Forty-two studies were included; 30 evaluated exercise interventions (1,765 participants), six evaluated mixed modality physiotherapy (546 participants) and six evaluated manual therapy, electrotherapy and taping (399 participants). The studies had some flaws: lack of a no-treatment control group; a control intervention that was too similar to the intervention under evaluation; lack of randomisation and blinding; small sample sizes; high drop-out rates and lack of long-term follow-up.
Exercise (30 studies)
Quality scores ranged from 14 to 24 out of 28. One study found increased laxity after the early implementation of open kinetic chain exercise after hamstring anterior cruciate ligament and four studies found that these exercise are safe following patella tendon bone anterior cruciate ligament reconstruction. Strengthening exercises showed improvements in outcomes for all ICF domains, especially eccentric training which showed statistically significant improvements in two studies. Multi-component exercise programmes showed improvements in patients with osteoarthritis, and land and water based exercises were equally effective in osteoarthritis and after total knee replacement. A walking and targeting foot exercise programme showed significant improvements in body function and structures, and activities in patients with osteoarthritis. A functional rehabilitation programme did not show any benefits over standard care in patients after total knee replacement.
Mixed modality physiotherapy (six studies)
The quality of these studies was considered good with scores of between 17 and 19 out of 28. Mixed modality physiotherapy regimes were found to be more effective than general quadriceps strengthening, no-treatment control or placebo for body function and structures and activities outcomes in patellofemoral joint pain (three studies). No benefits were seen in three other studies of other knee conditions.
Manual therapy, electrotherapy and taping (six studies)
Quality scores ranged between 15 and 21 out of 28. Short-term benefits of manual therapy for patients with patellofemoral joint pain and osteoarthritis were shown for body function and structures, and activities. Short-term functional improvements for patients with anterior cruciate ligament reconstruction using electrical muscle stimulation combined with closed kinetic chain exercises were also shown but there were no long-term benefits. Patellofemoral joint taping was shown to significantly reduce osteoarthritic pain.