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Dutch multidisciplinary guideline on anterior knee pain: Patellofemoral pain and patellar tendinopathy.

Authors :
Ophey M
Koëter S
van Ooijen L
van Ark M
Boots F
Ilbrink S
Lankhorst NA
Piscaer T
Vestering M
den Ouden Vierwind M
van Linschoten R
van Berkel S
Source :
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2025 Feb; Vol. 33 (2), pp. 457-469. Date of Electronic Publication: 2024 Jul 24.
Publication Year :
2025

Abstract

Purpose: The purpose of this study was to develop a multidisciplinary guideline for patellofemoral pain (PFP) and patellar tendinopathy (PT) to facilitate clinical decision-making in primary and secondary care.<br />Methods: A multidisciplinary expert panel identified questions in clinical decision-making. Based on a systematic literature search, the strength of the scientific evidence was determined according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method and the weight assigned to the considerations by the expert panel together determined the strength of the recommendations.<br />Results: After confirming PFP or PT as a clinical diagnosis, patients should start with exercise therapy. Additional conservative treatments are indicated only when exercise therapy does not result in clinically relevant changes after six (PFP) or 12 (PT) weeks. Pain medications should be reserved for cases of severe pain. The additional value of imaging assessments for PT is limited. Open surgery is reserved for very specific cases of nonresponders to exercise therapy and those requiring additional conservative treatments. Although the certainty of evidence regarding exercise therapy for PFP and PT had to be downgraded ('very low GRADE' and 'low GRADE'), the expert panel advocates its use as the primary treatment strategy. The panel further formulated weaker recommendations regarding additional conservative treatments, pain medications, imaging assessments and open surgery ('very low GRADE' to 'low GRADE' assessment or absence of scientific evidence).<br />Conclusion: This guideline recommends starting with exercise therapy for PFP and PT. The recommendations facilitate clinical decision-making, and thereby optimizing treatment and preventing unnecessary burdens, risks and costs to patients and society.<br />Level of Evidence: Level V, clinical practice guideline.<br /> (© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Details

Language :
English
ISSN :
1433-7347
Volume :
33
Issue :
2
Database :
MEDLINE
Journal :
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
Publication Type :
Academic Journal
Accession number :
39045713
Full Text :
https://doi.org/10.1002/ksa.12367