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Effect of unplanned athletic movement on knee mechanics: a systematic review with multilevel meta-analysis
  1. Florian Giesche1,
  2. Felix Stief2,
  3. David A Groneberg1,
  4. Jan Wilke3
  1. 1 Division of Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
  2. 2 University Hospital Frankfurt, Department of Orthopedics (Friedrichsheim), Movement Analysis Lab, Goethe University Frankfurt, Frankfurt am Main, Germany
  3. 3 Division of Health and Performance, Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
  1. Correspondence to Florian Giesche, Division of Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; giesche{at}


Objective To compare the effects of pre-planned and unplanned movement tasks on knee biomechanics in uninjured individuals.

Design Systematic review with meta-analysis.

Data sources Five databases (PubMed, Google Scholar, Cochrane Library, ScienceDirect and Web of Science) were searched from inception to November 2020. Cross-sectional, (randomised) controlled/non-controlled trials comparing knee angles/moments of pre-planned and unplanned single-leg landings/cuttings were included. Quality of evidence was assessed using the tool of the Grading of Recommendations Assessment, Development and Evaluation working group.

Methods A multilevel meta-analysis with a robust random-effects meta-regression model was used to pool the standardised mean differences (SMD) of knee mechanics between pre-planned and unplanned tasks. The influence of possible effect modifiers (eg, competitive performance level) was examined in a moderator analysis.

Results Twenty-five trials (485 participants) with good methodological quality (Downs and Black) were identified. Quality of evidence was downgraded due to potential risk of bias (eg, confounding). Moderate-quality evidence indicates that unplanned tasks evoked significantly higher external knee abduction (SMD: 0.34, 95% CI: 0.16 to 0.51, 14 studies) and tibial internal rotation moments (SMD: 0.51, 95% CI: 0.23 to 0.79, 11 studies). No significant between-condition differences were detected for sagittal plane mechanics (p>0.05). According to the moderator analysis, increased abduction moments particularly occurred in non-professional athletes (SMD: 0.55, 95% CI: 0.14 to 0.95, 5 studies).

Conclusion Unplanned movement entails higher knee abduction and tibial internal rotation moments, which could predispose for knee injury. Exercise professionals designing injury-prevention protocols, especially for non-elite athletes, should consider the implementation of assessments and exercises requiring time-constrained decision-making.

PROSPERO registration number CRD42019140331.

  • knee
  • athletes
  • biomechanical phenomena
  • injury prevention
  • exercise test

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  • Contributors Each of the authors has been fully involved in the study and preparation of the manuscript, each author read and concurs with the content in the final manuscript and revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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