Tensor Fascia Latae Muscle Structure and Activation in Individuals With Lower Limb Musculoskeletal Conditions: A Systematic Review and Meta-Analysis.

BACKGROUND: Dysfunction of the tensor fascia latae (TFL) muscle is often clinically implicated in many musculoskeletal disorders.

OBJECTIVE: To systematically review the literature of the TFL muscle to determine whether there are differences in its structure and activation between individuals with and without lower limb musculoskeletal conditions.

DATA SOURCES: A comprehensive search in MEDLINE, EMBASE, CINHAL, and LILACS was undertaken from year of inception to 9 July 2019.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies that directly investigated the structure or activity of the TFL muscle between individuals with a lower limb musculoskeletal condition and a pain-free control group.

RESULTS: Seventeen studies were included (n = 556 participants), eight reporting structure and ten activation of the TFL muscle. Conditions included lateral hip pain, hip joint pathology, ACL injury, iliotibial band syndrome, and patellofemoral joint osteoarthritis. Meta-analysis identified with low confidence (p value = 0.07) a small tendency towards hypertrophy in the affected side of participants with hip joint diseases (SMD 0.37, 95% CI [- 0.02, 0.77]). Moderate effect sizes were found for a higher cross-sectional area of the TFL/sartorius ratio in abductor tendon tear (SMD 0.74; 95% CI [0.05, 1.43, p value = 0.04), and for a smaller body mass normalized TFL volume in patellofemoral joint osteoarthritis (SMD - 0.61; 95% CI [- 1.23, 0.00], p value = 0.05). Normalised electromyography (EMG) amplitude did not differ between groups for any condition, but when EMG was analysed as linear envelopes or synergies, some differences in pattern of TFL activation were observed between individuals with lateral hip pain and controls. Timing of TFL activation did not differ between individuals with knee conditions and controls.

CONCLUSIONS AND IMPLICATIONS: Common clinical assumptions of the role of TFL muscle in lower limb musculoskeletal conditions are not well investigated and poorly supported by current research. There are contradictory findings on the muscle size of TFL. Differing methodology in muscle activation studies precludes a clear interpretation for comparison between groups.

PROSPERO REGISTRATION NUMBER: CRD42017076160.