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Tang P, Wen T, Lu W, Jin H, Pan L, Li H, Zeng B, Zhou Y, Xiao W, Li Y. The efficacy of extracorporeal shock wave therapy for knee osteoarthritis : an umbrella review. Int J Surg 2024; 110:2389-2395. [PMID: 38668665 PMCID: PMC11020044 DOI: 10.1097/js9.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/09/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND An umbrella review was conducted to compare the effectiveness of extracorporeal shock wave therapy (ESWT) versus non-ESWT in the treatment of knee osteoarthritis (KOA). MATERIALS AND METHODS Three databases including PubMed, Embase and Web of science were searched up to September 2023. Literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. Meta-analysis of outcome indicators was performed using Revman 5.4 software. RESULTS A total of eight meta-analysis were included in this umbrella review. All meta-analysis were graded against a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) and scored between 8 and 11. Compared to the sham group, the ESWT group showed better results in WOMAC (Western Ontario and McMaster Universities Arthritis Index) [mean difference (MD)=-2.94, 95% CI: -5.52, -0.37, P=0.03, I²=60%], Visual Analog Scale (VAS) (MD=-2.0, 95% CI: -2.5, -1.5, P<0.01, I²=0%), range of motion (ROM) (MD=17.55, 95% CI: 13.49, 21.61, P<0.00001, I²=0%), and Lequesne index (MD=-2.85, 95% CI: -3.64, -2.07, P<0.00001, I²=48%). CONCLUSION Based on the results of our analysis, ESWT is now an effective therapy for improving pain and function in patients with KOA.
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Affiliation(s)
- Peiyuan Tang
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ting Wen
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wenhao Lu
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hongfu Jin
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Linyuan Pan
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hengzhen Li
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Biyun Zeng
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | | | - Wenfeng Xiao
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yusheng Li
- Departments ofOrthopedics
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Al-Abbad H, Reznik JE, Biros E, Paulik B, Will R, Gane S, Moss P, Wright A. Evaluation of treatment parameters for focused-extracorporeal shock wave therapy in knee osteoarthritis patients with bone marrow lesions: a pilot study. J Rehabil Med 2024; 56:jrm13207. [PMID: 38470167 PMCID: PMC10949080 DOI: 10.2340/jrm.v56.13207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/25/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES To evaluate the effect of different dosage parameters of focused-extracorporeal shock wave therapy on pain and physical function in knee osteoarthritis patients with bone marrow lesions. In addition, to investigate pathophysiological changes based on imaging and biomarker measures. METHODS Using a single-case experimental design, a total of 12 participants were randomly allocated in 4 equal groups of 3 to receive different dosages of focused-extracorporeal shock wave therapy. Each group received either 4 or 6 sessions of 1500 or 3000 shocks over 4 or 6 weekly sessions. Participants underwent repeated measurements during the baseline, intervention, and post-intervention phases for Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, aggregated locomotor function score and pressure pain threshold. Imaging and inflammatory biomarker outcomes were measured at baseline and 3 months following the intervention. RESULTS The group receiving the highest dosage of focused-extracorporeal shock wave therapy showed clinical improvements superior to those of participants in the other 3 groups. Statistically significant changes during the follow-up phase in contrast to baseline measurements for the WOMAC score (Tau-U= -0.88, p < 0.001), aggregated locomotor function score (Tau-U= -0.77, p = 0.002), and pressure pain threshold (Tau-U= 0.54, p = 0.03) were observed. Bone marrow lesion and inflammatory cytokines demonstrated no change. CONCLUSION A dose-dependent effect for focused-extracorporeal shock wave therapy on osteoarthritis-related symptoms was suggested. However, these improvements were not associated with changes in the underlying pathophysiological mechanisms.
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Affiliation(s)
- Hani Al-Abbad
- Physical Therapy department, Rehabilitation hospital, King Fahad Medical City. Riyadh, Saudi Arabia; College of Healthcare Science and Division of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Jacqueline E Reznik
- College of Healthcare Science and Division of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Erik Biros
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Bruce Paulik
- Hollywood Functional Rehabilitation Clinic, Nedlands, Perth, WA, Australia
| | - Rob Will
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | | | - Penny Moss
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Anthony Wright
- School of Allied Health, Curtin University, Perth, WA, Australia.
