Orthotic devices for treating patellofemoral pain syndrome
(Review)
D’hondt NE, Struijs PAA, Kerkhoffs GMMJ, Verheul C, Lysens R, Aufdemkampe G, Van Dijk
CN
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2002, Issue 2
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Orthotic devices for treating patellofemoral pain syndrome (Review)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
T A B L E O F C O N T E N T S
1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5AUTHORS’ CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
iOrthotic devices for treating patellofemoral pain syndrome (Review)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
[Intervention Review]
Orthotic devices for treating patellofemoral pain syndrome
NE D’hondt, PAA Struijs, GMMJ Kerkhoffs, C Verheul, R Lysens, G Aufdemkampe, Van CN Dijk
Contact address: Mr Norman D’hondt, Physiotherapist, Sports & Orthopaedic Rehabilitation Centre, Van Huis & Van’t Kloosterv,
Physiotherapists, Catharijnesingel 73, Utrecht, 3511 GM, NETHERLANDS. [email protected].
Editorial group: Cochrane Bone, Joint and Muscle Trauma Group.
Publication status and date: Unchanged, published in Issue 4, 2008.
Review content assessed as up-to-date: .
Citation: D’hondt NE, Struijs PAA, Kerkhoffs GMMJ, Verheul C, Lysens R, Aufdemkampe G, Van Dijk CN. Orthotic devices
for treating patellofemoral pain syndrome. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD002267. DOI:
10.1002/14651858.CD002267.
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
A B S T R A C T
Background
Patellofemoral pain syndrome is a frequently reported condition in active adults. A wide variety of conservative treatment strategies
have been described. As yet, no optimal strategy has been identified. Application of orthotic devices e.g. knee braces, knee straps, forms
of taping of the knee, active training devices, knee sleeves and in-shoe orthotics to support the foot have been advocated to treat this
condition.
Objectives
To assess the effectiveness of foot and knee orthotics for treatment of patellofemoral pain syndrome.
Search strategy
We searched the Cochrane Musculoskeletal Injuries Group specialised register (December 2001), the Cochrane Controlled Trials
register (Issue 2, 2000), MEDLINE (January 1966 to March 2000; EMBASE (January 1988 to March 2000); CINAHL (January
1982 to March 2000) and PEDro (up to March 2000). Relevant orthotic companies were contacted.
Selection criteria
All randomised and quasi-randomised trials comparing the effectiveness of knee or foot orthotics for treatment of patellofemoral pain
syndrome were selected. Trials describing the use of orthotic devices in conjunction with operative treatment were excluded.
Data collection and analysis
Three reviewers independently assessed methodological quality of the identified trials by use of a modified version of the Cochrane
Musculoskeletal Injuries Group assessment tool, consisting 11 items. Two reviewers extracted data without blinding. Trialists were
contacted to obtain missing data.
Main results
Five trials involving 362 participants were included in this review. Five other trials await possible inclusion if further information can be
obtained and one awaits further assessment. Due to clinical heterogeneity, we refrained from statistical pooling and conducted analysis
by grading the strength of scientific evidence. The level of obtained research-based evidence was graded as limited as all trials were of
low methodological quality.
This limited research-based evidence showed the Protonics orthosis at six week follow-up was significantly more effective for decrease in
pain (weighted mean difference (WMD) between groups 3.2; 95% confidence interval (CI) 2.8 to 3.6), functional improvement on the
1Orthotic devices for treating patellofemoral pain syndrome (Review)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Kujala score (WMD 45.6; 95% CI 43.4 to 47.7) and change in patellofemoral congruence angle (WMD 17.2; 95% CI 14.1 to 20.3)
when compared to no treatment. A comprehensive programme including tape application was significantly superior to a monitored
exercise programme without tape application for decrease in worst pain (WMD 1.6; 95% CI 0.4 to 2.8) and usual pain (WMD 1.2;
95% CI 0.2 to 2.1), and clinical change and functional improvement questionnaire scores (WMD 10, 95% CI 2.07 to 17.93) at four
weeks follow-up. The trials reported statistically significant differences in patient satisfaction after applied therapy (WMD 3.3; 95%
CI 0.5 to 6.1) in favour of the McConnell regimen compared with the Coumans bandage at six weeks follow-up.
