Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review.

Erin M Macri,Harvi F Hart,Marienke Van Middelkoop,Kay M Crossley,Sita M.A Bierma-Zeinstra,Christian J Barton,David Thwaites

doi:10.3390/jcm9113397

Abstract

Patellofemoral pain (PFP) and patellofemoral osteoarthritis (PFOA) are common, persistent conditions that may lie along a pathological spectrum. While evidence supports exercise-therapy as a core treatment for PFP and PFOA, primary care physicians commonly prescribe medication, or refer for surgical consults in persistent cases. We conducted a systematic review of medical interventions (pharmaceutical, nutraceutical, and surgical) for PFP and PFOA to inform primary care decision making. Methods: Following protocol registration, we searched seven databases for randomized clinical trials of our target interventions for PFP and PFOA. Our primary outcome was pain. We assessed risk of bias, calculated standardized mean differences (SMDs) and determined the level of evidence for each intervention. Results: We included 14 publications investigating pharmaceutical or nutraceutical interventions, and eight publications investigating surgical interventions. Two randomized control trials (RCTs) provided moderate evidence of patellofemoral arthroplasty having similar pain outcomes compared to total knee arthroplasty in isolated PFOA, with SMDs ranging from −0.3 (95% CI −0.8, 0.2, Western Ontario McMaster Pain Subscale, 1 year post-surgery) to 0.3 (−0.1, 0.7, SF-36 Bodily Pain, 2 years post-surgery). Remaining studies provided, at most, limited evidence. No efficacy was demonstrated for oral nonsteroidal anti-inflammatories or arthroscopic surgery. Conclusions: Pharmaceutical and nutraceutical prescriptions, and surgical referrals are currently being made with little supporting evidence, with some interventions showing limited efficacy. This should be considered within the broader context of evidence supporting exercise-therapy as a core treatment for PFP and PFOA.

Highlights

Patellofemoral pain (PFP) is a condition characterized by diffuse peri- or retro-patellar pain that is made worse by activities that increase patellofemoral joint load such as squatting, negotiating stairs, or running [1]
Like PFP, patellofemoral osteoarthritis (PFOA) is associated with pain [9,19], reduced physical function [19], and lower quality of life [20], and PFOA in turn may lead to whole knee osteoarthritis (OA) [21]
Where adequate data were reported, we reported effect sizes as Hedge’s standardized mean differences (SMD) with 95% confidence intervals (CI) using Stata SE 15.1 (StataCorp LLC, College Station, TX, USA)

Summary

Introduction

Patellofemoral pain (PFP) is a condition characterized by diffuse peri- or retro-patellar pain that is made worse by activities that increase patellofemoral joint load such as squatting, negotiating stairs, or running [1]. Like PFP, PFOA is associated with pain [9,19], reduced physical function [19], and lower quality of life [20], and PFOA in turn may lead to whole knee osteoarthritis (OA) [21]. These long-term consequences implore clinicians and researchers to ensure that the best evidence informs patient management, and highlights an urgent need for research aimed at improving patient outcomes

Methods

Results

Conclusion