The Efficacy of Hip and Knee Muscles Strengthening Versus Knee Muscle Strengthening Alone in Managing Patellofemoral Pain Syndrome: A Systematic Review and Meta-Analysis.

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Patellofemoral pain syndrome (PFPS) is a common knee issue in young adults characterised by anterior knee pain during knee flexion with weight-bearing or prolonged sitting. Physical therapy is the primary treatment. This systematic review and meta-analysis compares the efficacy of hip and knee muscle strengthening (HKS) versus knee muscle strengthening alone (KS) in managing PFPS. Following PRISMA guidelines, a systematic search of Elsevier, PubMed, Cochrane, and Web of Science identified randomized controlled trials (RCTs) comparing HKS and KS in PFPS patients. A risk of bias tool assessed study quality. Outcomes, including pain, functional activity, and muscle strength, were analysed using a random-effects model with standardized mean difference (SMD) and 95% confidence intervals. Six RCTs involving 241 patients (96.3% females) were included. HKS significantly improved pain (SMD=-1.29, 95% CI [-1.98, -0.59], p=0.0003, I2=87%) and functional activity (SMD=0.99, 95% CI [0.22, 1.76], p=0.01, I2=88%) compared to KS. No significant difference was observed in muscle strength (SMD=0.20, 95% CI [-0.31, 0.71], p=0.44, I2=63%). HKS effectively reduces pain and improves functional activity in patients with PFPS. Further research is needed to confirm these findings and address study limitations. This systematic review was registered in PROSPERO (CRD42023451065) and reported by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.