GRADE evidence profile: nonoperative and operative treatment for isolated patellofemoral osteoarthritis
| Quality assessment |
Summary of findings |
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|---|---|---|---|---|---|---|---|---|---|---|---|
| A | B | C | D | E | F | G | H | I | J | K | 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 | |||||||||||
| 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 | (+) | |