Biomechanics associated with tibial stress fracture in runners: A systematic review and meta-analysis

•Tibial stress fracture (TSF) is an overuse running injury with a long recovery.•Many studies refer to biomechanical risk factors for TSF, but only 14 reports have compared biomechanics in runners with TSF to controls.•Meta-analysis indicated vertical impact peak, vertical active peak, and peak braking force were not statistically significantly different between runners with TSF and controls.•No conclusive biomechanical risk factors but several variables with moderate or large effects were identified for further investigation.•Studies may have been underpowered to detect differences. We encourage future studies to include larger samples sizes utilizing multi-center collaborations as appropriate to achieve this. Tibial stress fracture (TSF) is an overuse running injury with a long recovery period. While many running studies refer to biomechanical risk factors for TSF, only a few have compared biomechanics in runners with TSF to controls. The aim of this systematic review and meta-analysis was to evaluate biomechanics in runners with TSF compared to controls. Electronic databases PubMed, Web of Science, SPORTDiscus, Scopus, Cochrane, and CINAHL were searched. Risk of bias was assessed and meta-analysis conducted for variables reported in 3 or more studies. The search retrieved 359 unique records, but only the 14 that compared runners with TSF to controls were included in the review. Most studies were retrospective, 2 were prospective, and most had a small sample size (5–30 per group). Many variables were not significantly different between groups. Meta-analysis of peak impact, active, and braking ground reaction forces found no significant differences between groups. Individual studies found larger tibial peak anterior tensile stress, peak posterior compressive stress, peak axial acceleration, peak rearfoot eversion, and hip adduction in the TSF group. Meta-analysis indicated that discrete ground reaction force variables were not statistically significantly different in runners with TSF compared to controls. In individual included studies, many biomechanical variables were not statistically significantly different between groups. However, many were reported by only a single study, and sample sizes were small. We encourage additional studies with larger sample sizes of runners with TSF and controls and adequate statistical power to confirm or refute these findings. [Display omitted]