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Jorgensen JE, Larsen P, Elsoe R, Mølgaard CM. Callus formation and bone remodeling in a tibial nonunion after minimal invasive percutaneous screw fixation followed by extracorporeal shockwave therapy 17-months after initial trauma - A case report. Physiother Theory Pract 2024; 40:395-407. [PMID: 35969158 DOI: 10.1080/09593985.2022.2112117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 08/06/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION The treatment of tibial nonunion is challenging and treatment may be conservative or surgical. Conservative strategies include functional braces and weight bearing, or focused extracorporeal shockwave therapy (fESWT). CASE DESCRIPTION A 45-year-old male patient sustained spiral tibial shaft fractures and was treated surgically within 24 hours after the initial accident with intramedullary nails. The tibial fracture was later classified as nonunion after 11 months. Radiologic evaluation 17 months after the initial trauma demonstrated clinical nonunion, and subsequently the patient was offered a conservative approach with fESWT to facilitate an increase in callus formation. The handpiece was fitted with a stand-off II (long), penetration depth of 15 mm. Three cycles were administered in month 17, 19 and 20 after baseline. Each cycle consisted of three treatments sessions spaced with 6-8 days apart, and consisted of 3000 to 4000 impulses each given at 0.25-0.84 mJ/mm2. The number of impulses and the power at the focus point varied according to the pain response. OUTCOMES The patient achieved union 23 months after fracture. A clinical important improvement was observed with both Lower Extremity Functional Scale (LEFS) (18-point difference) and Patient Specific Functional Scale (PSFS) (average: 4.7 points,) The "worst pain last 24 hours" was reduced by 5 points. These values express minimal clinically important difference (MCID) values in these functional patient-reported outcome measures. CONCLUSION This treatment strategy may be viable in a broader setting, including private practice physiotherapy thereby treating the patient in close proximity to the patient's everyday life.
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Affiliation(s)
| | - Peter Larsen
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Rasmus Elsoe
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Carsten M Mølgaard
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
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Choi IJ, Jeon JH, Choi WH, Yang HE. Effects of extracorporeal shockwave therapy for mild knee osteoarthritis: A pilot study. Medicine (Baltimore) 2023; 102:e36117. [PMID: 37986308 PMCID: PMC10659666 DOI: 10.1097/md.0000000000036117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Extracorporeal shockwave therapy (ESWT) has been widely used for various musculoskeletal disorders, including knee osteoarthritis (OA), and has been shown in several studies to be a safe treatment. Although some studies have confirmed the pain-relieving effect of ESWT for knee OA, research on objectivity for structural changes in knee OA is lacking. The aim of this study was to evaluate the ESWT treatment mechanisms in patients with knee OA by means of clinical symptoms and ultrasound techniques as objective measures. METHODS Eighteen patients with mild knee OA were enrolled and randomized to 1 of 2 treatment groups: active or sham. Patients in the experimental group received 0.05 mJ/mm² total energy with 1000 pulses weekly for 3 weeks. We then assessed them before, immediately after, and 1-month after the last treatment using the following measurements: pain on a visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index, Lequesne index, knee joint range of motion, and ultrasonographic features (articular cartilage thickness, Doppler activity, and joint effusion height). RESULTS All 18 patients completed the 3 treatment sessions without any complication. Both the experimental and control groups improved in terms of OA symptoms, as measured by the visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index score, and Lequesne index (P < .05). The height of the suprapatellar effusion decreased with time course in the experimental group (P < .05) and showed significant differences with control group at 1-month follow-up (P < .05). The experimental group showed an increase in knee flexion range of motion and Doppler activity immediately following the last treatment session (P < .05), but the effect was not sustained at the 1-month follow-up. CONCLUSIONS Although the therapeutic activity itself could improve OA symptoms, objective improvements were only observed after ESWT. Suprapatellar effusion height was reduced after ESWT and the effect was maintained after 1-month. Our results suggest that ESWT may be effective in reducing suprapatellar effusion and improving symptoms in mild knee OA. However, studies with a larger sample size are required.
