Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review
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...
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MDPI AG
2020-10-01
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author | Erin M. Macri Harvi F. Hart David Thwaites Christian J. Barton Kay M. Crossley Sita M.A. Bierma-Zeinstra Marienke van Middelkoop |
author_facet | Erin M. Macri Harvi F. Hart David Thwaites Christian J. Barton Kay M. Crossley Sita M.A. Bierma-Zeinstra Marienke van Middelkoop |
author_sort | Erin M. Macri |
collection | DOAJ |
description | 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. |
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issn | 2077-0383 |
language | English |
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publishDate | 2020-10-01 |
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spelling | doaj.art-2b29e06ae9fe4a15b16f776edc11b1172023-11-20T18:16:33ZengMDPI AGJournal of Clinical Medicine2077-03832020-10-01911339710.3390/jcm9113397Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic ReviewErin M. Macri0Harvi F. Hart1David Thwaites2Christian J. Barton3Kay M. Crossley4Sita M.A. Bierma-Zeinstra5Marienke van Middelkoop6Department of General Practice, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The NetherlandsSport and Exercise Medicine Research Centre, La Trobe University, Health Sciences Building 3, Bundoora VIC 3086, AustraliaSport and Exercise Medicine Research Centre, La Trobe University, Health Sciences Building 3, Bundoora VIC 3086, AustraliaSport and Exercise Medicine Research Centre, La Trobe University, Health Sciences Building 3, Bundoora VIC 3086, AustraliaSport and Exercise Medicine Research Centre, La Trobe University, Health Sciences Building 3, Bundoora VIC 3086, AustraliaDepartment of General Practice, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The NetherlandsDepartment of General Practice, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The NetherlandsPatellofemoral 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.https://www.mdpi.com/2077-0383/9/11/3397patellofemoral painpatellofemoral osteoarthritispharmaceuticalsnutraceuticalssurgery |
spellingShingle | Erin M. Macri Harvi F. Hart David Thwaites Christian J. Barton Kay M. Crossley Sita M.A. Bierma-Zeinstra Marienke van Middelkoop Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review Journal of Clinical Medicine patellofemoral pain patellofemoral osteoarthritis pharmaceuticals nutraceuticals surgery |
title | Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review |
title_full | Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review |
title_fullStr | Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review |
title_full_unstemmed | Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review |
title_short | Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review |
title_sort | medical interventions for patellofemoral pain and patellofemoral osteoarthritis a systematic review |
topic | patellofemoral pain patellofemoral osteoarthritis pharmaceuticals nutraceuticals surgery |
url | https://www.mdpi.com/2077-0383/9/11/3397 |
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