OBJECTIVE: To determine the effects of nonsurgical treatments on pain and function in people with patellofemoral pain (PFP). DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: We searched MEDLINE, Web of Science, and Scopus databases from their inception until May 2022 for interventional randomized controlled trials (RCTs) in people with PFP. STUDY SELECTION CRITERIA: We included RCTs that were scored =7 on the PEDro scale. DATA SYNTHESIS: We extracted homogenous pain and function data at short- (=3 months), medium- (>3 to =12 months) and long-term (>12 months) follow-up. Interventions demonstrated primary efficacy if outcomes were superior to sham, placebo, or wait-and-see control. Interventions demonstrated secondary efficacy if outcomes were superior to an intervention with primary efficacy. RESULTS: We included 65 RCTs. Four interventions demonstrated short-term primary efficacy: knee-targeted exercise therapy for pain (standardized mean difference [SMD], 1.16; 95% CI: 0.66, 1.66) and function (SMD, 1.19; 95% CI: 0.51, 1.88), combined interventions for pain (SMD, 0.79; 95% CI: 0.26, 1.29) and function (SMD, 0.98; 95% CI: 0.47, 1.49), foot orthoses for global rating of change (OR = 4.31; 95% CI: 1.48, 12.56), and lower-quadrant manual therapy for function (SMD, 2.30; 95% CI: 1.60, 3.00). Two interventions demonstrated short-term secondary efficacy compared to knee-targeted exercise therapy: hip-and-knee-targeted exercise therapy for pain (SMD, 1.02; 95% CI: 0.58, 1.46) and function (SMD, 1.03; 95% CI: 0.61, 1.45), and knee-targeted exercise therapy and perineural dextrose injection for pain (SMD, 1.34; 95% CI: 0.72, 1.95) and function (SMD, 1.21; 95% CI: 0.60, 1.82). CONCLUSIONS: Six interventions had positive effects at 3 months for people with PFP, with no intervention adequately tested beyond this time point. J Orthop Sports Phys Ther 2022;52(11):750-768. Epub: 8 September 2022. doi:10.2519/jospt.2022.11359.
|Rehab Clinician (OT/PT)|
Given how common this problem is in a pediatric rheumatology practice, this is a highly relevant and high-quality synthesis of interventions. Useful reading for pediatric rheumatologists, although many pediatric rheumatologists may already be familiar with the results. Possibly less relevant for adult rheumatologists
I liked looking from the other end of the telescope and think it is worthwhile identifying therapies that are ineffective.
Patellofemoral pain has a multifactorial etiology and includes different pathologic categories (e.g., lateral patellar compression, stress syndromes, and maltracking disorders) due to local disorders (e.g., patella Alta, trochlear dysplasia, and so many others), lower limb axial and rotational disorders (e.g., genu Valgum and Varum), distant disorders (e.g., valgus heel, femoral anteversion, and weak core muscles), in addition to generalized joint laxity. Conservative treatment mainly (selected P.T) depends on the pathoanatomical site(s). It is not universal since we have > 30 pathoanatomical sites for these disorders.
This systematic review justifies the short-term conservative treatment of multiple combined interventions in patellofemoral pain syndrome. Long-term evidence is more difficult to prove ethically and strategically.
This is an important summary of pain research that has received insufficient attention. This is particularly important for early intervention; but as noted in the paper, longer-term investigations are sorely needed.
It was surprising to me that a condition that we consider relatively common is so poorly understood and studied. It was useful to understand what treatments were clearly shown as not being helpful.
These results will likely lead to changes in practice and should prompt studies of interventions in patients: people with persistent PFP should not be offered wait-and-see care given there are appropriate interventions with evidence of benefit available in the short term.