Low Level Laser Therapy in Knee Osteoarthritis: A Narrative Review

Physical modalities for the treatment of knee osteoarthritis: a network meta-analysis

OBJECTIVE

This network meta-analysis (NMA) aimed to compare the efficacy of various physical modalities in alleviating pain, stiffness, and functional impairment in patients with knee osteoarthritis (KOA).

METHODS

In accordance with PRISMA-P guidelines, we systematically searched nine databases(CNKI, VIP Database, Wanfang Database, SinoMed, PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library) from inception to October 2024 to identify randomized controlled trials (RCTs) evaluating physical therapies for KOA. The interventions assessed included electrical stimulation therapy (EST), low-level light therapy (LLLT), thermotherapy (TT), cryotherapy (CT), and extracorporeal shock wave therapy (ESWT), with resistance and range of motion exercises (RRE) serving as comparators. Outcome measures comprised the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 6-minute walk test (6 MWT). Bayesian network meta-analyses and pairwise meta-analyses were performed using Stata 17.0 and R 4.4.1 software.

RESULTS

32 RCTs involving 2,078 participants were included. LLLT demonstrated the highest efficacy for pain reduction (VAS: MD=-3.32, 95% CI:-3.82 to-0.75; WOMAC pain: MD=-3.74, 95% CI:-6.68 to-0.72) and joint function improvement (SUCRA = 79.8). ESWT ranked second for pain relief (VAS: MD=-1.31, 95% CI:-2.42 to-0.16) and mobility enhancement (6 MWT: SUCRA = 71.5), while TT showed superior efficacy in reducing stiffness (WOMAC stiffness: MD=-2.09, 95%CI:-3.06 to-0.94; SUCRA = 98.1). In contrast, ultrasonic therapy (UT) did not provide significant benefits.

CONCLUSIONS

The findings suggest that LLLT and ESWT may be optimal for pain relief and functional improvement in patients with KOA, whereas TT appears to be the most effective in reducing stiffness. Optimal dosing parameters of these physical modalities are crucial for maximizing clinical benefits. Clinicians should individualize treatment strategies based on patient-specific factors. Future large-scale RCTs are warranted to validate these protocols and address the heterogeneity of existing evidence.

CLINICAL TRIAL NUMBER

Not applicable.

Predicting Severe Knee Arthritis Based on Two Inertial Measurement Unit Sensors as a Dynamic Coordinate System Using Classical Machine Learning

Background

Aging of societies in recent and upcoming years has made musculoskeletal disorders a significant challenge for healthcare system. Knee osteoarthritis (KOA) is a progressive musculoskeletal disorder that is typically diagnosed using radiographs. Considering the drawbacks of X-ray imaging, such as exposure to ionizing radiation, the need for a noninvasive, low-cost alternative method for diagnosing KOA is essential. The purpose of this study was to evaluate the ability of a wearable device to differentiate between healthy individuals and those with severe osteoarthritis (grade 4).

Methods

The wearable device consisted of two inertial measurement unit (IMU) sensors, one on the lower leg and one on the thigh. One of the sensors is used as a dynamic coordinate system to improve the accuracy of the measurements. In this study, to discriminate between 1433 labeled IMU signals collected from 15 healthy individuals and 15 people with severe KOA aged over 45, new features were extracted and defined in dynamic coordinates. These features were employed in four different classifiers: (1) naive Bayes, (2) K-nearest neighbors (KNNs), (3) support vector machine, and (4) random forest. Each classifier was evaluated using the 10-fold cross-validation method (K = 10). The data were applied to these models, and based on their outputs, four performance metrics - accuracy, precision, sensitivity, and specificity - were calculated to assess the classification of these two groups using the mentioned software.

Results

The evaluation of the selected classifiers involved calculating the four specified metrics and their average and variance values. The highest accuracy was achieved by KNN, with an accuracy of 93.71 ± 1.1 and a precision of 93 ± 1.31.

Conclusion

The novel features based on the dynamic coordinate system, along with the success of the proposed KNN model, demonstrate the effectiveness of the proposed algorithm in diagnosing between signals received from healthy individuals and patients. The proposed algorithm outperforms existing methods in similar articles in sensitivity showing an improvement of 4% and at least. The main objective of this study is to investigate the feasibility of using a wearable device as an auxiliary tool in the diagnosis of arthritis. The reported results in this study are related to two groups of individuals with severe arthritis (grade 4), and there is a possibility of weaker results with the current method.

Navigating the Global Landscape of Exercise Interventions for Knee Osteoarthritis: Exploring Evolving Trends and Emerging Frontiers From a Bibliometric and Visualization Analysis Perspective (2011-2022)

OBJECTIVES

This study utilizes visual analysis methods to retrospectively examine the evolution and trends in exercise interventions for knee osteoarthritis (KOA) research from 2011 to 2022.

