Anterior knee pain is a chronic condition that presents frequently to sports
medicine clinics, and can have a long-term impact on participation in physical
activity. Conceivably, effective early management may prevent chronicity
and facilitate physical activity. Although a variety of nonsurgical interventions
have been advocated, previous systematic reviews have consistently
been unable to reach conclusions to support their use. Considering a decade
has lapsed since publication of the most recent data in these reviews, it is
timely to provide an updated synthesis of the literature to assist sports medicine
practitioners in making informed, evidence-based decisions. A systematic review
and meta-analysis was conducted to evaluate the evidence for nonsurgical
interventions for anterior knee pain.

A comprehensive search strategy was used to search MEDLINE, EMBASE,
CINAHL and Pre-CINAHL, PEDro, PubMed, SportDiscus
Web of Science ,BIOSIS Previews, and the full Cochrane Library, while
reference lists of included papers and previous systematic reviews were hand

Studies were eligible for inclusion if they were randomized clinical
trials that used a measure of pain to evaluate at least one nonsurgical intervention
over at least 2 weeks in participants with anterior knee pain. A
modified version of the PEDro scale was used to rate methodological quality
and risk of bias. Effect size calculation and meta-analyses were based on
random effects models.

Of 48 suitable studies, 27 studies with low-to-moderate risk of bias were
included. There was minimal opportunity for meta-analysis because of
heterogeneity of interventions, comparators and follow-up times.

Metaanalysis of high-quality clinical trials supports the use of a 6-week multimodal
physiotherapy programme (standardized mean difference [SMD] 1.08, 95%
CI 0.73, 1.43), but does not support the addition of electromyography biofeedback
to an exercise programme in the short-term (4 weeks: SMD -0.21,
95% CI -0.64, 0.21; 8–12 weeks: SMD -0.22, 95% CI -0.65, 0.20). Individual
study data showed beneficial effects for foot orthoses with and without
multimodal physiotherapy (vs flat inserts), exercise (vs control), closed chain
exercises (vs open chain exercises), patella taping in conjunction with exercise
(vs exercise alone) and acupuncture (vs control).

Findings suggest that, in implementing evidence-based practice for the
nonsurgical management of anterior knee pain, sports medicine practitioners
should prescribe local, proximal and distal components of multimodal
physiotherapy in the first instance for suitable patients, and then consider
foot orthoses or acupuncture as required.

Collins N et al. Efficacy of Nonsurgical Interventions for Anterior Knee Pain
Systematic Review and Meta-Analysis of Randomized Trials.Sports Med 2012; 42 (1): 31-49