Conservative treatment of patellofemoral pain: effectiveness of strength exercises compared to other treatments. a systematic review with meta-analysis

Objective: The aim of the study was to investigate the effectiveness of strengthening exercise compared to other conservative treatment methods to reduce pain and improve functional abilities for patellofemoral pain. Methods: MEDLINE, Physiotherapy Evidence Database, Scopus, Cochrane Central Register of Controlled Trials and Embase were the databases consulted from inception until June 2024. Randomised controlled trials (RCTs) were included with patients diagnosed with patellofemoral pain, adolescents over 16 years of age and adults up to 44 years of age, athletes and non-athletes, regardless of gender, and in which pain recorded at 4–6 weeks or 8–12 weeks follow-up was the primary outcome. Functional evaluation scales of the knee as the Anterior Knee Pain Scale, with a follow-up of 8–12 weeks or 6 months were secondary outcome. Results: Database search yielded a total of 1,654 papers and 12 papers were included. The meta-analysis on the change in pre- and post-treatment pain at 4–6 weeks and 8–12 weeks showed an average reduction of -1.44 (CI. -2.20; -0.67) for 601 patients included and -0.8 (CI -1.23; -0.37) in favour of the intervention group with exercises for 719 patients. In subgroup analysis performed for woman population, the mean difference in pain reduction was -2.81 (CI -4.39; -1.23). At 8–12 weeks, standardized mean difference for functional outcomes, in pre-post treatment variation between the two groups was 0.08 (CI -0.07; 0.24) in favour of the intervention for 685 patients included. A very low and low level of certainty of the evidence was recorded based on Risk of Bias analysis and GRADE method. Conclusion: A positive effect in the use of muscle strengthening strategies in the treatment of patellofemoral pain was highlighted, albeit with a low level of certainty of the results. Women benefit most from treatment with strengthening exercises.