Review Article

The Effects of Leg Length Discrepancy on Stability and Kinematics-Kinetics Deviations: A Systematic Review

Table 4

Summary of the kinematics and kinetics parameters related to LLD studies.

AuthorCategoryPlaneLL differenceParametersLLDControl value
KinematicsKinetics

Swaminathan et al. [14]Lowered leg3.5 cmWD
Raised leg (control)
Zhang et al. [11]Gait walker (LLD), shoe (control)Coronal4.6 cmAnkle eversion (°)−2.8 ± 4.6−4.5 ± 2.3
Ankle ROM (°)1.8 ± 4.98.7 ± 3.3
Hip adduction (°)5.1 ± 3.65.8 ± 2.8
Hip ROM (°)6.1 ± 2.08.3 ± 2.4
Knee adduction (°)3.9 ± 2.24.6 ± 2.9
Knee ROM (°)2.4 ± 2.53.3 ± 1.8
SagittalAnkle dorsiflexion (°)11.1 ± 4.311.9 ± 3.4
Ankle ROM (°)7.3 ± 4.35.7 ± 4.6
Hip extension (°)2.4 ± 9.50.6 ± 10.9
Hip ROM (°)37.2 ± 4.437.1 ± 5.4
Knee flexion (°)22.7 ± 4.915.5 ± 8.7
Knee ROM (°)9.5 ± 4.78.5 ± 5.4
Resende et al. [3]Short leg (control)Coronal1.45 cmHip adduction (°)−6.89 ± 17.8−1.82 ± 18.8
Pelvic obliquity decrease (°)7.13 ± 11.20.23 ± 12.5
Ankle inversion moment (Nm·kg−1)−0.09 ± 0.80.008 ± 0.8
Rearfoot inversion (°)7.79 ± 21.01.65 ± 21.1
Rearfoot dorsiflexion (°)
SagittalKnee flexion (°)16.2 ± 18.9−5.4 ± 16.9
Hip flexion (°)−10.08 ± 52.7−2.44 ± 48.1
Ankle dorsiflexion moment (Nm·kg−1)−18.03 ± 34.92.79 ± 35.2
Knee flexion moment (Nm·kg−1)1.01 ± 0.9−0.25 ± 1.0
Hip flexion moment (Nm·kg−1)0.46 ± 1.560.05 ± 1.5
Long leg (control)Coronal1.45 cmRearfoot inversion (°)0.36 ± 0.93−0.22 ± 0.9
Hip adduction (°)−9.44 ± 20.01.65 ± 21.1
Knee adduction8.71 ± 23.3−1.82 ± 18.8
SagittalRearfoot dorsiflexion (°)moment (Nm·kg−1)−0.13 ± 0.70.03 ± 0.8
Knee flexion (°)−10.8 ± 19.3−5.4 ± 16.9
Hip flexion (°)12.52 ± 53.9−2.44 ± 48.1
Pelvic obliquity down (°)15.24 ± 33.92.79 ± 35.2
Ankle dorsiflexion moment (Nm·kg−1)−7.36 ± 14.70.23 ± 12.5
−0.77 ± 0.8−0.25 ± 1.0
Ankle flexion moment (Nm·kg−1)−0.5 ± 1.540.05 ± 1.5
Walsh et al. [4]LLDs, short legCoronal0 cmPelvic obliquity (°)
Sagittal,1 cm0.3 ± 2.2
Lateral2 cm2 cm
2.5 cm2.5 ± 1.4
3 cm3.4 ± 1.6
5 cm2.7 ± 1.7
0 cmHip flexion (°)2.7 ± 1.7
1 cm32.2 ± 3.6
2 cm33.5 ± 3.2
2.5 cm35.0 ± 3.0
3 cm35.1 ± 3.1
5 cm36.0 ± 3.8
0 cmKnee flexion (°)39.7 ± 4.5
1 cm13.6 ± 5.4
2 cm16.9 ± 4.5
2.5 cm15.4 ± 3.6
3 cm14.5 ± 5.6
5 cm15.9 ± 2.7
0 cmAnkle flexion (°)20.8 ± 4.5
1 cm53.3 ± 3.0
2 cm9.6 ± 3.0
2.5 cm11.2 ± 2.2
3 cm14.6 ± 3.6
5 cm15.1 ± 5.2
LLDs, short legCoronal0 cmKnee flexion (°)14.7 ± 5.0
Sagittal1 cm49.8 ± 11.3
Lateral2 cm48.2 ± 8.7
2.5 cm48.0 ± 7.1
3 cm48.3 ± 7.4
5 cm48.4 ± 7.0
0 cmAnkle flexion (°)43.7 ± 7.0
1 cm−17.8 ± 6.9
2 cm−21.5 ± 5.0
