Are running biomechanics different between females and males with knee injuries? A systematic review and meta-analysis.

This systematic review and meta-analysis asked whether running biomechanics differ between females and males who have knee injuries such as patellofemoral pain, iliotibial band syndrome, or ACL reconstruction. Researchers pooled data from 16 studies involving 517 participants (389 with patellofemoral pain, 78 with iliotibial band syndrome, 50 post-ACL reconstruction), 51% female, and combined results for eight biomechanical variables reported across three or more studies. Females showed statistically significantly higher peak hip adduction (mean difference 3.84°) and peak hip internal rotation (mean difference 2.88°) angles during running compared to males. No sex differences emerged for knee angles, ankle eversion, or knee flexion and adduction moments.

The authors note the certainty of this evidence is very low, meaning these findings should be interpreted cautiously and may change as more research emerges.

This review looked at whether men and women with knee injuries (like patellofemoral pain, iliotibial band syndrome, or after ACL surgery) run differently. Researchers combined findings from 16 studies covering 517 people, just over half of them female. The review found that women showed more inward hip movement (hip adduction) and more inward hip rotation while running compared to men, with these differences being statistically significant.

Other movements at the knee and ankle, and forces measured at the knee, did not differ between sexes. The researchers rated the overall quality of this evidence as very low certainty. This means the results give an early signal about possible sex differences but are not strong enough to be confident about, and future studies could change the picture.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review synthesised 16 studies (n=517; 389 PFP, 78 ITBS, 50 ACLr; 51% female) examining sex-based differences in running biomechanics among people with knee injuries. Meta-analyses were possible for eight variables reported by three or more studies, using random-effects models, with risk of bias assessed via the Newcastle-Ottawa Scale and biomechanical reporting quality via a dedicated checklist. Statistically significant differences emerged only for two proximal kinematic variables: females demonstrated higher peak hip adduction (MD 3.84°, 95% CI 2.82-4.86) and peak hip internal rotation (MD 2.88°, 95% CI 1.35-4.41) than males.

No differences were found for knee angles (flexion, abduction, rotation), ankle eversion, or knee flexion/adduction moments. The authors explicitly flag very low certainty of evidence, limiting confidence in these pooled estimates. Heterogeneity across injury types (PFP, ITBS, ACLr) and small per-condition sample sizes constrain generalisability, and the review does not establish whether these kinematic differences are causally linked to injury mechanisms or outcomes.