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Affiliation(s)
- I Jun Choi
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Jong Hu Jeon
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Woo Hwa Choi
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Hea-Eun Yang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Republic of Korea
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Li J, Ma Q, Hou J, Liu Y, Lu P, Liu P, Zhang Z, Xing G. The Efficacy of Microfracture Combined with Extracorporeal Shock Wave Therapy for Treating Osteochondral Lesion of the Talus and the Quality of Regenerated Cartilage: A Retrospective Cohort Study and MRI Assessment. J Clin Med 2023; 12:jcm12082966. [PMID: 37109300 PMCID: PMC10143927 DOI: 10.3390/jcm12082966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/27/2023] [Accepted: 03/24/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND osteochondral lesion of the talus (OLT) is a common disease in the physically active population, and extracorporeal shock wave therapy (ESWT) is a noninvasive treatment. We hypothesized that microfracture (MF) combined with ESWT may have great potential to become a novel combination treatment of OLT. METHODS the OLT patients who received MF + ESWT or MF + platelet-rich plasma (PRP) injection were retrospectively included, with a minimal follow up of 2y. The daily activating VAS, exercising VAS, and American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS) were used to assess the efficacy and functional outcome, and ankle MRI T2 mapping was used to evaluate the quality of regenerated cartilage in the OLT patients. RESULTS only transient synovium-stimulated complications were found during the treatment sessions; the complication rate and daily activating VAS did not have differences between groups. MF + ESWT had a higher AOFAS and a lower T2 mapping value than MF + PRP at the 2y follow up. CONCLUSIONS the MF + ESWT had superior efficacy for treating OLT, which resulted in better ankle function and more hyaline-like regenerated cartilage, superior to the traditional MF + PRP.
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Affiliation(s)
- Jian Li
- Department of Orthopaedics, China Aerospace Science & Industry Corporation Hospital 731, Beijing 100074, China
- Department of Orthopedics, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Qiaozhi Ma
- Department of Radiology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Jianlei Hou
- Department of Orthopedics, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Yufen Liu
- Department of Orthopedics, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Pengfei Lu
- Department of Orthopedics, Changshou People's Hospital of Chongqing, Chongqing 401220, China
| | - Pengwei Liu
- Department of Orthopedics, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Zhongwen Zhang
- Department of Orthopedics, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Gengyan Xing
- Department of Orthopedics, The Third Medical Center of PLA General Hospital, Beijing 100039, China
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Stewart HL, Easley JT, Selberg KT, Puttlitz CM, Nakamura LK, Johnson JW, Kawcak CE. Experimental models of bone marrow lesions in ovine femoral condyles. Vet Surg 2023; 52:284-298. [PMID: 36523261 PMCID: PMC10108275 DOI: 10.1111/vsu.13919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 09/27/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To develop an in vivo experimental model for bone marrow lesions (BMLs) in ovine femorotibial joints. STUDY DESIGN Randomized, prospective experimental study. ANIMALS Eighteen healthy, skeletally-mature Dorper cross ewes. METHODS One medial femoral condyle was penetrated with a 1.1 mm pin, and the contralateral medial femoral condyle was treated with transcutaneous extracorporeal shockwave (ESW) at 0.39 ± 0.04 mJ/mm2 . Clinical examination, magnetic resonance imaging (MRI), computed tomography (CT), and histopathological analyses were used to detect and characterize the development and progression of BMLs in the medial femoral condyle at 4, 8, and 12 weeks post-surgery. RESULTS Pin penetration induced a BML detected on MRI within 2 weeks and lasted at least 12 weeks. BMLs were not observed in ESW-treated condyles. Histologically, BMLs were characterized by hemorrhage and inflammatory cellular infiltrate, and progressed to more dense fibrous tissue over time. Pathological changes were not observed in the articular cartilage overlying the region of BMLs. CONCLUSIONS Direct, focal trauma to all layers of the osteochondral unit was sufficient to create an experimentally-induced BML which persisted for at least 90 days. The protocol used for ESW in this study did not induce BMLs. CLINICAL SIGNIFICANCE Experimental induction of BMLs is possible and mimicked naturally occurring disease states. Volumetric imaging is a sensitive method for characterization of the dynamic nature of these lesions.
