Table 1 The study characteristics, level of evidence, outcomes, setting, methods, and results of the included studies

Study

Study Design, Level of Evidence

Number of partecipants,age, sex

Outcome Parameters

Setting

Method

Results

Ueno et al. 2020 [4, 17]

Descriptive laboratory study,Level of evidence III

30 females (mean age 15.6 ± 1.6 years)

relationships between knee abduction moment and frontal plane biomechanics

Motion analysis and electromyography

Jump-landing task from a 30 cm step

Knee abduction moment was predicted by lower gluteus medius strength

Llurda-Almuzara et al. .2020 [21]

Descriptive laboratory study, Level of evidence III

50 healthy men (between 18 to 29 years old)

Dynamic knee valgus (DKV) and hip and knee neuromuscular response (NMR).

Motion analysis and electromyography

Jump-landing task from a 50 cm step

No correlation between DKV and NMR and this could be explained because of the influence of Central Nervous System

Cronin et al. 2016 [22]

Descriptive laboratory study, Level of evidence III

40 healthy active females (mean age, 21.0 ± 1.7 years)

Relationship between Hip abduction and knee motion during a single-leg jump-cutting task in females.

Motion analysis and electromyography

Single-leg jump-cuts

The gluteus maximus, functioning as a hip abductor may take on a pivotal role in controlling hip adduction and knee valgus motion during these types of tasks

Smeets et al. 2019 [23]

Randomized controlled trial, Level of evidence I

21 athletes who had an ACLR and 21 uninjured controls (mean age 23.8 ± 4.2 years and 21.5 ± 1.5 years)

Comparison between ACLR athletes and uninjured athletes during landing kinematic, kinetic and/or muscle activation profiles fatigue induced.

Motion analysis and electromyography

Single leg hop,medial and lateral hop,vertical hop with 90° of medial or lateral rotation

ACLR athletes and uninjured athletes have similar biomechanical and neuromuscular responses to fatigue.

Neamatallah et al. 2019 [39]

Correlation study, Level of evidence III

17 males and 17 females respectively aged 26.9 ± 3.8 years and 25.7 ± 4.5 years

Gluteal muscle EMG activity related to hip abduction and extension muscle strength and consequent knee and hip angles and moments.

Motion analysis and electromyography

Single-leg Squat,Forward Land and Side land) from a 30 cm platform.

In females knee abduction moments and angles were strongly correlated to hip abduction strength. In males the relationships were less clear.

Patrek et al., 2011 [10]

Descriptive laboratory study Level of evidence IV

20 physically active women (mena age 21.0 ± 1.3 years)

examine the changes in single-leg landing mechanics and gluteus medius recruitment that occur after a hip-abductor fatigue protocol.

Maximum isometric strength of the hip abductors was tested using a Nicholas MMT handheld dynamometer and stabilization strap

Participants were tested before and after a hip-abductor fatigue protocol.

Changes observed during single-leg landings after hip-abductor fatigue were not generally considered unfavorable to the integrity of the anterior cruciate ligament.

Study

Study Design, Level of Evidence

Number of partecipants,age,sex

Outcome Parameters

Setting

Method

Results

Hogg et al., 2021 [24]

Comparative study, Level of evidence III

45 healthy females (mean age 20.1 ± 1.7); and 45 healthy males (mean age 20.8 ± 2.0)

Gluteal strength and activation mediate associations between femoral alignment measures and functional valgus collapse.

Three-dimensional biomechanics and surface electromyography.

Single-leg forward landing.

In females less gluteal strength and higher muscle activation were marginally associated with valgus movement. In males, less gluteal strength was associated with a more varus posture.

Dai et al., 2014 [25]

Comparative study, Level of evidence III

13 male and 15 female recreational athletes (mean age: 21.1¬ ± 2.4 years)

Quantify the effects of a resistance band on internal hip abduction moments and gluteus medius activation during the pre-landing and early-landing phases of a jump–landing–jump task.

Surface electrodes, retroreflective markers. Reaction forces were collected using a force plate.

jump-landing-jump tasks with or without a resistance band applied to their lower shanks.

A resistance band applied to the lower shanks increased internal hip abduction moments and gluteus medius EMG during the pre-landing and early-landing phases of a jump–landing and jump task.

Homan et al. 2012 [8]

Comparative study, Level of evidence III

41 males, 41 females aged respectively 21 ± 3 and 21 ± 3 years

Define the Influence of hip strength on gluteal activation and knee valgus motion.

Electromyography

Maximal isometric hip abduction and external rotation contractions during jump landing.

Weaker individuals compensate for a lack of force production via heightened neural drive. As such, hip muscle strength influences knee valgus motion indirectly by determining neural drive requirements

Rath et al., 2016 [26]

Descriptive laboratory study Level of evidence IV

12 female soccer players (mean age: 19.4 ± 1.4 years, with supple planus (SP) or rigid feet (RF).

