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Is patellofemoral pain preventable? A systematic review and meta-analysis of randomised controlled trials
  1. Adam G Culvenor1,
  2. Marienke van Middelkoop2,
  3. Erin M Macri2,
  4. Kay M Crossley1
  1. 1 La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
  2. 2 Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
  1. Correspondence to Dr Adam G Culvenor, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC 3086, Australia; a.culvenor{at}latrobe.edu.au

Abstract

Objective To evaluate the effectiveness of interventions to reduce the risk of incident patellofemoral pain.

Design Systematic review and meta-analysis, with strength of evidence evaluated separately for each intervention type.

Data sources MEDLINE, EMBASE, CINAHL, Web of Science and SPORTDiscus.

Eligibility criteria for selecting studies Randomised controlled trials evaluating the effectiveness of interventions to reduce patellofemoral pain risk compared with a control/non-exposed group.

Results Thirteen trials of mostly military recruits and young athletes analysed six different interventions. There was low certainty evidence from two trials (227 participants) that patellofemoral braces worn during physical activity (compared with no brace) effectively reduced the risk of patellofemoral pain (risk ratio (RR) 0.40, 95% CI 0.22 to 0.73; I2=24.0%). There was low certainty evidence from one trial (320 participants) that running technique retraining to (run softer) reduced patellofemoral pain risk (RR 0.21, 95% CI 0.07 to 0.60). There was low certainty evidence from four trials (3364 participants) that multicomponent (strengthening/neuromuscular) exercise programmes did not significantly reduce the risk of patellofemoral pain (RR 0.49, 95% CI 0.18 to 1.36; I2=64.9%), although broad CIs may reflect exercise dose variations among studies. There was very low certainty evidence from four trials (2314 participants) that foot orthoses (compared with flat inserts/no orthosis) did not significantly reduce the risk of patellofemoral pain (RR 0.63, 95% CI 0.35 to 1.13; I2=0.0%). Static stretching and a running programme that progressed intensity (compared with volume) did not significantly influence patellofemoral pain risk (single studies).

Conclusion There is low-level evidence that patellofemoral braces and running technique retraining can reduce the risk of patellofemoral pain by 60%–79%.

  • knee injuries
  • prevention
  • rehabilitation
  • physiotherapy

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Footnotes

  • Twitter @agculvenor, @mvanmiddelkoop

  • Contributors All authors contributed to the conception, data analysis and interpretation, and writing and/or drafting of the manuscript. All authors approve the final version.

  • Funding AGC is a recipient of a National Health and Medical Research Council of Australia Early Career Fellowship (Neil Hamilton Fairley Clinical Fellowship, APP1121173). EMM received funding support from a Canadian Institutes of Health Research Banting Postdoctoral Fellowship.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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