Extracorporeal Shockwave Therapy In Knee Osteoarthritis Research Articles

Extracorporeal Shock Wave Therapy as Regenerative Medicine in Knee Osteoarthritis: Pre-Experiment for Matrix Metalloproteinase-3 Evaluation.

Knee osteoarthritis (KOA) is currently treated by regenerative therapies that aim to inhibit arthritic degeneration. Extracorporeal shock wave therapy (ESWT) is one of the physical regenerative approaches used for KOA management. However, little is known regarding the impact of shock wave treatment on matrix metalloproteinase-3 (MMP-3), which is one of the enzymes mediating cartilage degradation. To evaluate the effect of ESWT on MMP-3 levels and pain intensity in patients with KOA. Fourteen patients diagnosed with Kellgren Lawrence, grades 2 and 3 KOA were recruited for the study. ESWT piezo shockwave was applied once a week for six weeks. MMP-3 levels in the blood were measured pre-test, mid-test (three weeks after therapy) and post-test (one week after the last session) by enzyme-linked immunosorbent assay (ELISA). The perceived pain was recorded at each session by the Wong Becker Face Scale. The median pre-test, mid-test and post-test MMP-3 levels were 19.92 ng/mL, 15.89 ng/mL and 18.82 ng/mL, respectively, and there were significant differences between the pre-test and mid-test, and the pre-test and post-test values (p < 0.05). The pain scores also decreased significantly over the period of intervention. MMP-3 levels decreased significantly in KOA patients after ESWT, and the decline was most obvious after 3 weeks of therapy. Therefore, EWST should be considered as a suitable treatment option for KOA.

Shockwave Therapy Combined with Autologous Adipose-Derived Mesenchymal Stem Cells Is Better than with Human Umbilical Cord Wharton’s Jelly-Derived Mesenchymal Stem Cells on Knee Osteoarthritis

Extracorporeal shockwave therapy (ESWT) and mesenchymal stem cells (MSCs) have been reported to have chondroprotective effects in knee osteoarthritis (OA). Here, we examined whether autologous adipose-derived mesenchymal stem cells (ADMSCs) and human umbilical cord Wharton’s jelly-derived mesenchymal stem cells (WJMSCs) increased the efficacy of ESWT in knee OA, and compared the efficacy of the two. The treatment groups exhibited significant improvement of knee OA according to pathological analysis, micro-computed tomography (CT), and immunohistochemistry (IHC) staining. The ADMSCs and ESWT+ADMSCs groups exhibited increased trabecular thickness and bone volume as compared with the ESWT, WJMSCs, and ESWT+WJMSCs groups individually. According to the results of IHC staining, Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) activity and caspase-3 were significantly reduced in the ADMSCs and ESWT+ADMSCs groups as compared with the WJMSCs and ESWT+WJMSC groups. In mechanistic factor analysis, the synergistic effect of ESWT+ADMSCs was observed as being greater than the efficacies of other treatments in terms of expressions of transforming growth factor (TGF)-β, runt-related transcription factor (RUNX)-2 and sex determining region Y-box (SOX)-9. The type II collagen was expressed at a higher level in the WJMSCs group than in the others. Furthermore, ESWT+ADMSCs reduced the expression of platelet-derived growth factor (PDGF)-BB and increased the expression of bone morphogenetic protein (BMP)-4. Therefore, we demonstrated that ESWT+ADMSCs had a synergistic effect greater than that of ESWT+WJMSCs for the treatment of early knee OA.

Extracorporeal shockwave therapy for the treatment of knee osteoarthritis: a meta-analysis.

Extracorporeal shockwave therapy (ESWT) has become a common practice for treating knee osteoarthritis (OA). However, the effectiveness and safety of this treatment are still questionable. This meta-analysis is aimed at determining the degree of pain reduction and functional outcome after ESWT for knee OA. We systematically searched MEDLINE, EMBASE, and other online databases. The articles comparing the outcomes between ESWT and controls were included in the analysis. Nine studies with 705 patients were included. The pooled data revealed significantly lower pain scores in the ESWT groups than in the control groups within two weeks of treatment and six months after treatment (visual analogue scale, - 1.59, p = 0.0003, 95% confidence interval (CI) - 2.45 to - 0.72 at 2weeks; - 1.12, p = 0.005, 95% CI - 1.89 to - 0.34 at 6months). The ESWT group also had better functional outcomes four to six weeks post treatment (Western Ontario and McMaster Universities Osteoarthritis Index, - 11.96, p = 0.003, 95% CI - 19.76 to - 4.15). No rebound pain was noted for up to 12months. Using ESWT to treat knee OA may reduce pain and improve functional outcomes. The effect may last six months to one year. More prospective studies are needed to investigate the settings for ESWT to optimize treatment results.

