Knee orthoses for treating patellofemoral pain syndrome

Smith, Toby; Drew, Benjamin; Meek, Toby H; Clark, Allan

doi:10.1002/14651858.cd010513.pub2

Cited by 26 publications

(18 citation statements)

References 83 publications

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“…Figure 1 summarises the updated consensus process. We identified two low-quality systematic reviews15 16 and three moderate-quality RCTs17–19 on exercise therapy; one low-quality systematic review20 and one moderate-quality RCT21 on combined interventions; one high-quality22 and two low-quality23 24 systematic reviews and two RCTs (one high-quality,25 one low-quality26) on patellar taping and bracing; and two high-quality,27 28 three moderate-quality18 29 30 and two low-quality31 32 RCTs on other adjunctive interventions. No new systematic reviews or RCTs were identified that related to foot orthoses.…”

Section: Resultsmentioning

confidence: 99%

2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017

et al. 2018

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Patellofemoral pain affects a large proportion of the population, from adolescents to older adults, and carries a substantial personal and societal burden. An international group of scientists and clinicians meets biennially at the International Patellofemoral Research Retreat to share research findings related to patellofemoral pain conditions and develop consensus statements using best practice methods. This consensus statement, from the 5th International Patellofemoral Research Retreat held in Australia in July 2017, focuses on exercise therapy and physical interventions (eg, orthoses, taping and manual therapy) for patellofemoral pain. Literature searches were conducted to identify new systematic reviews and randomised controlled trials (RCTs) published since the 2016 Consensus Statement. The methodological quality of included systematic reviews and RCTs was graded using AMSTAR and PEDro, respectively. Evidence-based statements were developed from included papers and presented to a panel of 41 patellofemoral pain experts for consensus discussion and voting. Recommendations from the expert panel support the use of exercise therapy (especially the combination of hip-focused and knee-focused exercises), combined interventions and foot orthoses to improve pain and/or function in people with patellofemoral pain. The use of patellofemoral, knee or lumbar mobilisations in isolation, or electrophysical agents, is not recommended. There is uncertainty regarding the use of patellar taping/bracing, acupuncture/dry needling, manual soft tissue techniques, blood flow restriction training and gait retraining in patients with patellofemoral pain. In 2017, we launched the International Patellofemoral Research Network (www.ipfrn.org) to consolidate and grow our patellofemoral research community, facilitate collaboration and disseminate patellofemoral pain knowledge to clinicians and the general public. The 6th International Patellofemoral Research Retreat will be held in Milwaukee, Wisconsin, USA, in October 2019.

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Section: Resultsmentioning

confidence: 99%

2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017

et al. 2018

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“…There is less evidence from randomized trials about the effects of patellar taping and bracing [ 16 , 30 , 34 ]. Selfe et al [ 29 ] could show that PFPS patients had improved coronal-plane and torsional control of the patella following the initiation of bracing and taping.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the potential synergistic benefit of a realignment brace on patients receiving exercise therapy for patellofemoral pain syndrome: a randomized clinical trial

Petersen

Ellermann

Rembitzki

et al. 2016

Arch Orthop Trauma Surg

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BackgroundIt has been previously shown that exercise programs for patellofemoral pain syndrome (PFPS) can be supported by medially directed taping. Evidence supporting the use of patellar braces is limited because previous studies have been low quality. The aim of this study is to compare the outcomes of patients with PFPS after treatment with a medially directed patellar realignment brace and supervised exercise.MethodsIn a prospective randomized multicenter trial, 156 patients with PFPS were included and randomly assigned to 6 weeks of supervised physiotherapy in combination with the patellar realignment brace, or supervised physiotherapy alone. Outcome measures were the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, numeric analog pain scores, and the Kujala score at baseline, 6 weeks, 3 months, and 1 year after the start of therapy. The patient’s self-reported perception of recovery was also assessed at these points.ResultsBoth treatment groups showed a significant improvement in all outcome measures over the study period. After 6 and 12 weeks of therapy, patients in the brace group had significantly higher KOOS sub-scale scores, a higher mean Kujala score, and less pain while climbing stairs or playing sports. After 54 weeks a group difference could be only detected for the KOOS ADL sub-scale.ConclusionThe use of a medially directed realignment brace leads to better outcomes in patients with PFPS than exercise alone after 6 and 12 weeks of treatment. After 1 year of follow-up this positive effect diminished.

