Background

Patellofemoral (knee) pain is one of the most commonly reported conditions to sports medicine providers, with estimates of incidence varying between 8% and 33% of all knee-related injuries (Glaviano, Kew, Hart, & Saliba, 2015). Knee orthoses such as braces, bandages, straps, and sleeves have been thought to reduce knee pain, and may be used in conjunction with other interventions such as nonsteroidal anti-inflammatories and exercise programs (Smith, Drew, Meek, & Clark, 2015). This is despite uncertainty from patellofemoral pain experts as to whether knee orthoses are an effective intervention for patellofemoral pain (Crossley et al., 2016).

Nonpharmacological methods of treating pain are an important aspect of nursing care. The Lippincott Nursing Centre (2018) recommends the use of physical therapy, orthotics, taping, and the use of an elastic knee sleeve for the nonpharmacological management of patellofemoral pain syndrome (PFPS). Physical therapy and orthotics are currently considered appropriate strategies for anterior knee pain management; however, there is less certainty as to the appropriateness of knee orthoses, such as elastic knee sleeves (Crossley et al., 2016).

Objectives

The objective of this Cochrane review is to assess the benefits and/or harms of knee orthoses for treating PFPS.

This review included randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) that evaluated the use of knee orthoses for treating PFPS. Crossover study designs were completely excluded from this review because of the potential for treatment "carryover" from one randomized arm to another. This review included trials where participants subjectively described knee pain diagnosed by the trial authors as PFPS. Other diagnostic terms included were anterior knee pain syndrome, patellar dysfunction, chondromalacia patellae, patellar syndrome, patellofemoral syndrome, or chondropathy. The review authors placed no restrictions on the age of participants, duration of symptoms, or stage of disease.

Methods

Excluded from this review were trials of asymptomatic or nonpathological participants. Other trials excluded were participants with a history of fracture, patellar dislocation, patellar tendonopathy, Hoffa's syndrome, Osgood-Schlatter syndrome, Sinding-Larsen-Johansson syndrome, iliotibial band friction syndrome, osteoarthritis, rheumatoid arthritis, plica syndrome, or tibiofemoral injury or dysfunction. Trials reporting the use of postsurgical knee orthoses were also excluded, as were trials where a percentage of participants may have had an alternative (possibly undiagnosed) knee pathology (unless the results of the PFPS cohort were presented separately, or the number of undiagnosed patients was small and evenly distributed between intervention groups).

Four RCTs and one quasi-RCT were included in this review, reporting results for 368 participants with PFPS. Three trials recruited participants from health clinics and two trials from military recruits undergoing training. No trials recruited professional or elite athletes; however, military training was identified as an intensive exercise regimen. All trials in this review were identified as being at high risk of bias because of the difficulty in blinding participants and their care providers.

Three different types of comparison were covered in this review: knee orthosis and exercise versus exercise alone, one type of knee orthosis versus a different type of knee orthosis, and knee orthosis versus exercise. All trials compared a knee orthosis versus a "no treatment" group, with all participants receiving an exercise program. A lack of clinically important difference was reported for a reduction of knee pain and knee function in the orthosis intervention groups. There were no reports on quality-of-life measures, resource use, or participant satisfaction. One trial reported adverse outcomes (discomfort or skin abrasion) from the use of knee sleeves in 36% (from 44 knees) of participants.

Outcomes/Implications on Practice

The authors of this review found that there is a lack of evidence to inform the use of knee orthoses for PFPS, including the mode and duration of use.

The lack of evidence for the use of knee orthoses in PFPS is conflicting for nursing practice. Nurses look to trusted sources for evidence-based information to guide their current practice; however, it has been found that knee orthoses are still being recommended for use in PFPS. It is acknowledged that there may be a role for combined therapy, utilizing a knee orthosis in conjunction with physical therapy, but further research to identify this role in isolation is required. Nurses may choose to recommend knee orthoses to patients based upon the individual assessment of that patient, but should keep in mind that the benefit from that intervention may be negligible.

References