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

被引:7
作者
Macri, Erin M. [1 ,2 ]
Hart, Harvi F. [3 ,4 ]
Thwaites, David [3 ]
Barton, Christian J. [3 ,5 ]
Crossley, Kay M. [3 ]
Bierma-Zeinstra, Sita M. A. [1 ]
van Middelkoop, Marienke [1 ]
机构
[1] Erasmus Univ, Dept Gen Practice, Med Ctr, Doctor Molewaterpl 40, NL-3015 GD Rotterdam, Netherlands
[2] Univ British Columbia, Dept Family Practice, 5950 Univ Blvd, Vancouver, BC V6T 1Z3, Canada
[3] La Trobe Univ, Sport & Exercise Med Res Ctr, Hlth Sci Bldg 3, Bundoora, Vic 3086, Australia
[4] Western Univ, Dept Phys Therapy, London, ON N6G 2V4, Canada
[5] Univ Melbourne, St Vincents Hosp, Dept Surg, Bldg 181,Grattan St, Melbourne, Vic 3010, Australia
关键词
patellofemoral pain; patellofemoral osteoarthritis; pharmaceuticals; nutraceuticals; surgery; ANTERIOR KNEE PAIN; QUALITY-OF-LIFE; GLYCOSAMINOGLYCAN POLYSULFATE; CONSERVATIVE MANAGEMENT; GENERAL-PRACTICE; NATURAL-HISTORY; FOLLOW-UP; EXERCISE; ARTHROPLASTY; PLACEBO;
D O I
10.3390/jcm9113397
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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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页数:19
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