Ankle dorsiflexion range of motion in patellofemoral pain: systematic review and meta-analysis

Abstract

Introduction: Decreased ankle dorsiflexion (ADF) range of motion (ROM) during dynamic activities has been reported in subjects with patellofemoral pain (PFP) and is theorised to play a role in its development. Objective: To compare the maximum ADF angle between individuals with PFP and asymptomatic controls. Methods: A systematic review and meta-analysis of studies of humans with PFP undergoing maximum ADF angle assessment, published in peer-reviewed journals in English. We searched CINAHL, Cochrane CENTRAL, EMBASE, LILACS, MEDLINE, PEDro, SciELO, SCOPUS, SPORTDiscus, and Web of Science databases. The outcome of interest was PFP, and the exposure of interest was maximum ADF ROM. Data extraction and risk-of-bias scoring were conducted in duplicate and independently. The Joanna Briggs Institute critical appraisal tools were used to assess the risk of bias. Effect sizes were pooled using random-effects models and reported as standardised mean differences (SMD). Subgroup analyses were conducted for ADF assessment characteristics. Results: Twelve studies providing 15 datasets were included. No significant difference in maximum ADF was found between individuals with PFP and asymptomatic controls (SMD = -0.3875; 95% CI: -1.02 to 0.25; p = 0.2123), with high heterogeneity (I2 = 95.56%). Subgroup analysis showed differences related to the type of assessment (active or passive) but not to position or weight-bearing status. Conclusion: Maximum ADF does not consistently differ between individuals with PFP and asymptomatic controls. Assessment of this variable in isolation does not appear sufficient to explain the presence of patellofemoral pain.