2.5 cm−21.9 ± 5.8
3 cm−21.3 ± 6.3
5 cm−21.6 ± 4.9
−24.3 ± 9.7
Resende et al. [18]LLD, short legSagittal1.45 cmRearfoot plantar flexion (°)
Knee flexion (°)
Hip abduction (°)
Pelvic external-internal rotation (°)
Trunk external-internal rotation (°)
Ankle dorsiflexion moment (Nm·kg−1)
Knee flexion moment (Nm·kg−1)
Knee abduction moment (Nm·kg−1)
Hip flexion moment (Nm·kg−1)
Hip abduction moment (Nm·kg−1)
Seeley et al. [17]LLDs, long legSagittal<1 cm
LLDs, short legHip (°)0.99 ± 0.01
Knee (°)0.99 ± 0.01
Ankle (°)0.97 ± 0.02
Hip moment (Nm·kg−1)0.94 ± 0.06
Knee moment (Nm·kg−1)0.85 ± 0.11
Ankle moment (Nm·kg−1)0.98 ± 0.02
Hip power (W·kg−1)0.81 ± 0.14
Knee power (W·kg−1)0.85 ± 0.07
Ankle power (W·kg−1)0.94 ± 0.04
≥1 cmHip (°)0.98 ± 0.04
Knee (°)0.96 ± 0.08
Ankle (°)0.87 ± 0.22
Hip moment (Nm·kg−1)0.66 ± 0.37
Knee moment (Nm·kg−1)0.96 ± 0.08
Ankle moment (Nm·kg−1)0.86 ± 0.15
Hip power (W·kg−1)0.41 ± 0.52
Knee power (W·kg−1)0.50 ± 0.38
Ankle power (W·kg−1)0.69 ± 0.31
Wünnemann et al. [8]Left leg, right leg (control)Coronal3.068.79
Hip adduction (°)−11.66−5.22
Hip abduction (°)32.1735.92
Hip flexion (°)−15.24−10.14
Hip extension (°)0.840.94
Trunk forward tilt(°)3.097.24
Pelvis lateral tilt (°)
SagittalKnee flexion (°)0.550.65
Foot dorsiflexion (°)1.241.11
Foot plantar flexion (°)3.125.58
Step length (cm)2.757.76
Single support time (s)−14.88−0.47
Hip extension moment (Nm·kg−1)71.1177.34
VGRF (N)37.3738.27
Knee flexion moment (Nm·kg−1)−0.31−0.05
Knee abduction moment (Nm·kg−1)0.640.47
Ankle plantar flexion moment (Nm·kg−1)1.621.01
Park et al. [5]Left leg, right leg (control)0 cmStep length (cm)64.00 ± 6.1563.29 ± 6.36
1 cm64.71 ± 6.6561.82 ± 6.26
2 cm65.71 ± 7.3562.35 ± 6.74
3 cm66.35 ± 8.7662.41 ± 7.38
0 cmStep time (s)0.63 ± 0.0550.62 ± 0.06
1 cm0.62 ± 0.0640.63 ± 0.06
2 cm0.61 ± 0.0480.65 ± 0.06
3 cm0.61 ± 0.0460.66 ± 0.06
0 cmStride length (cm)127.47 ± 12.6
1 cm126.59 ± 12.8
2 cm128.18 ± 14.1
3 cm129.00 ± 15.9
0 cmStride time (s)1.25 ± 0.11
1 cm1.25 ± 0.13
2 cm1.26 ± 0.10
3 cm1.26 ± 0.10
0 cmSingle leg support (%)34.13 ± 1.5134.68 ± 1.04
1 cm34.49 ± 1.5134.21 ± 1.11
2 cm35.41 ± 1.6033.92 ± 1.11
3 cm35.78 ± 1.7533.39 ± 1.27
0 cmDouble leg support (%)31.21 ± 2.22
1 cm31.30 ± 2.07
2 cm30.67 ± 2.13
3 cm30.84 ± 2.26
Stief et al. [16]LCPDs, short leg (control)Coronal1.10 ± 0.53Max. adduction knee moment (Nm·kg−1)0.14 ± 0.110.26 ± 0.08
Max. adduction hip moment (Nm·kg−1)0.42 ± 0.040.58 ± 0.11
SagittalMax. knee flexion (°)19.5 ± 9.022.8 ± 6.1
Max. knee extension (°)10.9 ± 5.85.9 ± 3.3
Knee ROM (°)11.8 ± 4.117.3 ± 6.0
