Neuromotor function following lower-limb muscle or tendon injury: Systematic review and meta-analysis

Alterations in neuromotor function occur following lower-limb injuries and might be a factor in recurrent injury. We evaluated if adults with previous lower-limb muscle or tendon injury demonstrate differences in neuromotor function compared with uninjured or control limbs. A systematic search of health databases MEDLINE, EMBASE, CINAHL, and SPORTDiscus was conducted from inception until the end of April 2024. Studies evaluating neuromotor function of adults with a history of lower-limb muscle or tendon injury compared to an uninjured contralateral or control limb were included. Inverse variance, random effects meta-analyses were used to generate effect estimates for neuromotor outcomes. A best evidence synthesis determined the level of evidence (LOE) and summary estimates for changes in neuromotor function. Sixty-three studies (1 796 participants) were included, with injuries to Achilles, gluteal and patella tendons and adductor, calf, hamstring and rectus femoris muscles. Below one quarter (21%) of 232 neuromotor outcomes identified were amenable to data pooling. Evidence for changes in neuromotor function were found, notably, a reduction in lateral hamstring activation during isokinetic contractions (LOE: strong) and knee joint position sense (2 studies: control SMD = 1.11, 95% CI = [0.61, 1.61]; p = < 0.000 1; 2 studies: uninjured SMD = 0.98, 95% CI = [0.37, 1.58]; p = 0.002; LOE: strong) in hamstring strain injury. Differences in neuromotor function were present in injured compared to control and uninjured limbs, including reduced muscle activation and proprioception in hamstring muscle injury. Methodological diversity was common, however, and variable results were found. As such, the overall impact of lower-limb muscle or tendon injury on neuromotor function remains uncertain.