Application and efficacy of extracorporeal shockwave treatment for knee osteoarthritis: A systematic review and meta‑analysis

The increasing aging of the world population is accompanied by a rise in the incidence of knee osteoarthritis (KOA). There has been a growing interest in shockwave treatment for orthopedic diseases, including KOA. In previous trials, extracorporeal shockwave therapy (ESWT) was compared to physical therapy or placebo in the treatment of KOA. However, the efficacy and safety of ESWT for KOA remains disputed. The present meta-analysis assessed the effects of ESWT in KOA. The PubMed, Medline, Embase, Web of Science, Research Gate and the Cochrane Library were searched to identify comparative studies involving ESWT for patients with KOA. The outcome indicators included the visual analog scale (VAS) score, range of motion (ROM), the Lequesne index (LI) and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC). In the comparison of the ESWT vs. placebo groups, the primary outcomes included the VAS score and ROM, while the LI was the secondary outcome. In the comparison of the ESWT vs. physical therapy groups, the primary outcomes included the pain score and ROM, while the secondary outcome was the WOMAC index. Relevant data were analyzed using RevMan v5.3. The ESWT group had a lower VAS core, larger ROM and a better LI than the placebo group after 1 month of therapy (P<0.05). Furthermore, at 1 month post-therapy, the ESWT group had a lower VAS score, larger ROM and a better WOMAC than the physical therapy group (P<0.05). The outcomes regarding pain, ROM, LI and WOMAC were significantly different between the two different groups (P<0.05). The present meta-analysis suggested that ESWT may achieve a better therapeutic effect for patients with KOA as compared to physical therapy. However, high-quality trials with large sample sizes are essential to substantiate these results.

Extracorporeal shockwave therapy with a modified peppering technique for knee osteoarthritis: study protocol for a randomized controlled trial

Background and objectives: Extracorporeal shockwave therapy (ESWT) has been shown to promote pain relief and functional improvement in osteoarthritis (OA) patients. We aimed to determine the efficacy of ESWT for knee OA with a modified peppering technique by comparison with sham treatment. Design: A single-center, double-blinded, randomized controlled trial. Methods: This trial will be performed at Taoyuan General Hospital, Taiwan, China. We will enroll at least 36 patients with knee OA (Kellgren-Lawrence grading scale, grade 2 to grade 4) to receive ESWT or sham ESWT. Using simple randomization patients will be assigned into two groups: ESWT and sham ESWT. In the ESWT group, patients will receive 1600 pulses of shockwave at 0.24 mJ/mm2 weekly for 3 weeks. In the sham ESWT group, patients will receive 1600 pulses of shockwave at 0.24 mJ/mm2 in the same area without jelly between applicator pad and handpiece. Outcome measures: The primary outcome measure is Western Ontario and McMaster Universities Osteoarthritis Index. The secondary outcome measures are Visual analog scale and six-minute walk test. The patients will be evaluated at baseline, 3rd week and 4th week. Discussion: The trial outcomes will investigate the effects of ESWT with a modified peppering technique in patients diagnosed with knee OA. Ethics and dissemination: This study protocol has acquired written approval from Ethics Committee, Taoyuan General Hospital, Ministry of Health and Welfare, Taiwan, China (IRB No. TYGH105013), and will be performed in accordance with the Declaration of Helsinki developed by the World Medical Association. Written informed consent will be obtained from all participants. The results will be published in peer-reviewed journals or disseminated via conference presentations. Trial registration: ClinicalTrial.gov identifier: NCT03048773; registered on February 9, 2017. Protocol version: 1.0.

The Dose-Related Effects of Extracorporeal Shock Wave Therapy for Knee Osteoarthritis.

ObjectiveTo investigate the dose-related effects of extracorporeal shock wave therapy (ESWT) for knee osteoarthritis.MethodsSeventy-five subjects were recruited, 60 of which met the inclusion criteria. The patients were randomly classified into two groups: group L, which was a low-energy group (n=30; 1,000 shocks/session; energy flux density [EFD], 0.040 mJ/mm2) and group M, which was a medium-energy group (n=30; 1,000 shocks/session; EFD, 0.093 mJ/mm2). For each group, 1,000 shock waves were delivered to the medial tibial plateau area, once a week, for 3 weeks. The main outcome measures were the visual analogue scale (VAS), the Roles and Maudsley (RM) score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and the Lequesne index. Each assessment was performed at the baseline and at 1, 4, and 12 weeks after ESWT.ResultsIn both groups, the VAS, the RM and WOMAC scores, and the Lequesne index were significantly improved over time (p<0.001), and group M showed greater improvement over group L at the 1, 4 and 12 weeks assessments.ConclusionIn this study, medium-energy group (group M) showed greater improvement in regard to relieving pain and restoring functional outcome than the low-energy group (group L). Therefore, EFD can be considered to have significant influence when treating with ESWT for knee osteoarthritis.