WITHDRAWN: Orthotic devices for treating patellofemoral pain syndrome.
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 inlay soles to support the foot have been advocated to treat this condition.


OBJECTIVE
To assess the effectiveness of foot and knee orthotics for treatment of patellofemoral pain syndrome.


METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, 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. The date of the most recent search was May 2000.


METHODS
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.


METHODS
Three reviewers independently assessed methodological quality of the identified trials by use of a modified version of the Cochrane Bone, Joint and Muscle Trauma Group assessment tool, consisting of 11 items. Two reviewers extracted data without blinding. Trialists were contacted to obtain missing data.


RESULTS
Five trials involving 362 participants were included in this review. Five other trials await possible inclusion if further information can be obtained. 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 brace 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 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 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.


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.
D'hondt
Norman E
NE
Sports & Orthopaedic Rehabilitation Centre, Van Huis & Van't Kloosterv, Physiotherapists, Catharijnesingel 73, Utrecht, Netherlands, 3511 GM. n.e.dhondt@altavista.net
Aufdemkampe
Geert
G
Kerkhoffs
Gino Mmj
GM
Struijs
Peter Aa
PA
Verheul
Claire
C
van Dijk
C N
CN
D018771:Arthralgia / Q000628:therapy*; D005269:Femur; D006801:Humans; D009989:Orthotic Devices; D010329:Patella; D016032:Randomized Controlled Trials as Topic; D013577:Syndrome