Authors’ conclusions
The evidence from randomised controlled trials is currently too limited to draw definitive conclusions about the use of knee and foot
orthotics for the treatment of patellofemoral pain. Future high quality trials in this field are warranted.
P L A I N L A N G U A G E S U M M A R Y
Not enough evidence from trials to determine the effect of knee and foot orthotics (tape, braces, straps, sleeves or in-shoe pads) in
easing kneecap pain
Patellofemoral pain syndrome (soreness around the area of the kneecap) is common in active adolescents and adults. It seems to be
made worse after activities involving heavy knee loads such as walking up stairs, running, or cycling. It can be treated either by surgery
or, more commonly, by using orthotics (tape, braces, straps, sleeves or inlay soles). These are usually used alongside some type of exercise
therapy. This review of trials found that there was not enough information on any of these orthotics to be able to say if they relieve
patellofemoral pain syndrome. More research is needed.
B A C K G R O U N D
Patellofemoral pain syndrome (PFPS), is a frequently diagnosed
entity in active adolescents and adults. The Dutch Institute for Re-
search in Health Care (NIVEL) reports that 56,000 new patients
per year contact their general practitioner with patellofemoral
complaints in The Netherlands alone (Van der Velden 1991).
Characteristically, PFPS develops gradually with diffuse peripatel-
lar and retropatellar pain, often accompanied by complaints of
“giving way” and crepitus (Van Linge 1995; Nissen 1998; Powers
1998). The onset of pain seems to be triggered by overuse of the
patellofemoral joint, as symptoms are typically provoked by phys-
ical activity. These can include such activities as walking up and
down stairs, running, cycling or prolonged sitting (theatre sign),
and are likely to be relieved by rest (Powers 1998; Nissen 1998;
Zomerdijk 1998).
There is no consensus in the medical literature concerning defini-
tion, etiology, diagnosis of patellofemoral pain syndrome (Holmes
1998; Wilk 1998) and no clear association is present between
the severity of symptoms and arthroscopic or radiological findings
(Natri 1998; Nissen 1998; Lindberg 1986). Current concepts on
the genesis of patellofemoral pain suggest that it is unlikely that
hyaline articular cartilage damage is a direct source of pain because
it is completely free of free nerve endings. On the contrary, the
patella’s subchondral bone and its surrounding structures (such
as the lateral and medial retinacula, the peripatellar synovium,
the medial plicae, the patellar and quadriceps tendon and the in-
frapatellar fat pad) were found to have these free nerve endings.
This indicates that several structures may participate in the genesis
of patellofemoral pain (Jackson 2001; Dye 2001; Biedert 2001).
Therefore it is difficult to have a clear diagnosis of PFPS as other
conditions associated with these structures, such as infrapatellar
fat pad impingement or insertion tendinopathy of the quadriceps
muscles, may be present.
Patellofemoral mal-alignment is frequently mentioned as an etio-
logic mechanism in the genesis of PFPS (Zomerdijk 1998). Mal-
alignment may lead to a deviant tracking pattern of the patella
with respect to the femoral groove, which could cause an ab-
normal distribution of the joint’s reaction stress on the patella’s
subchondral bone and impingement of surrounding soft tissues
(Badalamente 1989; Grelsamer 1998). Tight anatomical struc-
tures (Puniello 1993; Nissen 1998), an unbalanced m. vastus me-
diales oblique / m. vastus lateralis response-reaction time ratio
(Witvrouw 1996) and deviation of anatomy (Holmes 1998) may
predispose to patellofemoral mal-alignment. Furthermore, deviant
tracking of the patella may also be induced by a dynamically in-
2Orthotic devices for treating patellofemoral pain syndrome (Review)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
creased valgus angle (also termed “kneeing-in”). Absence of ade-
quate muscle control and excessive pronation of the foot, result-
ing in an internal rotation of the lower extremity, could provoke
this. In a large two-year follow-up study, it was suggested that the
development of patellofemoral pain in an athletic population is
predisposed by a shortened quadriceps muscle, an altered vastus
mediales obliques muscle reflex response time, a decreased explo-
sive strength, and a hyper-mobile patella (Witvrouw 2000).
