Are running biomechanics different between females and males with knee injuries? A systematic review and meta-analysis

PURPOSE: To synthesise the evidence comparing lower limb running biomechanics between females and males with knee injuries. METHODS: We searched six databases (Medline, Embase, Cinahl, SPORTdiscus, Web of Science, and Scopus) from inception to October 2025. We included studies that reported biomechanical data separately for females and males with knee injuries (e.g. patellofemoral pain (PFP), iliotibial band syndrome (ITBS), anterior cruciate ligament reconstruction (ACLr)) during running using three-dimensional motion capture and/or force plates. Risk of bias and the quality of biomechanical reporting was assessed using the Newcastle-Ottawa Scale and Biomechanics Reporting Checklist, respectively. Biomechanical variables reported by three or more studies were pooled, and meta-analyses were conducted using random-effects models. RESULTS: A total of 16 studies involving 517 participants were included (389 PFP, 78 ITBS and 50 ACLr) with 51% female (n = 262). Meta-analyses were performed for eight biomechanical variables (six kinematic and two kinetic). Females had significantly higher peak hip adduction and peak hip internal rotation angles during running compared to males (mean difference (MD)= 3.84°, 95% confidence interval (CI) = 2.82-4.86; MD = 2.88°, 95% CI = 1.35-4.41, respectively). There were no sex-specific differences for knee joint angles (flexion, abduction, rotation), ankle joint angles (eversion), and knee joint moments (flexion and adduction). CONCLUSION: Females with knee injuries exhibit higher hip adduction and internal rotation angles during running compared to males. Findings of this systematic review must be interpreted with caution, given the very low certainty of evidence.