Max. hip flexion (°)29.9 ± 7.635.7 ± 5.3
Max. hip extension (°)−3.0 ± 9.6−10.3 ± 4.9
Hip ROM (°)33.2 ± 9.846.7 ± 6.0
Max. pelvis obliquity (°)3.7 ± 3.34.4 ± 2.9
Pelvis obliquity ROM (°)7.7 ± 2.79.9 ± 3.8
Maeda et al. [9]Right legCoronal0.1 cmWD (%)
Left leg (control)Sagittal≥0.6 cmWD (%)
Left legCoronal0.1 cmWD (%)
Right leg (control)Sagittal≥0.4 cmWD (%)
Faraj et al. [10]LLD, right leg, short left leg (control)Coronal±2.25 cmMean peak plantar pressure (kpa)400300
Stance contact duration (msec)750500
4535
Contact area (cm2)
Ali et al. [2]LLD, right legSagittal1 cmMax. foot pronation
Short left leg (control)Max. foot supination
Lopes et al. [22]LLD, short leg (control)CoronalHHA (°)1.02 ± 3.860.68 ± 3.57
AHA (°)−0.07 ± 2.700.31 ± 1.67
ASISHA (°)0.07 ± 2.70−0.23 ± 2.01
AcASHA (°)0.14 ± 3.35−0.52 ± 2.67
RLFA (°)−2.98 ± 5.65−2.59 ± 4.76
LLFA (°)−2.70 ± 4.01−3.19 ± 5.12
DBLL (°)−0.74 ± 5.661.38 ± 5.09
TTHA (°)0.75 ± 2.271.31 ± 1.71
RHA (°)17.3 ± 13.123 ± 15.9
LHA (°)19.8 ± 1620.4 ± 12.4
ST3Has (cm)0.08 ± 24.81.12 ± 24.8
RLHA (°)2.30 ± 8.976.58 ± 8.21
LLHA (°)5.60 ± 8.795.98 ± 8.80
SagittalHHA (R) (°)39.6 ± 7.8140.7 ± 8.50
HVA (R) (°)23.5 ± 11.520.8 ± 12.7
TVA (R) (°)−5.88 ± 3.50−2.85 ± 3.22
HA (R) (°)−12.7 ± 7.55−6.63 ± 5.53
BVA (R) (°)1.25 ± 1.501.37 ± 1.39
PHA (R) (°)−12.7 ± 6.96−18.1 ± 9.57
KA (R) (°)−1.62 ± 7.351.18 ± 6.23
AA (R) (°)84.8 ± 3.9085.1 ± 3.40
HHA (L) (°)39.1 ± 7.9141.6 ± 9.20
HVA (L) (°)24 ± 10.219.5 ± 12.3
TVA (L) (°)−5.31 ± 3.40−3.23 ± 3.17
AHA (°)−0.07 ± 2.700.31 ± 1.67
HA (L) (°)−12.5 ± 6.88−8.31 ± 5.41
BVA (L) (°)1.36 ± 1.711.71 ± 1.24
PHA (L) (°)−12.3 ± 9.02−20.2 ± 6.20
KA (L) (°)−2.71 ± 6.85−0.68 ± 5.19
AA (L) (°)85.5 ± 3.9885.4 ± 3.23

HHA: head horizontal alignment; AHA: acromion horizontal alignment; ASISHA: anterior-superior iliac spine horizontal alignment; AcaSISA: angle between the acromion and anterior-superior iliac spine alignment; RLFA: right limb frontal angle; LLFA: left limb frontal angle; DBLL: difference between lower limbs; TTHA: tibia tuberosity horizontal angle; RHA: right hip angle; LHA: left hip angle; RLHA: right leg-heel angle; LLHA: left leg-heel angle; HVA: head vertical alignment; TVA: trunk vertical alignment; HA: hip angle; BVA: body vertical alignment; PHA: pelvis horizontal alignment; KA: knee angle; AA: ankle angle; BL: bilateral; FP: foot pronation; FS: foot supination; LWD: lateral weight distribution; AWD: anterior weight distribution; BS: bilateral-sagittal; CL: contralateral; (R): right side; (L): left side; (°): angle