Conservative treatment of PFPS is generally preferred to operative
treatment, consisting of releasing the lateral retinaculum or reposi-
tioning the tibial tuberosity (Brody 1998; Shelton 1991; Scunderi
1992). A wide variety of conservative strategies is reported in the
literature, varying from quadriceps strengthening exercises, the use
of non-steroidal anti-inflammatory drugs (NSAIDs), and the ap-
plication of orthotic devices (Arroll 1997, Zomerdijk 1998). In
one systematic review, (Arroll 1997), five clinical trials on non-op-
erative management of PFPS were identified. It was concluded that
insufficient evidence was present to draw definitive conclusions
on the effectiveness of conservative treatment strategies. Another
systematic review, which identified six randomised clinical trials
on conservative treatment, confirmed this conclusion (Zomerdijk
1998).
The use of in-shoe orthotics and knee orthotics, both tending to
influence the patella’s tracking pattern, were previously advocated
for treatment of patellofemoral pain syndrome (Eng 1993; Gerrard
1989; Harrison 1999; Klingman 1997; Powers 1998; Saxena 1998;
Shellock 1994; Shelton 1991), and remain a treatment of choice.
Types of orthotic modalities vary from knee braces, knee straps,
knee sleeves and taping techniques. These are meant to directly
support patellar tracking or re-distribute stress on the articulating
patellar surface and, in-shoe orthotics, to support the medial arch
of the foot. The latter prevents excessive pronation of the foot.
This review has been undertaken to assess the effectiveness of these
knee and foot orthotics in the treatment of PFPS.
O B J E C T I V E S
The objective of this review was to assess the use of foot and knee
orthotics (e.g. brace, sleeve, taping techniques, bandage, straps,
in-shoe orthotics) as a conservative treatment strategy for PFPS in
active adolescents and adults, without limiting for sex, or level of
physical activity.
The specific null hypothesis was:
There are no differences in treatment outcome for PFPS when
managed with or without the use of orthotic devices.
Comparisons included:
a) no treatment versus orthotic devices;
b) one type of orthotics versus other(s);
c) another conservative treatment versus orthotic devices.
R E S U L T S
Due to the clinical heterogeneity of interventions investigated, no
pooling of data from the included studies was undertaken.
McCONNELL REGIMEN VERSUS COUMANS BANDAGE
Wijnen 1996 compared the McConnell regimen to the applica-
tion of a Coumans bandage. This trial involved only 18 subjects.
Three subjects dropped out of the study and were not taken into
account in the statistical analysis. Although there was a trend show-
ing that the McConnell regimen could have been more effective
than the Coumans bandage, the only statistically significant dif-
ference between the groups was found in rating of satisfaction of
applied therapy. The weighted mean difference (WMD) between
the groups was 3.3 (95%CI 0.5 to 6.1) in favour of the McConnell
regimen.
Pain was measured during ascending and descending stairs, after
prolonged sitting and during squatting. It was rated on an 11
point numeric rating scale (0-10). Both groups showed a reduction
in pain after six weeks. The McConnell group presented a larger
mean reduction in pain rating, but none of the differences were
statistically significant. The WMDs between groups for decrease
in pain for ascending and descending stairs was 0.3 (95% CI -2.9
to 3.5); prolonged sitting, 1.2 (95% CI -2.7 to 5.1) and squatting,
2.0 (95% CI -1.2 to 5.2). Functional improvement was assessed
by use of the Ranawatt score and the Kujala score. No significant
difference in mean improvement was identified for either score.
