Sports Medicine

, Volume 42, Issue 1, pp 31–49 | Cite as

Efficacy of Nonsurgical Interventions for Anterior Knee Pain

Systematic Review and Meta-Analysis of Randomized Trials
  • Natalie J. Collins
  • Leanne M. Bisset
  • Kay M. Crossley
  • Bill VicenzinoEmail author
Review Article Anterior Knee Pain Management: Systematic Review


Anterior knee pain is a chronic condition that presents frequently to sports medicine clinics, and can have a long-term impact on participation in physical activity. Conceivably, effective early management may prevent chronicity and facilitate physical activity. Although a variety of nonsurgical interventions have been advocated, previous systematic reviews have consistently been unable to reach conclusions to support their use. Considering a decade has lapsed since publication of the most recent data in these reviews, it is timely to provide an updated synthesis of the literature to assist sports medicine practitioners in making informed, evidence-based decisions. A systematic review and meta-analysis was conducted to evaluate the evidence for nonsurgical interventions for anterior knee pain.

A comprehensive search strategy was used to search MEDLINE, EMBASE, CINAHL® and Pre-CINAHL®, PEDro, PubMed, SportDiscus®, Web of Science®, BIOSIS Previews®, and the full Cochrane Library, while reference lists of included papers and previous systematic reviews were hand searched. Studies were eligible for inclusion if they were randomized clinical trials that used a measure of pain to evaluate at least one nonsurgical intervention over at least 2 weeks in participants with anterior knee pain. A modified version of the PEDro scale was used to rate methodological quality and risk of bias. Effect size calculation and meta-analyses were based on random effects models.

Of 48 suitable studies, 27 studies with low-to-moderate risk of bias were included. There was minimal opportunity for meta-analysis because of heterogeneity of interventions, comparators and follow-up times. Metaanalysis of high-quality clinical trials supports the use of a 6-week multimodal physiotherapy programme (standardized mean difference [SMD] 1.08, 95% CI 0.73, 1.43), but does not support the addition of electromyography biofeedback to an exercise programme in the short-term (4 weeks: SMD −0.21, 95% CI −0.64, 0.21; 8–12 weeks: SMD −0.22, 95% CI −0.65, 0.20). Individual study data showed beneficial effects for foot orthoses with and without multimodal physiotherapy (vs flat inserts), exercise (vs control), closed chain exercises (vs open chain exercises), patella taping in conjunction with exercise (vs exercise alone) and acupuncture (vs control).

Findings suggest that, in implementing evidence-based practice for the nonsurgical management of anterior knee pain, sports medicine practitioners should prescribe local, proximal and distal components of multimodal physiotherapy in the first instance for suitable patients, and then consider foot orthoses or acupuncture as required.


Standardize Mean Difference Anterior Knee Pain Supplemental Digital Content Electric Muscle Stimulation Comprehensive Search Strategy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Natalie Collins was the recipient of a National Health and Medical Research Council of Australia Public Health Scholarship (No. 351663), and currently holds a National Health and Medical Research Council of Australia Health Professional Post-Doctoral Research Fellowship (No. 628918). The work of the authors was independent of the funding body. All authors declare no conflicts of interest that are directly relevant to the content of this review.


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Copyright information

© Adis Data Information BV 2012

Authors and Affiliations

  • Natalie J. Collins
    • 1
    • 2
  • Leanne M. Bisset
    • 3
    • 4
  • Kay M. Crossley
    • 1
  • Bill Vicenzino
    • 2
    Email author
  1. 1.Melbourne School of EngineeringThe University of MelbourneMelbourneAustralia
  2. 2.School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneAustralia
  3. 3.School of Physiotherapy and Exercise ScienceGriffith UniversityGold CoastAustralia
  4. 4.Gold Coast Health Services DistrictGold CoastAustralia

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