DESIGN

Bibliometric and visualization analysis review.

SETTING AND PARTICIPANTS

Using the Web of Science database, the literature search range is from January 1, 2011, to December 31, 2022, with the language specified as English and document type set to Article.

METHODS

Visual analysis was used to analyze literature in the field of exercise interventions for KOA, with KOA and exercise interventions as the key search terms. Visualization maps for countries/regions were created using Tableau and Scimago Graphica software. Institutional, author, and keyword visualization maps were drawn using CiteSpace and VOSviewer software.

RESULTS

In total, 3137 articles were included in the visual analysis. The United States emerged as the leading country in terms of publication volume and contribution. Moreover, developed countries such as the United States, Australia, United Kingdom, and Canada have established close and stable cooperative relationships. The University of Melbourne stood out as the institution with both the highest publication volume and centrality. At the forefront of research output in this field was Bennell K.L. from the University of Melbourne. The journal with the highest co-citation frequency was Osteoarthritis and Cartilage. The keyword clustering map highlighted an evolution in the field of exercise interventions for KOA, emphasizing 8 key research themes spanning knee osteoarthritis, serum cartilage, osteoarthritis initiative, patellofemoral pain, total knee arthroplasty, exercise-induced hypoalgesia, isometric exercise, and anterior cruciate ligament reconstruction. Burst analysis revealed that older adult was the earliest and most prominent keyword, with contemporary topics such as patellofemoral pain, safety, musculoskeletal disorder, and neuromuscular exercise considered as research hotspots and future directions in this field.

CONCLUSIONS AND IMPLICATIONS

The global attention on exercise interventions for KOA research is expanding, emphasizing the importance of strengthened connections among developing countries and collaborative author groups. Recent trends have shifted toward topics such as neuromuscular training, treatment safety, and musculoskeletal disorders, whereas research interest in patellofemoral pain remains unabated. Neuromuscular training for KOA represents the current frontier in this field. Future research should delve into the effects of diverse types of exercise interventions for KOA on neuromuscular injury and recovery, exploring feasibility and safety to formulate personalized exercise plans for patients with KOA.

Efficacy of High-Intensity and Low-Level Laser Therapy Combined With Exercise Therapy on Pain and Function in Knee Osteoarthritis: A Systematic Review and Network Meta-analysis

Introduction: High-intensity laser therapy (HILT) and low-level laser therapy (LLLT) combined with exercise therapy (ET) have emerged as effective treatment options for musculoskeletal pain. However, there have remained uncertainties regarding the magnitude of their effects in reducing pain and improving function in patients with knee osteoarthritis. Hence, we performed a systematic review and network meta-analysis of available evidence in the literature to answer this query. Methods: A literature search was carried out in Embase, PubMed, and Scopus databases without any language restrictions from 1 January 1990 to 31 December 2023. We examined randomized controlled trial (RCT) studies that investigated the efficiency of HILT or LLLT plus knee osteoarthritis ET in pain and functional improvement of the knee. We performed a network meta-analysis and provided the standardized mean difference (SMD) with a 95% confidence interval (CI) by pooling the continuous data on the visual analogue scale (VAS) pain score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score using a random-effects model. Results: In total, 11 eligible RCTs were included. Our analysis revealed significant improvements in the VAS pain and WOMAC function scores on weeks 4 and 8 after interventions in groups treated with LLLT+ET and HILT+ET compared with placebo+ET. Moreover, HILT+ET showed a greater reduction in the VAS pain score (SMD=-1.41; 95% CI: -2.05 to -0.76) and improvement in the WOMAC function score (SMD=-2.20; 95% CI: -3.21 to -1.19) than LLLT+ET in week 8. Conclusion: Based on our findings, both HILT+ET and LLLT+ET treatments effectively reduced pain and improved function, but HILT+ET showed a more significant improvement in both outcomes compared to LLLT+ET.

Efficacy and safety comparison of infrared laser moxibustion and traditional moxibustion in knee osteoarthritis: study protocol for a Zelen-design randomized controlled non-inferiority clinical trial

BACKGROUND

Knee osteoarthritis (KOA) is the most common chronic degenerative joint disease and places a substantial burden on the public health resources in China. The purpose of this study is to preliminarily evaluate whether infrared laser moxibustion (ILM) is non-inferior to traditional moxibustion (TM) in the treatment of KOA.

