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Is body mass index associated with patellofemoral pain and patellofemoral osteoarthritis? A systematic review and meta-regression and analysis
  1. Harvi F Hart1,2,
  2. Christian J Barton2,
  3. Karim M Khan1,
  4. Henrik Riel3,
  5. Kay M Crossley2
  1. 1Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
  3. 3Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  1. Correspondence to Professor Kay M Crossley, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia; k.crossley{at}


Background Patellofemoral pain (PFP) occurs frequently, and may be related to patellofemoral osteoarthritis (PFOA). Obesity is associated with increased risk of knee OA. This systematic review involves a meta-regression and analysis to determine the relationship between body mass index (BMI) and PFP and PFOA, and to determine the link between BMI and interventional outcomes.

Methods We searched seven electronic databases and reference lists of relevant papers and systematic reviews, for cross-sectional, prospective, human-based observational and interventional studies reporting BMI in individuals with PFP or PFOA compared to healthy controls. Two independent reviewers appraised methodological quality (epidemiological appraisal instrument). Where possible, data from prospective studies were pooled to conduct meta-regression and case–control, and intervention studies to conduct meta-analysis using the following categories: adolescents with PFP, adults with PFP and PFOA.

Results 52 studies were included. We found greater BMI in adults with PFP (standardised mean difference: 0.24, 95% CI 0.12 to 0.36) and PFOA (0.73, 0.46 to 0.99) compared to healthy controls, but not in adolescents with PFP (−0.19, −0.56 to 0.18). We also observed statistical trends (p<0.10) towards higher BMI being a predictor for development of PFP in adults (0.34, −0.04 to 0.71). No significant link between BMI and intervention outcomes in adults with PFP was identified.

Conclusions Higher BMI is present in PFP and PFOA, but not in adolescents with PFP.

PROSPERO registration number CRD42015024812.

  • Body mass index
  • Osteoarthritis

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  • Twitter Follow Christian Barton @DrChrisBarton and Henrik Riel @Henrik_Riel and Kay Crossley @kaymcrossley

  • Contributors HFH, CJB, KMK and KMC were involved in the conception and design. HFH, CJB and KMC were involved in the search strategy. HFH, CJB and KMC were involved in the screening of the articles. HFH and KMC was involved in data extraction. HFH, HR and KMC were involved in the methodological quality ratings. HFH, CJB and KMC were involved in the data analysis. HFH, CJB, KMK, HR and KMC were involved in manuscript preparation. All authors were fully involved in the study and preparation of the manuscript. Each author has read and concurs with the content in the final revised manuscript.

  • Competing interests None declared.

  • Ethics approval This project was exempt from the local University Ethical Review Board as published data were pooled.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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