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Affiliation(s)
- Holly L Stewart
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Jeremiah T Easley
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Kurt T Selberg
- Environmental & Radiological Health Sciences Department, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Christian M Puttlitz
- Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado, USA
| | - Lucas K Nakamura
- Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado, USA
| | - Jimmy W Johnson
- Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado, USA
| | - Christopher E Kawcak
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Imamura M, Shinzato GT, Sugawara AT, Uchiyama SST, Matheus D, Simis M, Ayres DVM, dos Santos ACA, Assone T, Ramos VD, Fregni F, Battistella LR. The Institute of Physical Medicine and Rehabilitation, Hospital das Clínicas University of São Paulo School of Medicine comprehensive rehabilitation program for elderly people with knee osteoarthritis. Front Med (Lausanne) 2022; 9:1029140. [DOI: 10.3389/fmed.2022.1029140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022] Open
Abstract
BackgroundKnee osteoarthritis (OA) is a leading cause of disability in the elderly population. Chronic disabling pain is associated with maladaptive neuroplastic changes in brain networks, commonly associated with central sensitization. The main clinical features of nociplastic pain conditions include combined peripheral and central sensitization, and it is crucial to recognize this type of pain, as it responds to different therapies than nociceptive and neuropathic pain.ObjectiveTo report the effect of the Institute of Physical Medicine and Rehabilitation (IMREA) comprehensive rehabilitation program to reduce pain and to improve functioning in elderly people with knee OA, under the DEFINE cohort.MethodsThis is a retrospective observational cohort of 96 patients with knee OA, recruited from October 2018 to December 2019. All patients were evaluated by a trained multidisciplinary team using the Kellgren Lawrence classification, bilateral knee ultrasonography, the visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain, rigidity and difficulty scores, the Timed Up and Go Test (TUG), 10-m and 6-min walking test (10 and 6 MWT), Berg Balance Scale, isokinetic dynamometry for knee extension and flexion strength, and pain pressure thresholds. The rehabilitation program included paraspinous lidocaine blocks, focal extracorporeal shockwaves combined with radial pressure waves and functional electrical stimulation according to individual needs. The baseline was compred with the treatment results with a paired t-test.ResultsThe study sample is composed of 96 participants, mostly females (n = 81, 84.38%), with bilateral osteoarthritis (n = 91, 94.79%), and a mean age of 68.89 (SD 9.73) years. Functional improvement was observed in TUG (p = 0.019), 6-mwt (p = 0.033), right knee flexion strength (p < 0.0001), WOMAC rigidity and difficulty domains (p < 0.0001). Pain was reduced from baseline as measured by WOMAC pain domain (p < 0.0001), VAS for both knees (p < 0.0001), and SF-36 pain domain (p < 0.0001). Pressure pain threshold was modified above the patella (p = 0.005 and p = 0.002 for right and left knees, respectively), at the patellar tendons (p = 0.015 and p = 0.010 for right and left patellar tendons, respectively), left S2 dermatome (p = 0.017), and L1-L2 (p = 0.008).ConclusionsThe IMREA comprehensive rehabilitation program improved functioning and reduced disabling pain in elderly people with knee OA. We highlight the relevance and discuss the implementation of our intervention protocol. Although this is an open cohort study, it is important to note the significant improvement with this clinical protocol.
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Comparison of Extracorporeal Shockwave Therapy with Non-Steroid Anti-Inflammatory Drugs and Intra-Articular Hyaluronic Acid Injection for Early Osteoarthritis of the Knees. Biomedicines 2022; 10:biomedicines10020202. [PMID: 35203417 PMCID: PMC8869751 DOI: 10.3390/biomedicines10020202] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022] Open
Abstract
Conservative treatments for early osteoarthritis (OA) of the knee included the use of non-steroid anti-inflammatory drugs (NSAIDs) and intra-articular hyaluronic acid (HA) injection. Recently, several animal studies reported that extracorporeal shockwave therapy (ESWT) demonstrated chondroprotective effects on knee OA. The present study compared the efficacy of oral NSAIDs, HA injection, and noninvasive ESWT for early OA of the knee. Forty-five patients with early knee OA were randomized into three groups. NSAIDs group received celecoxib 200 mg daily for 3 weeks. HA group received intra-articular injection of HA once a week for 3 weeks. ESWT group received ESWT for 3 sessions at bi-weekly interval. All patients were followed up for one year. Evaluations included the visual analogue scale (VAS) score, serum enzyme-linked immunosorbent assay (ELISA), plain radiography, dual-energy X-ray absorptiometry (DEXA), and magnetic resonance imaging (MRI). In addition, the functional scores were performed including, WOMAC (Western Ontario and McMaster Universities Arthritis Index) score, KOOS (knee injury and osteoarthritis outcome) score, and IKDC (International Knee Documentation Committee) score. All three groups showed significant improvement in VAS and functional scores as well as in the collected one-year follow-up data after treatments. ESWT group had better pain relief than NSAIDs and HA groups. ESWT group had better therapeutic effects in the functional scores than NSAIDs and HA groups. The bone mineral density (BMD) of proximal tibia is significantly increased after ESWT than others. In the serum ELISA, ESWT inhibited the expression of COMP in knee OA patients as compared with NSAIDs and HA groups. The parameters of MRI showed no significant differences between three groups after treatments. ESWT and intra-articular HA injection showed comparable results than NSAIDs. ESWT was superior in pain relief than HA and NSAIDs. The results demonstrated that ESWT was an effective and alternative therapy than HA and NSAIDs for early osteoarthritis of the knees.
