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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Main Authors: Erin M. Macri, Harvi F. Hart, David Thwaites, Christian J. Barton, Kay M. Crossley, Sita M.A. Bierma-Zeinstra, Marienke van Middelkoop
Format: Article
Language:English
Published: MDPI AG 2020-10-01
Series:Journal of Clinical Medicine
Subjects:
Online Access:https://www.mdpi.com/2077-0383/9/11/3397
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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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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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