A Systematic Review of Acupuncture Treatment Effect for Patellofemoral Pain Syndrome

This systematic review examined the efficacy of acupuncture in the treatment of patellofemoral pain syndrome (PFPS), a common condition that causes pain at the front of the knee, especially during activities such as climbing stairs, squatting, and running. PFPS represents about 25% of all knee injuries and primarily affects young people aged 10-35 years, with higher prevalence in women. The researchers conducted a comprehensive search in 10 international and national databases, including PubMed, Cochrane, Embase, and Chinese, Japanese, and Korean databases. Of the 158 studies initially identified, only 7 randomized controlled trials met the strict inclusion criteria.

The included studies involved 431 participants, with 230 in the acupuncture group and 201 in control groups. Acupuncture interventions varied between traditional manual acupuncture, electroacupuncture, and dry needling. Treatment lasted on average 5.3 weeks, with sessions 2-5 times per week. The most commonly used points were Xuehai (SP-10), Yanglingquan (GB-34), Zusanli (ST-36), and Yinlingquan (SP-9), following traditional Chinese medicine principles to move qi and blood.

Pain assessment was done primarily using the visual analog scale (VAS), while function was measured by scales such as Kujala and isokinetic testing. All studies demonstrated significant improvement in pain and function before and after acupuncture treatment. However, when compared directly with other treatments (exercise, placebo, medications), the results were partially significant. Some studies showed superiority of acupuncture, while others did not find statistically significant differences.

Methodologic quality analysis revealed important concerns. All 7 studies showed some risk of bias, mainly related to inadequate randomization, lack of blinding of therapists and participants, and selective reporting of outcomes. Two studies were classified as high risk because of incomplete data. Limitations include the small number of available studies, heterogeneity in interventions and outcome measures, and the inability to perform meta-analysis because of data variability.

Clinically, the results suggest that acupuncture can be a beneficial therapeutic option for PFPS, especially as an adjunct to rehabilitation exercises. Point selection followed traditional principles, focusing on channels that nourish blood and move qi, such as the stomach and spleen meridians. Treatment proved safe, with no reports of serious adverse events in the analyzed studies.