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Kaya Şimşek E, Haberal B, Korkmaz Kasap Y, Yurtcu E. Could radial extracorporeal shock wave therapy have an effect on wound healing in clinical practice by creating genotoxic damage? An in vitro study in mouse fibroblasts. Jt Dis Relat Surg 2021; 32:658-667. [PMID: 34842098 PMCID: PMC8650679 DOI: 10.52312/jdrs.2021.315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/04/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: This study aims to evaluate wound healing effects of in vitro radial extracorporeal shock wave (rESW) application on mouse fibroblasts and whether the cytotoxic effect of extracorporeal shock wave (ESW) was due to a possible genotoxic effect. Patients and methods: After creating an in vitro wound healing model in L929 mouse fibroblast culture, fibroblasts were stimulated with a frequency of 3 Hz, and 100, 250, 500, 1,000 and 1,500 pulses shock waves were applied. Energy flux densities ranging from 0.01 to 0.23 mJ/mm2 (14.3 MPa) at a constant pressure level of 0.5 and 1 bar were applied. Wound healing, cell viability, and genotoxicity were evaluated at 24 and 48 h. Results: All shot numbers for both pressures significantly reduced cell viability (p<0.05). For both 0.5 and 1 bar pressures, in both intervals, the rate of wound healing decreased, regardless of the number of shots (p<0.05). In vitro genotoxic damage was detected at both 0.5 and 1 bar pressures, in both time intervals, regardless of the number of shots. The genotoxic damage increased from 24 to 48 h. Conclusion: The study results suggest that, when ESWT is applied in this in vitro experimental setup, cell viability decreases and wound healing is delayed under all conditions. Furthermore, genotoxic damage can be prevented by using shots below 1,000 pulses. Therefore, while investigating the therapeutic effect of ESW therapy in vitro, the upper limit for the number of shots should be 1,000 pulses.
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Affiliation(s)
| | - Bahtiyar Haberal
- Başkent Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 06490 Bahçelievler, Ankara, Türkiye.
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Computed Tomography Image Segmentation Algorithm to Detect the Curative Effect of Radial Shock Wave Therapy for Knee Osteoarthritis. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:7098924. [PMID: 34394896 PMCID: PMC8363439 DOI: 10.1155/2021/7098924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate the values of computed tomography (CT) imaging technology based on image segmentation algorithm (ISA). It was applied in the radial shock wave therapy (RSWT) to treat knee osteoarthritis (KOA), so its curative effect and rehabilitation effect on nerve function were mainly analyzed in this study. 84 patients with KOA were selected and grouped into an ultrasonic treatment group (group A) and a RSW group (group B). All the patients received the ISA-based CT examination and high-quality nursing intervention. There were comparisons on the effects of pain improvement, knee joint function, and nerve function rehabilitation of patients in groups A and B. Results showed that visual analogue scale (VAS) scores before and after treatment were markedly different among all patients, and the pain degree of patients in group B was lower than the degree of group A (P < 0.05). The knee joint function of group B after treatment was greatly better than group A (P < 0.05). Scandinavian stroke scale (SSS) scores of nerve function rehabilitation after nursing in patients from group B were sharply lower than the scores of group A (P < 0.05). Results indicated that ISA-based CT images could be applied in analysis of curative effect on KOA, and there was more obvious effect of RSWT in the treatment of KOA.
