PURPOSE Females typically present with a higher prevalence of knee osteoarthritis (KOA), and such a higher prevalence may be due to unique knee biomechanics during walking. However, the sex-dependent ambulatory mechanics has been yet to be clarified. To address this critical knowledge gap, this study implemented a series of computational approaches 1) to identify sex-related knee joint biomechanics during ambulation in persons with KOA and 2) to compare these biomechanical measures between individuals with versus without KOA, stratified by sex. METHODS We searched five electronic databases for studies reporting sex-specific knee biomechanics in persons with and/or without KOA. Summary estimates were computed using random-effects meta-analysis and stratified by sex. RESULTS The systematic review identified 18 studies (308 males and 383 females with KOA; 740 males and 995 females without KOA). A series of meta-analyses identified female-specific knee biomechanics in a disease-dependent manner. Females with KOA had lower first peak knee adduction moment and peak knee adduction compared with male counterparts. On the other hand, healthy females had lower peak knee flexion moment than male counterparts. Effect estimate in each meta-analysis displayed poor quality of evidence according to the GRADE approach. CONCLUSIONS The current study is the first to consider sex as a biological variable into ambulatory mechanics in the development of KOA. We discovered that sex-dependent alterations in knee biomechanics is a function of the presence of KOA, indicating that KOA disease may be a driver of the sex-dependent biomechanical alterations or vice versa. Although no strong conclusion can be drawn because of the low quality of evidence, these findings provide new insight into the sex differences in ambulatory knee biomechanics and progression of KOA.

中文翻译：

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动态生物力学的性别差异：一项提供膝骨关节炎机制见解的荟萃分析。


目的 女性通常表现为膝骨关节炎 （KOA） 的患病率较高，而如此高的患病率可能是由于行走时独特的膝关节生物力学。然而，性别依赖性动态机制尚未阐明。为了解决这一关键知识差距，本研究实施了一系列计算方法 1） 确定 KOA 患者在行走过程中与性别相关的膝关节生物力学，以及 2） 比较患有 KOA 和不患有 KOA 的个体之间的这些生物力学指标，按性别分层。方法 我们检索了五个电子数据库，以查找报告患有和/或没有 KOA 的人的性别特异性膝关节生物力学的研究。使用随机效应荟萃分析计算汇总估计值，并按性别分层。结果 系统评价确定了 18 项研究 （308 名男性和 383 名女性患有 KOA;740 名男性和 995 名女性没有 KOA）。一系列荟萃分析以疾病依赖性方式确定了女性特异性膝关节生物力学。与男性相比，患有 KOA 的女性患者的第一峰值膝关节内收力矩和峰值膝关节内收率较低。另一方面，健康女性的膝关节屈曲峰值矩低于男性。根据 GRADE 方法，每项荟萃分析中的效果估计显示证据质量较差。结论 目前的研究是首次将性别作为 KOA 发展中动态力学的生物变量。我们发现膝关节生物力学的性别依赖性改变是 KOA 存在的函数，表明 KOA 疾病可能是性别依赖性生物力学改变的驱动因素，反之亦然。 尽管由于证据质量低，无法得出强有力的结论，但这些发现为动态膝关节生物力学的性别差异和 KOA 的进展提供了新的见解。