Efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a randomized controlled trial
ABSTRACT Extracorporeal shockwave therapy (ESWT) has been widely used for pain relief and treatment of musculoskeletal disorders. We aimed to assess ESWT for knee osteoarthritis (OA) over 12 wk by comparison with placebo treatment.
We randomized 70 patients to receive placebo (n = 36) or ESWT (n = 34). For ESWT, patients received 4000 pulses of shockwave at 0.25 mJ/mm(2) weekly for 4 wk. In the placebo group, patients received shockwave at 0 mJ/mm(2) in the same area. The effect on OA was assessed by pain on a visual analog scale and disability on the Lequesne index, Western Ontario and McMaster University Osteoarthritis Index, and patient perception of the clinical severity of OA. Evaluation was performed at baseline and after 1, 4, and 12 wk.
We found no adverse events during and after ESWT. ESWT was more effective than placebo in reducing pain on movement at each period (P < 0.01). The mean visual analog scale score with ESWT was 3.83 at 12 wk versus 7.56 at baseline (P < 0.01). The Lequesne index and the Western Ontario and McMaster University Osteoarthritis Index score were reduced with ESWT. Moreover, patient perception of clinical severity of OA was significantly greater with ESWT than that with placebo (P < 0.01).
ESWT is effective in reducing pain and improving knee function, with better results than placebo during the 12-wk treatment. However, further pilot studies are needed to determine whether ESWT should be recommended at an early or later stage of OA or combined with conventional therapies.
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ABSTRACT: For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. Comparison diagnoses included rheumatoid arthritis and other painful conditions of the knee, exclusive of referred or para-articular pain. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.Arthritis & Rheumatology 09/1986; 29(8):1039-49. · 7.87 Impact Factor
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ABSTRACT: This study investigated the effects of extracorporeal shockwave technology (ESWT) in osteoarthritis of the knee in rats. Thirty-six Sprague-Dawley rats were randomly divided into three groups with 12 rats in each group. Group I was the control group and received neither anterior cruciate ligament transection (ACLT) nor ESWT. In groups II and III, ACLT was performed in left knee and osteoarthritis (OA) was verified at 12 wk. Group II received no ESWT, and group III received ESWT at 12 wk after ACLT. Radiographs and bone mineral density (BMD) were obtained at 0, 12, and 24 wk. The animals were sacrificed at 24 wk. One half of the animals were subjected to bone strength test, and the other half for histomorphologic examination and immunohistochemical analysis. Radiographs of the left knee showed progressive OA changes at 12 and 24 wk in group II, whereas, very subtle OA changes were noted in group I and group III. BMD and bone strength were significantly lower in group II compared with groups I and III, but no difference was noted between group I and group III. The cartilage degradations were significantly higher in group II compared with groups I and III, but no difference was noted between group I and group III. The subchondral bone remodeling was significantly less pronounced in group II compared with groups I and III, but no difference was noted between group I and group III. Application of ESWT to the subchondral bone of the medial tibia condyle showed regression of osteoarthritis of the knees in rats.Journal of Surgical Research 12/2011; 171(2):601-8. DOI:10.1016/j.jss.2010.06.042 · 2.12 Impact Factor