The Effect of Orthotic Treatments on Patellofemoral Pain Syndrome: A Systematic Review with Meta-Analysis

Patellofemoral Pain Syndrome is one of the most common musculoskeletal disorders of the knee. There are various treatment approaches to manage this condition including surgery, physiotherapy and orthoses. The objective of this study was to review the effectiveness of orthotic interventions in patients with patellofemoral pain syndrome.
Papers from 2004 to 2015 were obtained using a systematic search within electronic databases. Keywords used in this study included various combinations of keywords for patellofemoral pain syndrome, orthosis and their synonyms. 67 articles were initially selected after reviewing titles and abstracts. In the next step, the full texts were reviewed in details and finally 31 full-text articles were selected for quality appraisal. Six articles with good and intermediate quality scores were entered to pooled data analyses. Meta-analyses were carried out using RevMan software for immediate and follow-up pain reduction as well as individual function of daily living activity.
From 31 selected articles, 17 papers focused on the effectiveness of foot orthoses (mainly were about the wedge insoles) and 14 papers focused on the knee orthoses (including knee brace, knee sleeve, patellar strap). Five articles also looked at the effects of exercise therapy used as adjacent intervention along with an orthosis. In spite of the low quality of the searched evidences, meta-analysis indicated that knee orthosis induces the pain reduction and functional improvement in patients with patellofemoral pain syndrome.
The results indicates that the application of an orthosis may reduce pain and improve individual function in daily living activities. It was also indicated that orthotic devices improve alignment of the leg and increase the quality of life, however, further robust evidence still required to justify this results for clinical implication. It is not clearly understood if orthotic therapy have had any effect on proprioception, biomechanical re-alignment or reduction of the muscle's fatigue.