Sixteen controlled trials (n=867) were included: 11 randomised (n=277) and 5 non-randomised (n=590); n ranged from 25 to 113.
Eight studies evaluated physiotherapy, mostly focusing on vastus medialis obliquus retraining by a variety of methods. The duration of treatment was usually 4 to 8 weeks. No studies compared it with a placebo control. There were two further studies of patellofemoral orthoses, four studies of assorted other techniques (i.e. low-level lasers, chiropractic patellar mobilisation, acupuncture, and sacroiliac joint manipulation), and one study each of progressive resistance braces and corrective foot orthoses. The follow-up varied from none to one year. No intervention was associated with a worsening of the symptoms.
Physiotherapy treatments.
Six of the physiotherapy studies compared essentially eccentric exercises with alternative forms of quadriceps strengthening (standard or isokinetic). It was stated that five found an overall better response to the eccentric exercises in terms of all or some of the outcome measures, particularly for functional impairment measures. There were no significant differences between the treatments in terms of the pain effect reported in the review. The two most methodologically-sound randomised controlled trials (RCTs) found contrasting results. A single trial compared physiotherapy with no treatment and found significant difference in pain. It was stated in the results that the evidence indicates that physiotherapy can reduce the pain associated with PFPS, but no actual results of the effect were quoted.
Patellar taping.
Two RCTs failed to find any benefit of taping in addition to physiotherapy, although one employed taping to a lesser extent than would be the case in routine clinical practice.
Patellofemoral orthoses. Two non-randomised trials with significant limitations found no evidence to support the use of these braces in the military setting, in which presumably the trials took place. Their use in other populations has not been evaluated.
Other interventions.
Low-level laser treatment provided no difference in outcome compared with sham laser in a triple-blind study of patients with arthroscopically-confirmed chondromalicia patella. Chiropractic patellar mobilisation showed no statistically-significant difference when compared with placebo in the single study. A 4-week RCT of acupuncture versus no treatment found significantly improved knee function symptoms at 12 months. A blinded RCT of sacroiliac joint mobilisation versus sacroiliac joint assessment was found to significantly decrease immediate quadriceps muscle inhibition, but the trial did not measure pain or function.
Progressive resistance brace.
One non-randomised study compared a programme of high-volume submaximal quadriceps strengthening using a progressive resistance brace with no treatment. This study found a significant improvement in pain, radiological patellar alignment, and function. The authors noted their costliness.
Corrective foot orthoses.
One non-blinded RCT compared the effects of adding corrective foot orthoses with a placebo insole for female patients with rearfoot varus receiving physiotherapy. Patients with the corrective orthoses had significantly less knee pain during aggravating activities.