Background Lower extremity overuse injuries are common in athletes participating in sports with repeated bouts of landing manoeuvres.

Objective To summarise and determine the relationship between kinematic alterations during a landing task and lower extremity overuse injuries in physically active populations.

Design Systematic review and meta-analysis considering prospective cohort, cross sectional or case-control study designs.

Setting Electronic databases PubMed, Embase, Web of Science, CINAHL, and SPORTDiscus were consulted in February 2020.

Participants Articles including an athletic or physically active, healthy population with an overuse injury of the lower extremity.

Assessment of risk factors Methodological quality was assessed by a modified Downs and Black checklist.

Main outcome measurements The relationship between three-dimensional (3D) landing kinematics in physically active populations and lower extremity overuse injuries.

Results Twenty-three studies that investigated 3D landing kinematics in subjects with either patellar tendinopathy (PT), patellofemoral pain (PFP), exertional medial tibial pain (EMTP) or groin overuse injury met the inclusion criteria. Based on this systematic review, there is evidence for decreased knee flexion range of motion (ROM) and increased knee abduction ROM during landing as risk factors for PFP. For PT, risk factors are poorly understood. Furthermore, the meta-analysis demonstrated significantly greater hip adduction at initial contact (IC) (p=0.02), greater knee internal rotation at IC (p<0.001), greater peak knee external rotation (p=0.05) and less ankle dorsiflexion at peak vertical ground reaction force (vGRF) (p=0.05) in subjects with knee overuse injuries compared to healthy controls. There is evidence of increased trunk, hip and knee transversal ROM as risk factors for EMTP. Groin injuries are associated with greater pelvic and hip frontal and transversal plane ROM in the injured group compared to the healthy controls.

Conclusion The results of this systematic review and meta-analysis provide preliminary evidence for impaired landing kinematics associated with lower extremity overuse injuries. Excessive frontal and transversal plane movements during landing manoeuvres might increase impact and tensile forces resulting in lower extremity overuse injuries.