Frontal plane knee moment in clinical gait analysis: A systematic review on the effect of kinematic gait changes

Introduction: The frontal plane knee moment (KAM1 and KAM2) derived from non-invasive three-dimensional gait analysis is a surrogate measure for knee joint load and of great interest in clinical and research settings. Many aspects can influence this measure either unintentionally or purposely in order to reduce the knee joint load to relieve symptoms and pain. All these aspects must be known when conducting a study or interpreting gait data for clinical decision-making.

Methods: This systematic review was registered with PROSPERO (CRD42020187038). Pubmed and Web of Science were searched for peer-reviewed, original research articles in which unshod three-dimensional gait analysis was undertaken and KAM1 and KAM2 were included as an outcome variable. Two reviewers independently screened articles for inclusion, extracted data and performed a methodological quality assessment using Downs and Black checklist.

Results: In total, 42 studies were included. Based on the independent variable investigated, these studies were divided into three groups: 1) gait modifications, 2) individual characteristics and 3) idiopathic orthopedic deformities. Among others, fast walking speeds (1) were found to increase KAM1; There were no sex-related differences (2) and genu valgum (3) reduces KAM1 and KAM2.

Conclusion: While consistent use of terminology and reporting of KAM is required for meta-analysis, this review indicates that gait modifications (speed, trunk lean, step width), individual characteristics (body weight, age) and idiopathic orthopedic deformities (femoral or tibial torsion, genu valgum/varum) influence KAM magnitudes during walking. These factors should be considered by researchers when designing studies (especially of longitudinal design) or by clinicians when interpreting data for surgical and therapeutic decision-making.