Comparing treatments for patellofemoral pain

What are the best options?

A combination of education and exercise, orthoses, taping, or mobilisation is the best option to achieve improvement of patellofemoral pain (PFP) after three months. At twelve months however, none of the analysed treatments has significant additional benefit when added to education alone. There is not enough evidence to recommend any particular treatment modality over another at this time point. Nevertheless, all modalities are superior to a wait-and-see approach. These conclusions are drawn by an international research group after conducting an extensive systematic review. 

In addition to the primary outcomes, this review also performed a subgroup analysis according to exercise region (hip/ knee or hip/ knee/ trunk) and did not find different effects across regions.

Another important aspect is that the heterogeneity in frequency and intensity of exercise, as well as the mode of delivery, makes it difficult to make accurate comparisons and provide conclusions on this matter.

> From: Winters et al., Br J Sports Med 55 (2021) 369-377 (Epub ahead of print). All rights reserved to The Author(s). Click here for the online summary.

Want to read deeper into this topic? You can find a free version of the full text article here!

Expert opinion

Despite the issues with the quality of the existing studies, there are still important takeaway messages from this review:

  1. Wait-and-see approaches should be avoided;
  2. Education and physical treatments seem more likely to have a positive effect;
  3. The effects of exercise may not be as region-specific as normally assumed.

The fact that education showed the biggest association with pain improvement and that the effects of exercise were not region-specific highlight the chronicity of PFP and the positive psychosocial effects of both these interventions.

Another advantage of this study is that it is a living review, which means that it can be updated when new evidence arises. For a more detailed overview of the findings, the full version of this review is available through open access.

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