title: Modifiable Factors Associated with Knee Abduction During Weight-Bearing Activities: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Increased knee abduction angle during activity is suggested to be a risk factor for sustaining an anterior cruciate ligament (ACL) injury or developing patellofemoral pain syndrome (PFPS). Knowledge of the modifiable mechanisms that are associated with increased knee abduction will aid in the appropriate design of preventive and rehabilitative strategies for these injuries.
  
  
  OBJECTIVE
  Our objective was to systematically review modifiable mechanisms contributing to increased knee abduction in healthy people and in individuals with an ACL injury or PFPS.
  
  
  METHODS
  We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the databases MEDLINE, CINAHL, and Embase until September 2015. Inclusion criteria were studies in healthy individuals and/or those with ACL injury or PFPS reporting (1) muscle strength, muscle activation, proprioception, and/or range of motion (ROM) and (2) knee abduction angle assessed with either motion analysis or visual observation during weight-bearing activity.
  
  
  RESULTS
  In total, 33 articles were included. Reduced trunk strength, reduced gluteus maximus amplitude, decreased ankle ROM, and increased hip external rotation ROM were moderately associated with increased knee abduction angle (r -0.34 or higher, standardized difference in means (SDM) greater than -0.39, p < 0.05, articles n = 3, total sample size n = 101-114) in healthy individuals. Decreased strength of hip abductors, external rotators, and extensors and knee flexors were at most weakly associated with increased knee abduction angle (r ≤ 0.21, p = 0.013-0.426, articles n = 2-9, total sample size n = 80-311). Too few articles included patients with knee injury to be included in any meta-analysis.
  
  
  CONCLUSIONS
  The associations identified in this review indicate that investigation of strengthening of the trunk muscles, and improvement of gluteus maximus activation and ankle ROM to change knee kinematics is merited. Studies on modifiable factors associated with increased knee abduction angle in people with knee injury are needed.
authors.affiliation: Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden. anna.cronstrom@med.lu.se.
authors.forename: Anna
authors.identifier: http://orcid.org/0000-0002-3282-6320
authors.initials: A
authors.lastname: Cronström
authors.affiliation: School of Exercise Science, Australian Catholic University, Brisbane, QLD, Australia.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Creaby
authors.affiliation: Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden.
authors.forename: Jenny
authors.initials: J
authors.lastname: Nae
authors.affiliation: Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Ageberg
mesh_terms: D016118:Anterior Cruciate Ligament / Q000503:physiopathology*; D000070598:Anterior Cruciate Ligament Injuries / Q000503:physiopathology; D001265:Athletic Injuries; D001696:Biomechanical Phenomena; D006801:Humans; D007717:Knee / Q000502:physiology / Q000503:physiopathology*; D007718:Knee Injuries; D007719:Knee Joint / Q000503:physiopathology; D016474:Weight-Bearing / Q000502:physiology*