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Häußer J, Wieber J, Catalá-Lehnen P. The use of extracorporeal shock wave therapy for the treatment of bone marrow oedema - a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:369. [PMID: 34107978 PMCID: PMC8188716 DOI: 10.1186/s13018-021-02484-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) has been used for various pathologies associated with bone marrow oedema (BME). However, it is still not clear whether ESWT may be favourable in the treatment of BME. Therefore, the aim of this systematic review was to assess the efficacy of ESWT for the treatment of BME. METHODS MEDLINE was searched for relevant literature with no time constraints. Both randomized and non-randomized trials were included. Case reports and conference abstracts were excluded. Titles and abstracts were screened and full-text articles of included studies were retrieved. Data on the effect of ESWT on pain, function, and the BME area on magnet resonance imaging were extracted. RESULTS Pain, function, and magnet resonance imaging results all improved across the studies - regardless of whether it was a randomized or non-randomized study. This effect was consistent across multiple pathologies such as osteonecrosis of the femoral head, BME associated with knee osteoarthritis, Kienböck's disease, and osteitis pubis. The meta-analysis showed that pain (after 1 month: weighted mean difference (WMD) = - 2.23, 95% CI - 2.58 to - 1.88, P < 0.0001; after 3-6 month: WMD = - 1.72, 95% CI - 2.52 to - 0.92, P < 0.00001) and function (after 1 month: WMD = - 1.59, 95% CI - 2.04 to - 1.14, P < 0.0001; after 3-6 month: WMD = - 2.06, 95% CI - 3.16 to - 0.96, P = 0.0002; after ≥ 12 month: WMD = - 1.20, 95% CI - 1.83 to - 0.56, P = 0.0002) was reduced in terms of ESWT treatment compared to a control group. CONCLUSIONS Based on the available evidence, ESWT may be an adequate option for conservative therapy in pathologies involving BME. TRIAL REGISTRATION PROSPERO, CRD42021201719 . Registered 23 December 2020.
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Affiliation(s)
- Jonathan Häußer
- LANS Medicum Hamburg — Center for Sports and Regenerative Medicine, Stephansplatz 5, 20354 Hamburg, Germany
| | - Juliane Wieber
- LANS Medicum Hamburg — Center for Sports and Regenerative Medicine, Stephansplatz 5, 20354 Hamburg, Germany
- LANS Medicum Hamburg — Center for Sports and Regenerative Medicine, Hohe Bleichen 24/26, 20354 Hamburg, Germany
| | - Philip Catalá-Lehnen
- LANS Medicum Hamburg — Center for Sports and Regenerative Medicine, Stephansplatz 5, 20354 Hamburg, Germany
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Wang YC, Huang HT, Huang PJ, Liu ZM, Shih CL. Efficacy and Safety of Extracorporeal Shockwave Therapy for Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis. PAIN MEDICINE 2021; 21:822-835. [PMID: 31626282 DOI: 10.1093/pm/pnz262] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this study was to assess the efficacy and safety of extracorporeal shockwave therapy (ESWT) for treatment of knee osteoarthritis (OA) using a systemic review and meta-analysis. METHODS An extensive search of relevant articles from electronic databases Pubmed, Embase, and Cochrane Library from inception to March 2019 was conducted. The treatment outcomes (visual analog scale [VAS] and the Western Ontario and McMaster Universities Arthritis Index [WOMAC]) of the included articles were pooled to calculate effect sizes. The assessment of heterogeneity among articles was evaluated using I2. Statistical analyses were conducted using RevMan software. RESULTS The results showed that the ESWT group had significant improvement in pain relief compared with the control group through 12 months based on WOMAC and VAS scores. Compared with the baseline level, the patients had significant improvement in pain relief at most follow-up points (one week to 12 months) based on WOMAC and VAS scores. The patients showed significant improvement in physical function at six- and 12-month follow-up when compared with the control group and for all follow-up (one to 12 months) when compared with the baseline level. Additionally, only minor complications were observed after ESWT treatment. CONCLUSIONS The use of ESWT for treatment of knee OA had a beneficial effect on pain relief and physical function improvement for up to 12 months, and only minor complications occurred after ESWT treatment. However, there remains a lack of clarity regarding the frequency and dosage levels of ESWT required to achieve the maximum improvement.
