Biomechanical differences between females and males with patellofemoral pain: A systematic review and meta-analysis

Patellofemoral pain (PFP) is more prevalent in females and altered lower limb biomechanics have been implicated in its development and persistence. However, it remains unclear whether movement patterns differ between men and women with PFP during functional activities. Many biomechanical studies rely on mixed-sex cohorts, potentially obscuring sex-specific movement patterns. Therefore, this study aimed to systematically review biomechanical differences between females and males with PFP during functional tasks.

PubMed/MEDLINE, Embase, Scopus, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews and Google Scholar were searched from inception to 10 September 2025. Studies comparing in vivo biomechanical characteristics of females and males with PFP during functional tasks were included, whereas studies using mixed-sex cohorts without sex-stratified analysis or focusing exclusively on a single sex were excluded. Extracted data comprised participant demographics, methodological characteristics and kinetic and kinematic outcomes. Methodological quality was assessed using a modified Downs and Black checklist. Random-effects meta-analyses were performed using standardized mean differences.

Five cross-sectional studies including 170 individuals with PFP (84 females and 86 males) were analysed. Tasks evaluated included single-leg squat, step-down, mini-squat and single-leg jumping activities. Meta-analysis of single-leg squat data showed greater peak hip adduction in females compared with males (mean difference 4.93°, 95% confidence interval [CI] 2.60-7.25; I ² = 0%). Females also demonstrated greater peak knee abduction (mean difference 5.74°, 95% CI 2.31-9.16; I ² = 66%). No significant differences were observed for contralateral pelvic drop. Qualitative synthesis indicated greater frontal-plane kinematics in females, whereas males demonstrated greater hip, knee and ankle extension moments during jumping tasks. Several findings were based on single studies.

Only a limited number of studies evaluated sex-specific biomechanics in individuals with PFP. Despite the small number of studies, consistent differences between females and males were observed, suggesting that sex influences movement strategies and should be considered in biomechanical assessment and rehabilitation.

Level IV.