STUDY DESIGN: Systematic literature review. OBJECTIVE: To evaluate the quality and outcomes of published research papers on the topic of fatigue-induced biomechanical changes in single-limb landings. BACKGROUND: Lower extremity fatigue causes a number of biomechanical alterations that may increase the risk of knee injury. It has therefore been suggested that fatigue elements be incorporated into injury prevention programs. For this to be successful, protocols that reliably induce fatigue need to be identified and the effect fatigue has on the lower-limb joints needs to be documented. METHODS: A systematic review was conducted to identify published studies that assessed the effect of fatigue on lower-limb biomechanics during single-limb landing tasks. Studies were identified by searching 6 databases, reference lists, and citation tracking. The methodological quality of each paper was assessed, and effect sizes were calculated to allow comparison of results across studies. RESULTS: Eight studies met the inclusion criteria. Numerous methodological differences between the studies made synthesis of data challenging. There was some evidence to show that vertical ground reaction forces and hip and knee joint moments were reduced after fatigue. Kinematic changes were less consistent and require further study. CONCLUSION: The current body of studies showed mixed findings, particularly in relation to landing kinematics after fatigue. Future studies should focus on developing standardized fatigue protocols that include both local and central fatigue effects and monitor progression of fatigue over time. This area of research should be extended to include individuals recovering from musculoskeletal injury or surgery.

J Orthop Sports Phys Ther 2010;40(8):464-473, Epub 22 April 2010. doi:10.2519/jospt.2010.3295

KEY WORDS: anterior cruciate ligament, kinematics, kinetics, knee joint

STUDY DESIGN: Systematic literature review. OBJECTIVE: To evaluate the quality and scope of recently published systematic reviews on the topic of patellofemoral pain syndrome (PFPS) and to provide an overview of their findings. BACKGROUND: PFPS is a commonly treated condition. There is a large body of literature on conservative nonpharmacological interventions for PFPS, including multiple systematic reviews, which require critiquing and summarizing. METHODS AND MEASURES: A systematic review of systematic reviews on conservative nonpharmacological treatment strategies for PFPS was performed. Published systematic reviews were identified by searching MEDLINE, EMBASE, CINAHL, SPORTDISCUS, Current Contents, The Cochrane Library, and PEDro electronic databases from the year 2000 until May 2007. Cited reference searches of each author in the Web of Science complemented this search. Review quality was evaluated by a specifically designed scale and only high-quality reviews were retained to validate and summarize reported findings. RESULTS: Ten reviews met the inclusion criteria. Among them, only 3 were considered to be high quality, covering exercise, foot and knee orthoses, and ultrasound intervention for PFPS. None of the 3 reviews included literature published after the year 2001. Some limited evidence for the use of exercise, exercise combined with taping, and exercise combined with the use of a Protonics brace was found for treatment of individuals with PFPS. CONCLUSION: Published systematic reviews and clinical trials need to be conducted with more rigorous methodological design. There are no up-to-date, high-quality systematic reviews covering conservative nonpharmacological treatments for individuals with PFPS, which indicates that updates in all areas are needed. LEVEL OF EVIDENCE: Therapy, level 1a.

J Orthop Sports Phys Ther. 2008;38(9):529-541, published online 3 June 2008. doi:10.2519/jospt.2008.2861

KEY WORDS: exercise, literature, orthoses, physical therapy, ultrasound