Relação entre as características da musculatura glútea e a estabilização dinâmica do joelho: revisão sistemática da literatura

Abstract

Introduction: The knee is responsible for the absorption of forces imposed by daily activities such as walking, jumping, climbing and going down stairs. Stability of this joint seems to be influenced by hip movement as it controls pelvic and femoral motion so that, distally, in the knee, motion takes place without any of the likely injuries associated with dynamic joint malalignment. Gluteal muscles seem to play an important part in the biomechanical characteristics of the knee joint. Objectives: To conduct a systematic review of the literature in order to identify possible characteristics and actions of gluteal muscles in dynamic knee stabilization and to investigate the effectiveness of interventional programs that focus on the gluteal muscles in improving the functional or symptomatologic outcomes associated with the knee joint. Methods: Systematic review performed according to PRISMA protocol (Preferred Report Items for Systematic Reviews and Meta-Analyses). Electronic databases (MEDLINE, SCIELO, COCHRANE, LILACS and PEDro) were searched using a search strategy of different combinations of terms related to the study subject. Inclusion criteria were: studies published up to March 2016, sample of subjects aged 18-60 years, language of publication unrestricted, involving assessment or treatment of any feature of the hip muscles in relation to dynamic knee stabilization. Results: Of the 109 studies found, eleven met inclusion criteria and were included. Of these, eight (73%) were of the observational exploratory type study and three (27%) randomized controlled trials (RCTs) (5PEDro8). All RCTs included young female adults with patellofemoral pain syndrome and assessed the gluteus medius muscle. According to the results of the most part of the included studies, gluteal muscles are involved in maintaining frontal plane lower limb alignment that reduces dynamic valgus during functional activities, therefore revealing the greater importance of magnitude of muscle activation rather than time of activation. The RCTs provided evidence of the importance of gluteal muscle interventions in knee rehabilitation programs: in symptomatic subjects with patellofemoral pain syndrome there was significant improvement in function and symptoms after this kind of intervention. Conclusion: Magnitude of activation and gluteal muscle strength play an important role in dynamic knee stability. Gluteal muscle interventions effectively improved functional and symptomatologic outcomes related to the knee joint.