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Article

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

1
Department of General Practice, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
2
Department of Family Practice, The University of British Columbia, 5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
3
Sport and Exercise Medicine Research Centre, La Trobe University, Health Sciences Building 3, Bundoora VIC 3086, Australia
4
Department of Physical Therapy, Western University, London CA N6G 2V4, UK
5
Department of Surgery, St Vincent’s Hospital, University of Melbourne, Building 181, Grattan St, Melbourne VIC 3010, Australia
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(11), 3397; https://doi.org/10.3390/jcm9113397
Received: 16 September 2020 / Revised: 6 October 2020 / Accepted: 19 October 2020 / Published: 23 October 2020
(This article belongs to the Special Issue Diagnosis and Treatment of Musculoskeletal Disorders)
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. View Full-Text
Keywords: patellofemoral pain; patellofemoral osteoarthritis; pharmaceuticals; nutraceuticals; surgery patellofemoral pain; patellofemoral osteoarthritis; pharmaceuticals; nutraceuticals; surgery
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MDPI and ACS Style

Macri, E.M.; Hart, H.F.; Thwaites, D.; Barton, C.J.; Crossley, K.M.; Bierma-Zeinstra, S.M.A.; van Middelkoop, M. Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review. J. Clin. Med. 2020, 9, 3397. https://doi.org/10.3390/jcm9113397

AMA Style

Macri EM, Hart HF, Thwaites D, Barton CJ, Crossley KM, Bierma-Zeinstra SMA, van Middelkoop M. Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review. Journal of Clinical Medicine. 2020; 9(11):3397. https://doi.org/10.3390/jcm9113397

Chicago/Turabian Style

Macri, Erin M., Harvi F. Hart, David Thwaites, Christian J. Barton, Kay M. Crossley, Sita M.A. Bierma-Zeinstra, and Marienke van Middelkoop. 2020. "Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review" Journal of Clinical Medicine 9, no. 11: 3397. https://doi.org/10.3390/jcm9113397

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