Isolated patellofemoral osteoarthritis

Figures & data

QUOROM flow diagram of included studies.

GRADE evidence profile: nonoperative and operative treatment for isolated patellofemoral osteoarthritis

Quality assessment							Summary of findings
A	B	C	D	E	F	G	H	I	J	K	L
Nonoperative treatment: Physiotherapy versus no physiotherapy
1	RT	No	Yes	No	No	U	40	43	Knee pain at 5 months (–6.4 mm; 95% CI –15.3 to 2.4; p = 0.16)Increased quadriceps strength at 5 months(+11.7 Nm; 95% CI 4.5 to 19.0; p = 0.002)WOMAC at 5 months (-0.6; 95% CI -3.7 to 2.4; p = 0.68)	H	(+)
Nonoperative treatment: Taping
1	RC	Yes (-1) ^b	Yes	No	No	U	14	(14)	Neutral vs. medial taping: knee pain at 4 days(15.5 mm; 95% CI 2.4 to 28.6; p = 0.023)Neutral vs. lateral taping: knee pain at 4 days(-8.0 mm; 95%CI -22.5 to 6.5, p = 0.26)	M	(+)
Nonoperative treatment: Intra-articular injection
1	O	Yes (-1) ^c	Yes	No	No	U	25	–		VL	(+)
Operative treatment: Arthroscopy
2	RT	No	No	S (-1)	No	U	196	135	KSPS at 24 months (placebo 51.6±23.7; lavage 53.7±23,7; debridement 51.4±23.2; p = 0.64 and p = 0.96)WOMAC at 24 months (-23±605; 95% CI -208 to 161; p = 0.22)	M	–
Operative treatment: Chondroplasty, resection arthroplasty, and lateral facetectomy
5	O	No	No	No	No	U	155	–		L	(+)
Operative treatment: Extensor mechanism alignment and lateral release
7	O	No	No	No	No	U	224	–		L	(–)
Operative treatment: Patellectomy
0
Operative treatment: Total knee arthroplasty
6	MO	No	No	No	No	U	271	–		L	(+)
Operative treatment: Patellofemoral arthroplasty
24	SO	No	No	No	No	U	2,938	–		L	(+)

A. Number of studies

B. Design

  RT: Randomized trial

  RC: Randomized crossover trial

  O: Observational

  MO: Matched case control, observational

  SO: Systematic review, observational

C. Limitations

  No: No serious limitations

  Yes: Serious

    ^b patients not blinded, short follow-up.

    ^c pilot study, important heterogeneity in diagnosis.

D. Inconsistency

  No: No serious inconsistency

  Yes: Only one study

E. Indirectness

  No: No serious indirectness

  S: Some uncertainty about directness (-1), not specifically limited to isolated patellofemoral osteoarthritis.

F. Imprecision

  No: No serious imprecision

G. Publication bias

  U: Undetected

H. Number of treated patients

I. Number of controls

J. Absolute effect and 95% confidence interval. KSPS: Knee Specific Pain Score.

K. Quality

  H: High

  M: Moderate

  L: Low

  VL: Very low

L. Recommendation

  (+): Weak for

  (–): Weak against

  –: Strong against