The WMD between the groups for improvement in the Ranawatt
score was 7.9 (95% CI -2.7 to 18.5) and the Kujala score, 11.0
(95% CI -2.2 to 24.2).
An improved isokinetic muscle strength was reported at both 300°
per second and 60° per second for both groups, with the only
significant result reported at 300° for flexion, in favour of the Mc-
Connell group (WMD 15.1 95% CI 0.3 to 29.9). The remain-
ing WMDs between the groups for improvement in isokinetic
strength were, at 300° per second, 7.6 (95% CI -11.1 to 26.3) for
extension; and at 60° per second 5.4 (95% CI -6.4 to 17.2) for
extension and 0.5 (95% CI -13.2 to 14.2) for flexion.
PALUMBO BRACE VERSUS CHO-PAT STRAP
Miller 1997 compared the Palumbo brace with the Cho-Pat knee
strap, both in conjunction with a physical therapy programme
and both were compared with a group exposed only to the co-
intervention. Fifty-nine subjects participated at baseline. Eight
subjects were lost to follow-up and were not taken into account
for statistical analysis. Although the study describes a follow-up
period of eight weeks, only data from the second (one week) and
third visit (two or three weeks) were presented.
3Orthotic devices for treating patellofemoral pain syndrome (Review)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Pain and motivation were both assessed on a 100mm VAS. No
statistically significant differences between groups were identified
for either of these outcomes measures. The calculated WMDs
between the groups for the average decrease in pain between the
first and the second visit were 0.4 (95% CI -1.1 to 1.9) when
comparing the no-brace group to the Palumbo group; 0.9 (95% CI
-0.6 to 2.4) when comparing the no-brace group to the Cho-Pat
group, and 0.5 (95% CI -1.1 to 2.0) when comparing the Palumbo
group to the Cho-Pat group. The calculated WMDs between the
groups for the average decrease in pain between the first and third
visit were 1.4 (95% CI -0.5 to 3.3) comparing the no-brace group
to the Palumbo group; 1.1 (95% CI -1.1 to 3.3) comparing the
no-brace group with the Cho-Pat group, and 0.26 (95% CI -1.8
to 2.3) comparing the Palumbo group with the Cho-Pat group.
PROTONICS ORTHOSIS VERSUS NO TREATMENT
Timm 1998 used a sample of 100 participants to determine the
difference in effect of using a Protonics orthosis for treating PFPS
compared with no treatment. During a four week follow-up pe-
riod, pain associated with ascending and descending stairs, rising
from sitting, squatting, and prolonged sitting, was assessed by use
of a 100mm visual analogue scale (VAS). Functional improvement
was assessed by use of the 0 to 100 point Kujala score. Further-
more, the so-called patellofemoral congruence angle (PFCA) was
determined by use of a Merchant x-ray view. All outcome measures
presented statistically significant differences between the groups
in favour of the Protonics orthosis.
The WMDs between the groups for decrease in pain were 3.2
(95% CI 2.8 to 3.6), for functional improvement assessed by the
Kujala score 45.6 (95% CI 43.4 to 47.7) and for change in PFCA
-17.2 (95% CI -20.2 to -14.1).
HOME EXERCISE VERSUS SAME WITH MONITORED
THERAPY VERSUS SAME WITH McCONNELL TAPE AND
BIOFEEDBACK
Harrison 1999 compared three strategies for treating
patellofemoral pain syndrome. At baseline, 113 participants were
randomly assigned to one of the three trial arms consisting of 1)
a home exercise programme; 2) a home exercise programme in
conjunction with stretching of tight lateral structures monitored
by a physical therapist; and 3) a home exercise programme in con-
junction with stretching of tight lateral structures, application of
McConnell tape and biofeedback. Treatment was maintained for
four weeks.
