across all gradual-onset knee disorders.</p><p><strong>Conclusion: </strong>Our findings suggest that assessing and targeting impairments in hamstring strength and flexibility during rehabilitation may be recommended for individuals with knee OA or PFP.</p>","PeriodicalId":48897,"journal":{"name":"Journal of Sport and Health Science","volume":" ","pages":"521-536"},"PeriodicalIF":9.7000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11184318/pdf/","citationCount":"0","resultStr":"{\"title\":\"There is more to the knee joint than just the quadriceps: A systematic review with meta-analysis and evidence gap map of hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders.\",\"authors\":\"Helder S Lopes, Marina C Waiteman, Liliam B Priore, Neal R Glaviano, David M Bazett-Jones, Ronaldo V Briani, Fábio M Azevedo\",\"doi\":\"10.1016/j.jshs.2023.08.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Impairments in hamstring strength, flexibility, and morphology have been associated with altered knee biomechanics, pain, and function. 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Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation, and evidence gap maps were created.</p><p><strong>Results: </strong>Seventy-nine studies across 4 different gradual-onset knee disorders (i.e., knee osteoarthritis (OA), patellofemoral pain (PFP), chondromalacia patellae, and patellar tendinopathy) were included. Individuals with knee OA presented with reduced hamstring strength compared to pain-free controls during isometric (standard mean difference (SMD) = -0.76, 95% confidence interval (95%CI) : -1.32 to -0.21) and concentric contractions (SMD = -0.97, 95%CI : -1.49 to -0.45). Individuals with PFP presented with reduced hamstring strength compared to pain-free controls during isometric (SMD = -0.48, 95%CI : -0.82 to -0.14), concentric (SMD = -1.07, 95%CI : -2.08 to -0.06), and eccentric contractions (SMD = -0.59, 95%CI : -0.97 to -0.21). No differences were observed in individuals with patellar tendinopathy. 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引用次数: 0
摘要
背景:腘绳肌力量、柔韧性和形态的损伤与膝关节生物力学、疼痛和功能的改变有关。确定逐渐发生的膝关节疾病患者是否存在这些损伤是很重要的,并可能指出评估和康复的目标。本系统综述旨在综合文献,以确定逐渐发病的膝关节疾病患者的腘绳肌力量、柔韧性和形态是否存在损伤。方法:检索MEDLINE、Embase、CINAHL、SPORTDiscus、Web of Science 5个数据库,检索时间为建库至2022年9月。本研究只包括了对逐渐发病的膝关节疾病患者与未受影响的肢体或无疼痛对照者的腿筋结果(如力量、柔韧性和/或形态)进行比较的研究。对每一种膝关节疾病进行meta分析。结果水平的确定性采用分级建议评估、发展和评估进行评估,并创建证据差距图。结果:79项研究涉及4种不同的渐进性膝关节疾病(即膝骨关节炎(OA)、髌骨股痛(PFP)、髌骨软骨软化症和髌骨肌腱病)。与无痛对照相比,膝关节OA患者在等距收缩(标准平均差(SMD) = -0.76,95%可信区间(95% ci) : -1.32至-0.21)和同心收缩(SMD = -0.97,95% ci : -1.49至-0.45)时腘绳肌力量降低。PFP面对患者减少肌腱力量相比,无痛控制在等距(SMD = -0.48,95% ci : -0.82到-0.14),同心(SMD = -1.07,95% ci : -2.08到-0.06),和偏心收缩(SMD = -0.59,95% ci : -0.97到-0.21)。在患有髌骨肌腱病变的个体中没有观察到差异。与无痛对照组相比,PFP患者腘绳肌柔韧性降低(SMD = -0.76,95%CI: -1.15至-0.36)。证据缺口图表明,在所有逐渐发病的膝关节疾病中,髌骨软骨软化症和腿筋形态的证据不足。结论:我们的研究结果表明,对于膝关节OA或PFP患者,在康复过程中评估和定位腘绳肌力量和柔韧性的损伤是值得推荐的。
There is more to the knee joint than just the quadriceps: A systematic review with meta-analysis and evidence gap map of hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders.
Background: Impairments in hamstring strength, flexibility, and morphology have been associated with altered knee biomechanics, pain, and function. Determining the presence of these impairments in individuals with gradual-onset knee disorders is important and may indicate targets for assessment and rehabilitation. This systematic review aimed to synthesize the literature to determine the presence of impairments in hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders.
Methods: Five databases (MEDLINE, Embase, CINAHL, SPORTDiscus, and Web of Science) were searched from inception to September 2022. Only studies comparing hamstring outcomes (e.g., strength, flexibility, and/or morphology) between individuals with gradual-onset knee disorders and their unaffected limbs or pain-free controls were included. Meta-analyses for each knee disorder were performed. Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation, and evidence gap maps were created.
Results: Seventy-nine studies across 4 different gradual-onset knee disorders (i.e., knee osteoarthritis (OA), patellofemoral pain (PFP), chondromalacia patellae, and patellar tendinopathy) were included. Individuals with knee OA presented with reduced hamstring strength compared to pain-free controls during isometric (standard mean difference (SMD) = -0.76, 95% confidence interval (95%CI) : -1.32 to -0.21) and concentric contractions (SMD = -0.97, 95%CI : -1.49 to -0.45). Individuals with PFP presented with reduced hamstring strength compared to pain-free controls during isometric (SMD = -0.48, 95%CI : -0.82 to -0.14), concentric (SMD = -1.07, 95%CI : -2.08 to -0.06), and eccentric contractions (SMD = -0.59, 95%CI : -0.97 to -0.21). No differences were observed in individuals with patellar tendinopathy. Individuals with PFP presented with reduced hamstring flexibility when compared to pain-free controls (SMD = -0.76, 95%CI : -1.15 to -0.36). Evidence gap maps identified insufficient evidence for chondromalacia patellae and hamstring morphology across all gradual-onset knee disorders.
Conclusion: Our findings suggest that assessing and targeting impairments in hamstring strength and flexibility during rehabilitation may be recommended for individuals with knee OA or PFP.
期刊介绍:
The Journal of Sport and Health Science (JSHS) is an international, multidisciplinary journal that aims to advance the fields of sport, exercise, physical activity, and health sciences. Published by Elsevier B.V. on behalf of Shanghai University of Sport, JSHS is dedicated to promoting original and impactful research, as well as topical reviews, editorials, opinions, and commentary papers.
With a focus on physical and mental health, injury and disease prevention, traditional Chinese exercise, and human performance, JSHS offers a platform for scholars and researchers to share their findings and contribute to the advancement of these fields. Our journal is peer-reviewed, ensuring that all published works meet the highest academic standards.
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