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Risk Factors for Patellofemoral Pain in the Military: Systematic Review With Meta-Analysis
Emannuel Alcides Bezerra Rocha1, Sanderson Josć Costa de Assis2, Dean Felipe Maciel Maia3
1Postgraduate Program in Rehabilitation Sciences, School of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, RN, Brazil; Postgraduate Programs in.
Background:
The main cause for military training attrition is musculoskeletal injuries to the knee, such as patellofemoral pain (PFP).
Objective:
To identify which factors increase the risk of PFP occurrence in military personnel.
Design:
Systematic review with meta-analysis.
Data Sources:
Searches were performed in MEDLINE/PubMed, CINAHL, Embase, SPORTDiscus, Web of Science, Scopus, and OpenGray databases.
Study Selection:
Included studies included military personnel and had a prospective cohort design investigating at least 1 variable as a risk factor for PFP.
Data Extraction:
Extraction was performed by 2 independent evaluators, and the data were separated between the military personnel who developed PFP and those who did not.
Data Synthesis:
Meta-analyses were performed using standardized mean differences (SMDs) and 95% CIs, and levels of recommendation were determined.
Results:
From 11 articles, this review grouped 7518 military personnel, of whom 572 (7.61%) developed PFP. We found moderate evidence that isokinetic knee-extensor weakness at 60°/s predicts PFP in the military (SMD = -0.69; 95% CI = -1.02, -0.35). A larger frontal-plane knee-projection angle during the single-legged squat was also identified as a risk factor for PFP in male military personnel (SMD = 0.55; 95% CI = 0.14, 0.97) with a moderate level of evidence. We found moderate evidence that sex, body mass index, isometric knee-extensor strength, and isokinetic knee-flexor strength do not predict PFP in military personnel. Finally, we found strong evidence that age and body mass do not predict PFP in this population.
Conclusions:
Deficits in isokinetic knee-extensor strength and a greater frontal-plane knee-projection angle are risk factors for PFP in military personnel. Given that these are modifiable factors, these aspects should be considered in injury-prevention interventions in the military.