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“…9,13 Nonlocal factors are related to the mechanics of the distal and proximal joints, such as increased foot pronation and increased hip adduction and Hip and Knee Strengthening Is More Effective Than Knee Strengthening Alone for Reducing Pain and Improving Activity in Individuals With Patellofemoral Pain: A Systematic Review With Meta-analysis Traditionally, rehabilitation protocols for treating persons with patellofemoral pain have focused exclusively on local factors, such as the use of knee orthoses (eg, patellar taping and bracing) and strengthening of the quadriceps muscles. 5,6,8,41 Although there is a lack of evidence on the use of knee orthoses, 41 knee strengthening increases patellofemoral joint contact area 6 and reduces pain intensity. 5,15,44 It has been suggested that strengthening of the hip abductors, lateral rotators, and extensors, associated or not with knee strengthening, may reduce excessive hip adduction and medial rotation during weight-bearing activities and decrease patellofemoral joint stress.…”

mentioning

confidence: 99%

Hip and Knee Strengthening Is More Effective Than Knee Strengthening Alone for Reducing Pain and Improving Activity in Individuals With Patellofemoral Pain: A Systematic Review With Meta-analysis

Nascimento¹,

Teixeira-Salmela²,

Souza³

et al. 2018

Journal of Orthopaedic & Sports Physical Therapy

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U t STUDY DESIGN:Systematic review with metaanalysis. U t BACKGROUND:The addition of hip strengthening to knee strengthening for persons with patellofemoral pain has the potential to optimize treatment effects. There is a need to systematically review and pool the current evidence in this area. U t OBJECTIVE:To examine the efficacy of hip strengthening, associated or not with knee strengthening, to increase strength, reduce pain, and improve activity in individuals with patellofemoral pain. U t METHODS:A systematic review of randomized and/or controlled trials was performed. Participants in the reviewed studies were individuals with patellofemoral pain, and the experimental intervention was hip and knee strengthening. Outcome data related to muscle strength, pain, and activity were extracted from the eligible trials and combined in a meta-analysis. U t RESULTS:The review included 14 trials involving 673 participants. Random-effects metaanalyses revealed that hip and knee strengthening decreased pain (mean difference, -3.3; 95% confidence interval [CI]: -5.6, -1.1) and improved activity (standardized mean difference, 1.4; 95% CI: 0.03, 2.8) compared to no training/placebo. In addition, hip and knee strengthening was superior to knee strengthening alone for decreasing pain (mean difference, -1.5; 95% CI: -2.3, -0.8) and improving activity (standardized mean difference, 0.7; 95% CI: 0.2, 1.3). Results were maintained beyond the intervention period. Meta-analyses showed no significant changes in strength for any of the interventions. U t CONCLUSION:Hip and knee strengthening is effective and superior to knee strengthening alone for decreasing pain and improving activity in persons with patellofemoral pain; however, these outcomes were achieved without a concurrent change in strength. U t LEVEL OF EVIDENCE: Therapy, level 1a-.

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Knee orthoses for treating patellofemoral pain syndrome

Cited by 26 publications

References 83 publications

2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017

2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017

Evaluating the potential synergistic benefit of a realignment brace on patients receiving exercise therapy for patellofemoral pain syndrome: a randomized clinical trial

Hip and Knee Strengthening Is More Effective Than Knee Strengthening Alone for Reducing Pain and Improving Activity in Individuals With Patellofemoral Pain: A Systematic Review With Meta-analysis

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