Five types of outcome measures were used to determine the treat-
ment effect. A 100mm VAS was used to measure worst and usual
pain. Functional improvement was measured by use of the Reid
Patellofemoral Function Scale (PF scale) and by use of a modified
version of the Chesworth Functional Index Questionnaire (FIQ).
Furthermore, a subjective clinical change was measured and a step
performance test was conducted. Assessments were performed at
four weeks of treatment and after three months, six months and
one year without treatment.
Significant differences were found for decrease in worst and usual
pain, clinical change and FIQ scores at four weeks follow-up pe-
riod when comparing groups two and three. On all three measures,
group three scored significantly better than two. Only sufficient
data on pain, patellofemoral scale scores and step test were pro-
vided for further statistical analysis. The WMDs between group
two and three at one month follow-up were 1.6 (95% CI 0.4,
2.8) for decrease in worst pain, and 1.2 (95% CI 0.2 to 2.1) for
decrease in usual pain. At one month, the WMD between groups
on the PF scale was significantly in favour of group three (WMD
10, 95% CI 2.07 to 17.93).
No significant differences were found between the groups for the
other follow-up periods of three months, six months or one year,
or patellofemoral scale scores and step test outcome.
CONCENTRIC VERSUS ECCENTRIC EXERCISE PRO-
GRAMME
Gaffney 1992 conducted a multi-centred trial in order to deter-
mine the difference in effect between a concentric exercise treat-
ment programme and an eccentric exercise treatment programme,
in conjunction with tape application. A follow-up period of six
weeks was conducted. At baseline 72 participants were randomised
to the two trial arms, and 60 participants completed the study.
Reasons given for withdrawal were that it was too far to attend (one
case), work commitments/travel (two cases) and two people with-
drew due to another injury. The reason for the seven remaining
withdrawals were unknown. Pain was partly measured by use of
an 11 point numeric VAS and partly by use of a three point rating
scale. Furthermore, improvement in function was also scored on
a three point rating scale. Subjective success was measured using
a dichotomous system. No statistically significant differences be-
tween groups were identified for any of these outcome measures.
The trial report only provided adequate data on subjective success,
with a non-significant difference between groups in favour of the
concentric programme (RR 0.84, 95% CI 0.66 to 1.07).
In conclusion, the reviewed level C research based evidence sug-
gested that the Protonics orthosis was effective for decreasing pain
(WMD 3.2; 95% CI 2.8 to 3.6), functional improvement (WMD
45.6; 95% CI 43.4 to 47.7) and change in PFCA (WMD 17.2;
95% CI 14.1 to 20.3) when compared with no treatment at six
weeks follow-up; secondly, a comprehensive exercise and stretch-
ing programme including tape application was significantly supe-
rior to a monitored programme without tape application on de-
crease in worst pain (WMD 1.6; 95% CI 0.4 to 2.8) and usual
pain (WMD 1.2; 95% CI 0.2 to 2.1) and on functional improve-
ment questionnaire scores (WMD 10, 95% CI 2.07 to 17.93) at
four weeks follow-up; thirdly, the McConnell regimen was supe-
rior when compared to the Coumans bandage for satisfaction rate
(WMD 3.3; 95% CI 0.5 to 6.1) at six weeks follow-up; fourthly,
4Orthotic devices for treating patellofemoral pain syndrome (Review)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
there were no significant differences in effect between the Cho-Pat
strap, the Palumbo brace and no brace at three weeks follow-up;
and lastly, there were no significant differences in effect between
a concentric training programme and an eccentric training pro-
gramme both in conjunction with tape application at six weeks
follow-up.
D I S C U S S I O N
The lack of properly described randomised clinical trials in this
field is disappointing for the overall assessment of orthotics for
patellofemoral pain syndrome. Initially, we assessed the method-
ological quality of the 10 trials which met our inclusion criteria.