MATERIALS AND METHODS

In the designed Zelen-design randomized controlled non-inferiority clinical trial, a total of 74 patients with KOA will be randomly allocated to one of two interventions: ILM treatment or TM treatment. All participants will receive a 6-week treatment and a follow-up 4 weeks after treatment. The primary outcomes will be the mean change in pain scores on the numeric rating scale (NRS) measured at baseline and the end of last treatment at week 6. The secondary outcomes will be the pain scores on the NRS from weeks 1 to 5 after the start of treatment and the changes from baseline to endpoints (weeks 6 and 10) in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), SF-36, knee circumference, and 6-min walking test. In addition, safety assessment will be performed throughout the trial.

CONCLUSION

The results of our study will help determine whether a 6-week treatment with ILM is non-inferior to TM in patients with KOA, therefore providing evidence to verify if ILM can become a safer alternative for TM in clinical applications in the future.

TRIAL REGISTRATION

Clinical Trial Registration Platform (ChiCTR2200065264); Pre-results. Registered on 1 November 2022.

High-frequency near-infrared diode laser irradiation suppresses IL-1β-induced inflammatory cytokine expression and NF-κB signaling pathways in human primary chondrocytes

Osteoarthritis (OA) and rheumatoid arthritis (RA) are common inflammation-associated cartilage degenerative diseases. Recent studies have shown that low-level diode laser treatment can reduce inflammatory cytokine expressions in cartilage. We recently reported that high-frequency low-level diode laser irradiation attenuates matrix metalloproteinases (MMPs) expression in human primary chondrocytes. However, the molecular mechanism underlying the effect of high-frequency low-level diode laser on chondrocytes remains unclear. Therefore, we aimed to elucidate the effect of high-frequency low-level diode laser irradiation on inflammatory cytokine expression in human primary chondrocytes. Normal human articular chondrocytes were treated with recombinant interleukin-1 beta (IL-1β) for 30 min or 24 h and irradiated with a high-frequency NIR diode laser at 8 J/cm². The expression of IL-1β, interleukin-6, and tumor necrosis factor-alpha was assessed using western blot analysis. To evaluate the nuclear factor-kappa B (NF-κB) signaling pathway, the phosphorylation, translocation, and DNA-binding activity of NF-κB were detected using western blot analysis, immunofluorescence analysis, electrophoretic mobility shift assay, and enzyme-linked immunosorbent assay analysis. High-frequency low-level diode laser irradiation decreased inflammatory cytokine expression in IL-1β-treated chondrocytes. Moreover, high-frequency low-level diode laser irradiation decreased the phosphorylation, nuclear translocation, and DNA-binding activity of NF-κB in the IL-1β-treated state. However, irradiation alone did not affect NF-κB activity. Thus, high-frequency low-level diode laser irradiation at 8 J/cm² can reduce inflammatory cytokine expressions in normal human articular chondrocytes through NF-κB regulation. These findings indicate that high-frequency low-level diode laser irradiation may reduce the expression of inflammatory cytokines in OA and RA.

Comparison of 10.6 μm Laser Moxibustion with Traditional Moxibustion in Knee Osteoarthritic Therapy: A Randomized Noninferiority Clinical Trial

Objective: To investigate the noninferiority of 10.6 μm laser moxibustion (LM) to traditional moxibustion (TM) in knee osteoarthritis (KOA). Methods: Ninety-two patients were recruited and randomly placed into one of two groups: 10.6 μm LM or TM in a 1:1 ratio. Each patient received 12 sessions of LM or TM, focusing on the ST-35 and Ashi acupoint. The sessions took place over 4 weeks, three times a week, and were followed up over 8 weeks. The endpoint outcomes were separated into two categories, primary and secondary. The primary endpoint was assessed at the end of the 4-week treatment, using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score. The secondary endpoint was evaluated at the end of the trial and consisted of the WOMAC function and stiffness score, visual analog pain [visual analog scale (VAS)] score, and 15-m walking time test. In addition, safety evaluation was performed throughout the trial. Results: Among the 92 randomized participants, 86 (93.48%) completed the trial; 43 in each group. The WOMAC pain score improved dramatically between the LM and TM groups, with a mean difference of 20.61 [95% confidence interval (CI): -2.28 to 43.50]. Given that the lower boundary of 95% CI was greater than -18.49, noninferiority was established. In addition, both LM and TM significantly decreased the WOMAC (pain, function and stiffness) score, VAS score (p < 0.05), and the 15-m walking time at the end of the trial. Interestingly, there were not significant differences between LM and TM (p > 0.05), suggesting that both are equally effective in treating KOA. Finally, among the 92 patients, 17 (18.48%) adverse effects were documented, namely 5 (10.87%) in the LM-treated group and 11 (26.09%) in the TM-treated group. Conclusions: 10.6 μm LM is not inferior to TM in treating KOA. Moreover, both LM and TM dramatically alleviated knee pain and enhanced function of knees. Clinical Trial Registration number: ISRCTN registry trial identifier: 14604492.