Objectives:
Fatigue may have a negative impact on joint biomechanics during landings. This systematic review aimed to synthesize and gather available data on the effects of fatigue on the biomechanics of the lower extremity limbs during various movements, such as landing, among physically active populations.
Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, searching the PubMed, Scopus, Web of Science, and Google Scholar databases for original and peer-reviewed articles using selected keywords from inception to June ۲۰۲۵. The quality of the included studies was assessed using the Joanna Briggs Institute checklist. Statistical analysis was conducted with Comprehensive Meta-Analysis (CMA) software version ۴. To evaluate data heterogeneity, the Q-test and I² statistic were applied. Egger’s test was used to assess publication bias.
Results: After examining the titles and abstracts of ۱۶۹۲ studies from chosen databases, ۴۴ articles were deemed suitable for inclusion in meta-analyses.
Fatigue showed no significant effect on lower extremity kinematics during landing for hip flexion (P = ۰.۹۴۷, ۹۵% CI = -۰.۲۰۶ to ۰.۱۹۲), knee flexion (P = ۰.۸۸۵, ۹۵% CI = -۰.۱۳۵ to ۰.۱۵۶), knee adduction (P = ۰.۴۰۲, ۹۵% CI = -۰.۰۶۰ to ۰.۱۴۹), knee internal rotation (P = ۰.۲۶۳, ۹۵% CI = -۰.۰۹۱ to ۰.۳۳۴), hip abduction (P = ۰.۵۱۶, ۹۵% CI = -۰.۰۹۹ to ۰.۱۹۷), hip rotation (P = ۰.۷۶۰, ۹۵% CI = -۰.۳۹۱ to ۰.۲۸۶), ankle dorsiflexion (P = ۰.۳۷۲, ۹۵% CI = -۰.۱۱۶ to ۰.۳۰۹), and ankle supination (P = ۰.۳۲۶, ۹۵% CI = -۰.۲۳۰ to ۰.۶۹۲). However, a significant effect was observed for ankle inversion (P = ۰.۰۰۳, ۹۵% CI = ۰.۱۱۴ to ۰.۵۳۷). No significant differences were found between males and females across all kinematic variables. High heterogeneity was noted in most analyses (I² ranging from ۲۸.۸۷۷% to ۸۳.۶۴۲%), except for ankle inversion (I² = ۰.۰۰۰%). Egger’s test indicated no significant publication bias across all variables (P > ۰.۰۵).
Discussion: Contrary to common belief, fatigue does not appear to consistently alter hip and knee landing kinematics in healthy, active individuals, though it does increase ankle inversion, potentially elevating the risk of ankle sprains.