In general the methodological quality of these trials varied from
moderate to poor. The mean overall quality score of the retrieved
trials was 12.4 (10 to 17 out of a maximum score of 22). Only one
trial (Eng 1993) was graded as a high quality trial and achieved 17
points (77%).
Seven trials (Arcand 1998; Eng 1993; Finestone 1993; Eburne
1996; Kowall 1996; Handfield 2000; Cameron 1997) have been
placed in Studies Awaiting Assessment due to insufficient data
provision or needing further classification, and may be included
in a future update of the review. The methodological quality of
the five remaining studies (Gaffney 1992; Wijnen 1996; Timm
1998; Miller 1997; Harrison 1999) appeared to be moderate to
poor.
Four of the five included trials did not describe the means of se-
lecting who received the intervention of interest. Therefore, it re-
mained unclear if adequate concealment of allocation was per-
formed. By leaving the selection of treatment up to the providers
and the recipients of care, decisions on whether or not to partic-
ipate can be related to prognosis and probable responsiveness to
treatment. This could cause an overestimation of the treatment
effect. That is, the effectiveness of the presented strategies might
be overestimated. Motivation is also likely to be higher in the par-
ticipating patients when compared to the total patient population.
All trials presented methodological flaws on blinding of both pa-
tients (item E) and treatment providers (item F). In trials concern-
ing physical rehabilitation and orthotic devices blinding seems to
be difficult to achieve. As these items are associated with the in-
troduction of performance bias (Karlowski 1975; Colditz 1989;
Schulz 1995), it is unlikely the possibility of this type of bias can
be eliminated completely in these trials.
The four to eight week follow-up periods most commonly used
in these trials might not be sufficient to detect clinically relevant
changes. Based on our own clinical experience we feel that the
short-term follow-up period should involve at least eight weeks.
Furthermore, it would be interesting to see if a positive effect is
maintained for a longer period after treatment.
To increase the evidence base for practice, there is an obvious need
for high quality, appropriately powered and reported RCTs on this
topic.
To avoid flawed reporting of a trial, it is recommended that future
trials adhere to the standards of reporting presented in the CON-
SORT statement (Begg 1996; Altman 2001). This will lead to a
higher standard of trial reporting. It should increase the applicabil-
ity of the trial report in practice and allow incorporation into sys-
tematic reviews. Furthermore, newly conducted trials should use
adequate outcome measures to evaluate effectiveness of treatment
strategies. They should have sufficient statistical power to detect
clinically relevant changes in outcome measures. In addition there
should be greater uniformity of outcome measures. These mea-
sures will increase the comparability of RCTs and may contribute
to avoidance of statistical heterogeneity.
In a review on physical rehabilitation, Karjalainen 2002 advocated
the evaluation of baseline expectations for the rehabilitation re-
sponse of both patients and therapists for both the intervention
and control groups. In addition, adequate methods of allocation
concealment should be applied to avoid any manipulation of the
randomisation process and it is recommended that future trials in-
volve a short-term (less than eight weeks), intermediate-term and
a long-term follow-up period.
A U T H O R S ’ C O N C L U S I O N S
Implications for practice
As the strength of retrieved evidence was graded as limited, it seems
inappropriate to make any clinical recommendation concerning
the use of knee and foot orthotics in the conservative treatment of
patellofemoral pain syndrome. At present the decision on whether
or not to use orthotic devices depends on the patient’s preference
and the clinician’s clinical experience. Current trial results should
be interpreted with caution.
Implications for research
There is an obvious need for high quality trials to provide clear
evidence for treatment in this area. It is important that the ef-
fectiveness of orthotic devices is assessed in such a way that bias
is reduced to a minimum. Future RCTs in this field should use
a high quality methodological design. Sufficient statistical power
is needed to show statistically significant differences in clinically
meaningful changes of relevant outcome measures. Furthermore,
studies should include an active systematic follow-up of patients
focused on short-, intermediate- and long-term effects. Clear de-
scription of data and methodology contributes to a valuable inter-
pretation of the trial’s results and conclusions. To achieve this, it
is strongly recommended that journal editors should rely on the
CONSORT statement when considering a trial for being pub-
lished (Begg 1996; Altman 2001).
