Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis

Patellofemoral pain (PFP) and patellofemoral osteoarthritis (PFOA) are common, persistentconditions that may lie along a pathological spectrum. While evidence supports exercise-therapyas 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 medicalinterventions (pharmaceutical, nutraceutical, and surgical) for PFP and PFOA to inform primarycare decision making. Methods: Following protocol registration, we searched seven databasesfor randomized clinical trials of our target interventions for PFP and PFOA. Our primary outcomewas pain. We assessed risk of bias, calculated standardized mean differences (SMDs) and determinedthe level of evidence for each intervention. Results: We included 14 publications investigatingpharmaceutical or nutraceutical interventions, and eight publications investigating surgicalinterventions. Two randomized control trials (RCTs) provided moderate evidence of patellofemoralarthroplasty 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 yearpost-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-inflammatoriesor arthroscopic surgery. Conclusions: Pharmaceutical and nutraceutical prescriptions, and surgicalreferrals are currently being made with little supporting evidence, with some interventions showinglimited efficacy. This should be considered within the broader context of evidence supportingexercise-therapy as a core treatment for PFP and PFOA.

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