Determine the degree to which subtalar joint pronation resulting from a SP foot affects knee alignment, hip muscle activation and ground reaction force attenuation

Surface EMG and force plate

three broad jump-to-cut trials

Decreased hip muscle activation during a broad jump-to-cut maneuver is associated with SP foot. This result in increased risk of non-contact ACL injury in female soccer players.

Sinsurin et al., 2020 [27]

Descriptive laboratory study Level of evidence IV

12 Males and 8 Females (mean age 30.8 ± 7 years)

Define differences in the trunk, pelvis,hip, and knee joints, and gluteus medius muscle activity

Motion analysis and electromyography

Walking and step down from two riser heights.

Gluteus Medius has a greater stabilizing role during the step-down tasks

Lubahn et al., 2011 [28]

Descriptive laboratory study, Level of evidence III

18 healthy females (mean age 22.3 ± 2.3 years)

Examine the muscular activation of the gluteus maximus and gluteus medius

Motion analysis and electromyography

Double and single leg squat

The SLS was most effective exercise for activating the gluteus maximus and gluteus medius. Applied knee load does not appear to increase muscle activation during SLS and FSU

Study

Study Design, Level of Evidence

Number of partecipants,age, sex

Outcome Parameters

Setting

Method

Results

Russell et al., 2006 [29]

Comparative study, Level of evidence III

16 Males mean age 24.6 ± 5 years, and 16 females: mean age 21.6 ± 6 years)

Determine if frontal-plane knee angle and Gluteus medius activation differ between the sexes at initial contact and maximal knee flexion during a single-leg drop landing.

Motion analysis laboratory

Evaluation at initial contact and maximal knee flexion during a single-leg drop landing.

Women tended to land in more knee valgus before and at impact than men. The GM muscle activation did not differ between the sexes.

Hollman et al. 2013 [30]

Descriptive laboratory study Level of evidence IV

40 Active, healthy women aged 18 to 36

Determine if hip muscles are correlated to frontal plane knee motion.

handheld dynamometer, electromyography

jump-landing task

Hip-extensor strength and gluteus maximus recruitment are both associated with frontal-plane knee motions during a dynamic weight-bearing task.

Cannon et al. 2019 [6]

Descriptive laboratory study Level of evidence IV

18 Female participants (mean age: 20.7 ± 1.3 years)

Investigate the influence of lumbar spine joint rotational stiffness (JRS), and gluteal musculature contribution to hip JRS, on dynamic knee valgus

Electromyography

Drop vertical jump

Increased JRS at the lumbar spine and greater JRS contributions from the gluteal musculature are linked with preventing high medial knee displacement.

Camparis Lessi et al., 216

Comparative study, Level of evidence III

7 Men mean age 23.90 ± 2.80 and 7 women mean age 24.7 ± 5.3 years)

Compare the effects of muscle fatigue on trunk, pelvis and lower limb kinematics and on lower limb muscle activation between male and female athletes who underwent ACL reconstruction.

Laboratory setting

Single leg drop vertical jump task, before and after a lower limb muscle fatigue protocol

Muscle fatigue produced kinematic alterations that have been shown to increase the risk for a second ACL injury in female athletes.

Fadari Dehcheshmeh et al. 2021 [31]

Descriptive laboratory study Level of Evidence IV

34 professional female athletes aged 18.29 ± 3.29 years

Influence of Lumbo-Pelvic Control (LPC) on landing mechanics and lower limb muscle activity in professional athletes engaged in sport requiring frequent landing.

Electromyography was used to record the activity of the gluteus medius (GMed), rectus femoris, and semitendinosus.

Jump-landing tasks

Poor lumbopelvic control afects the kinematics and activity of the lower limb muscles, and may be a risk factor for lower limb injuries, especially of the knee

Study

Study Design, Level of Evidence

Number of partecipants,age, sex

Outcome Parameters

Setting

Method

Results

Baker et al. 2018 [28]

Comparative study, Level of evidence III

16 Men mean age 33.70 ± 7.80 and 14 women mean age 32.7 ± 6.3 years)

Influence of Iliotibial Band Syndrome in Knee and Hip Adduction and Hip Muscle activation in runners.

Motion capture, Surface electromyography

30 minutes running evaluation

Injured runners demonstrated increased knee adduction compared with control runners at 30 minutes

Willson et al. 2012 [12]

Comparative study, Level of evidence III

19 Men mean age 20.4 ± 1.80 and 19 Women mean age 20.5 ± 1.5 years)

Differences in the timing and magnitude of gluteal muscle activity as well as hip and knee joint frontal and transverse plane kinematics between male and female runners in the context of this gender bias.

