Abstract
Early osteoarthritis (EOA) still represents a challenge for clinicians. Although there is no consensus on its definition and diagnosis, a prompt therapeutic intervention in the early stages can have a significant impact on function and quality of life. Exercise remains a core treatment for EOA; however, several physical modalities are commonly used in this population. The purpose of this paper is to investigate the role of physical agents in the treatment of EOA. A technical expert panel (TEP) of 8 medical specialists with expertise in physical agent modalities and musculoskeletal conditions performed the review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) model. The TEP searched for evidence of the following physical modalities in the management of EOA: “Electric Stimulation Therapy”, “Pulsed Electromagnetic field”, “Low-Level Light Therapy”, “Laser Therapy”, “Magnetic Field Therapy”, “Extracorporeal Shockwave Therapy”, “Hyperthermia, Induced”, “Cryotherapy”, “Vibration therapy”, “Whole Body Vibration”, “Physical Therapy Modalities”. We found preclinical and clinical data on transcutaneous electrical nerve stimulation (TENS), extracorporeal shockwave therapy (ESWT), low-intensity pulsed ultrasound (LIPUS), pulsed electromagnetic fields stimulation (PEMF), and whole-body vibration (WBV) for the treatment of knee EOA. We found two clinical studies about TENS and PEMF and six preclinical studies—three about ESWT, one about WBV, one about PEMF, and one about LIPUS. The preclinical studies demonstrated several biological effects on EOA of physical modalities, suggesting potential disease-modifying effects. However, this role should be better investigated in further clinical studies, considering the limited data on the use of these interventions for EOA patients.
Highlights
Osteoarthritis (OA) is the most common degenerative and progressive joint disease, characterized by localized pain and impaired mobility, with relevant implications on both the quality of life of affected patients and socio-economic burden [1]
The first definition of early OA (EOA) was provided by Luyten et al, stating that early knee OA (EKOA) is defined if three of the following criteria are met: two or more episodes of knee pain lasting more than 10 days, Kellgren and Lawrence (KL) grades 0–2, cartilage lesions in arthroscopy, magnetic resonance imaging (MRI) evidence of cartilage or meniscus damage, and/or bone marrow lesions (BMLs) of the subchondral bone [4]
Migliore et al proposed diagnostic criteria of EKOA in patients over 40 years based on symptoms lasting for less than 6 months, the presence of clinical risk factors, and no radiological findings of OA (KL grade 0) [5]
Summary
Osteoarthritis (OA) is the most common degenerative and progressive joint disease, characterized by localized pain and impaired mobility, with relevant implications on both the quality of life of affected patients and socio-economic burden [1]. This condition is very challenging to manage, considering the extreme variability of clinical and instrumental findings of OA patients. Migliore et al proposed diagnostic criteria of EKOA in patients over 40 years based on symptoms lasting for less than 6 months (knee pain without any recent trauma associated with joint stiffness), the presence of clinical risk factors (e.g., family history of OA, metabolic syndrome, malalignment and/or leg length discrepancy), and no radiological findings of OA (KL grade 0) [5]. Luyten et al proposed new EKOA classification criteria based on patientreported outcomes (i.e., Knee Injury and Osteoarthritis Outcome score (KOOS) for defining pain and functional limitation), clinical examination (joint line tenderness and/or crepitus), and KL grade 0–1 [6]
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