5Orthotic devices for treating patellofemoral pain syndrome (Review)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
A C K N O W L E D G E M E N T S
This study served as the basis for a Master’s thesis for the degree
of a Master of Science in Physiotherapy at the Department of
Physiotherapy, Faculty of Physical Education & Physiotherapy at
the Katholieke Universiteit, Leuven. The thesis was supervised by
Prof R Lysens and G Aufdemkampe, MSc PT.
We would like to thank Dr Helen Handoll and Ms Leeann Morton
for their help and advice in constructing the protocol. We also
would like to thank Prof Dan Carr, Prof Bill Gillespie, Mr Peter
Herbison, Dr Bruce Arroll, Dr John Kellett, Mrs Lesley Gillespie,
Prof Rajan Madhok and Prof Marc Swiontkowski for their helpful
comments at editorial review.
We thank Mr Wolbert van den Hoorn for his contribution to the
search for trials.
R E F E R E N C E S
References to studies included in this review
Gaffney 1992 {published data only}
Gaffney K, Fricker P, Dwyer T, Barret E, Skibinski K,
Coutts R. Patellofemoral joint pain: A comparison of two
treatment programmes. Excel 1992;8:179–189.
Harrison 1999 {published data only}
Harrison EL, Sheppard MS, McQuarrie AM. A randomised
controlled trial of physical therapy treatment programs in
patellofemoral pain syndrome. Physiotherapy Canada 1999;
51(2):93–100,106.
Miller 1997 {published data only}
Miller MD, Hinkin DT, Wisnowski JW. The efficacy of
orthotics for anterior knee pain in military trainees. A
preliminary report. American Journal of Knee Surgery 1997;
10(1):10–13.
Timm 1998 {published data only}
Timm KE. Randomized controlled trial of Protonics on
patellar pain, position, and function. Medicine and Science
in Sports and Exercise 1998;30(5):665–670.
Wijnen 1996 {published data only}
Wijnen LACM, Lenssen AF, Kuys-Wouters YSM,
De Bie RA, Borghouts JAJ, Bulstra SK. McConnel-
therapy versus Coumansbandage in Patellofemoral
Pain [McConnel–therapie versus Coumansbandage bij
patellofemorale pijnklachten]. Nederlands Tijdschrift voor
Fysiotherapie 1996;Sept(Special):12–17.
References to studies excluded from this review
Beetsma 1996
Beetsma AJ, Zomerdijk TE, Van Horn JR, Van Wijck R.
Funktionele behandeling van het Patellofemoraal Pijnsyndroom
bij adolescente meisjes - Is het McConnellprogramma efectief?
- Een pilot studie [Functional treatment of the patellofemoral
pain syndrome in adolescent girls - is the McConnell program
efficacious? - a pilot study ] [thesis]. Groningen (NL): RUG
Univ of Groningen, 1996.
BenGal 1997
BenGal S, Lowe J Mann G, Finsterbush A, Matan Y. The
role of the knee brace in the prevention of anterior knee
pain syndrome. American Journal of Sports Medicine 1997;
25(1):118–122.
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S O U R C E S O F S U P P O R T
External sources of support
• No sources of support supplied
Internal sources of support
• No sources of support supplied
N O T E S
The title of the protocol was “Orthotics for anterior knee pain”.
I N D E X T E R M S
Medical Subject Headings (MeSH)
Arthralgia [∗therapy]; ∗Femur; ∗Orthotic Devices; ∗Patella; Randomized Controlled Trials as Topic; Syndrome
MeSH check words
Humans
9Orthotic devices for treating patellofemoral pain syndrome (Review)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.