Motion analysis and electromyography

Running evaluation

Females ran with 40% greater peak gluteus maximus activation level and 53% greater average activation level than males. Female runners also displayed greater hip adduction and knee abduction angles at initial contact.

Sritharan et al. 2012 [32]

Descriptive laboratory study Level of Evidence IV

8 healthy males (age: 26 ± 4 years)

Muscle contribution to the external knee adduction moment, tibiofemoral joint reaction force, and reaction moment.

Motion analysis and electromyography

Walking

Gluteus medius contributed substantially to the medial compartment compressive force leading to greater dynamic knee valgus

Pohl et al. 2015 [33]

Descriptive laboratory study Level of Evidence IV

8 healthy, active males (mean age 27 ± 6 years)

To experimentally reduce hip-abduction strength and observe the subsequent changes in frontal-plane biomechanics.

Superior gluteal nerve block injection and subsequent gait analysis

Walking

Reduction in hip-abductor strength was not associated with alterations in the frontal-plane gait biomechanics of young, healthy men

Sinsurin et al. 2019 [27]

Descriptive laboratory study Level of Evidence IV

12 Males and 8 females (mean age 30.9 ± 7 years)

explore differences in the coronal biomechanics of the trunk, pelvis,hip, and knee joints, and gluteus medius muscle activity during walking and step down

Motion analysis and electromyography

Walking and step down

Significantly greater knee adduction moments were seen during both step-down tasks comparedto level walking with significantly greater Gluteus medius activity

DeJong et al. 2019 [34]

Descriptive laboratory study Level of Evidence IV

8 Males and 20 females (mean age 19.6 ± 1.5 years)

Determine differences in Ultrasound Imaging gluteal muscle activity during gait.

Ultrasound of the gluteus maximus and medius during quiet stance, heel strike, and walking.

Walking and quiet stance

USI highlighted gluteal activity differences of Medial Knee Displacement limbs during gait, which may contribute to inadequate hip stabilization during this daily repetitive task

Henriksen et al. 2009 [35]

Descriptive laboratory study Level of Evidence IV

6 males and 9 females (mean age. 24.8 ± 6.1 years)

Test that reduced function of the gluteus medius muscle would lead to increased external knee adduction moment during walking in healthy subjects.

Intramuscular hypertonic saline injection and subsequent gait analysis with electromyography

Walking

Experimentally reduced Gluteus Medius function, leads to reduced internal hip abductor moments and external knee adduction moments.

Study

Study Design, Level of Evidence

Number of partecipants,age, sex

Outcome Parameters

Setting

Method

Results

Hollman et al. 2013 [30]

Descriptive laboratory study Level of evidence IV

40 Active, healthy women aged 18 to 36

Examine relationships between hip muscle strength, recruitment and frontal plane knee kinematics and knee valgus during squat task

Muscle strength was measured bilaterally with a handheld dynamometer, recruitment was measured with surface electromyography.

Single leg Squat

Gluteus maximus recruitment may modulate frontal plane knee kinematics during single-leg squats..

Kim et al. 2015 [36]

Descriptive laboratory study Level of evidence IV

20 females (mean age 22.6 ± 2.5 years)

Examine the relationship of anticipatory activity of the gluteus medius to pelvic drop and knee abduction moment.

Motion analysis and electromyography

Squat task

The amount of gluteus medius activity is more important for controlling knee and pelvic stability in the frontal plane than the onset of activation.

Nakagawa et al. 2012 [31]

Comparative study, Level of evidence III

20 men with PFPS 20 men without, 20 women with PFPS and 20 without, aged from 18 to 35 years

differences between sexes in trunk, pelvis,hip, and knee kinematics, hip strength, and gluteal muscle activation during the performance of a single-leg squat in individuals with patellofemoral pain syndrome (PFPS) and control participants.

Hip abduction and external rotation eccentric strength was measured on an isokinetic dynamometer

Single leg Squat

Both males and females with PFPS had reduced eccentric strength of the hip abductors and external rotators.

Lubahn et al. 2011 [28]

Level of Evidence III

18 healthy females (mean age 22.3 ± 2.3)

Examine the muscular activation of the gluteus maximus and gluteus medius during squat task

Motion analysis and electromyography

Single and double leg squat

Single leg squat achieved the highest activation of the gluteus maximus and gluteus medius

Padua et al. 2012 [37]

Descriptive laboratory study

Level of evidence IV

60 partecipants,30 females (23.9 ± 3.6) and 30 males 22.2 ± 2.6.

Compare hip muscle strength in patients with Knee Medial Displacement

Motion analysis and electromyography

Double leg squat

Medial knee displacement during squatting tasks appears to be associated with increased hip-adductor activation.