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Affiliation(s)
- Ying-Chun Wang
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsuan-Ti Huang
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Ju Huang
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zi-Miao Liu
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Lung Shih
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Identification of bone marrow edema of the knee: diagnostic accuracy of dual-energy CT in comparison with MRI. Radiol Med 2020; 126:405-413. [PMID: 32840730 DOI: 10.1007/s11547-020-01267-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/12/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND To assess the diagnostic accuracy of dual-energy computed tomography (DECT) in diagnosing bone marrow edema (BME) of the knee in traumatic and non-traumatic patients. METHODS This prospective IRB approved study included 33 consecutive patients (20 males, 13 females; mean age of 52.2 years) evaluated with DECT (80 and 150 kV) and MRI within 6 days. Two experienced radiologists qualitatively and quantitatively evaluated DECT images. The accuracy values were calculated by using receiver operator curves (ROC) and area under the curve (AUC), using MRI as the reference standard. Inter-observer and intra-observer agreement were calculated with k-statistics. A p < 0.05 was considered statistically significant. RESULTS MRI depicted BME in 25/33 patients (75.7%). The sensitivity, specificity, PPV, NPV, and accuracy of per-partition qualitative analysis were 92.9, 92.9, 78.2, 97.9, and 92.9%, for reader 1, and 88.2, 93.9, 79.8, 96.6, and 92.6%, for reader 2, respectively. The inter-observer agreement was substantial (k = 0.793) and the intra-observer agreement was near-perfect (k = 0.844). At the quantitative analysis, a significant difference (p < 0.001) was depicted between the density values of positive (mean 3.6 ± 25.3 HU) and negative cases (mean - 72.2 ± 45.1 HU). By using - 15 HU cutoff to identify BME, sensitivity, specificity, PPV, NPV, and accuracy of DECT were 84.7, 93.6, 78.2, 95.7, and 91.6%, respectively. CONCLUSION DECT can accurately identify BME of the knee.
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Günaydin ÖE, Bayrakci Tunay V. Comparison of the added effects of kinesio taping and extracorporeal shockwave therapy to exercise alone in knee osteoarthritis. Physiother Theory Pract 2020; 38:661-669. [PMID: 32574094 DOI: 10.1080/09593985.2020.1780657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Pain and functional limitations affect quality of life of patients with knee osteoarthritis (OA). PURPOSE The purpose of this study was to compare the effects of two different applications (Kinesio taping; KT and Extracorporeal Shock Wave Therapy; ESWT) added to an home-exercise program on pain, strength and function in patients with knee OA. METHODS Sixty voluntary female subjects were randomly assigned into groups of; KT (n = 22), ESWT (n = 18) and control (CON) (n = 20) respectively. KT and ESWT were applied for 6 weeks and all the groups were taken home exercise program during 12 weeks in all groups. The outcome measures were; Visual Analog Scale for pain (during squat, rest and sleep), Isokinetic strength for quadriceps and hamstring strength, 'The Knee Injury and Osteoarthritis Outcome Survey', Timed Up & Go and 10 m Walk tests for function. The assessments were carried out at baseline, 6th and 12th weeks. RESULTS The mean age was 58.8 ± 6.2 years. Significant improvements were observed in all groups in all tests (p < .05). There was no difference found between groups (p > .05) except pain levels during sleep. CON group showed significant reduction in pain during sleep compared to ESWT group (p < .05). CONCLUSION KT and ESWT have similar effects in terms of decreasing pain, improving knee strength and function in patients with knee OA. However it can be said that if a well-designed home exercise program were done by the patients correctly and regularly then it will be the best treatment option for patients with knee OA.
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Affiliation(s)
- Özge Ece Günaydin
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Aydın Adnan Menderes University, Aydın, Turkey
| | - Volga Bayrakci Tunay
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Extracorporeal Shock Wave Therapy for the Treatment of Osteoarthritis: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1907821. [PMID: 32309424 PMCID: PMC7104126 DOI: 10.1155/2020/1907821] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/22/2020] [Indexed: 02/05/2023]
Abstract
Background Osteoarthritis is the most common musculoskeletal disease. Extracorporeal shockwave therapy had shown an effect on osteoarthritis in both some animal experiments and clinical studies, but there was no systematic review to confirm the value of shockwave therapy in the treatment of all types of osteoarthritis and compare it with other traditional therapies (especially traditional Chinese medicine). Method PubMed, Medline, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, WANFANG database, and VIP database were searched up to December 10, 2019, to identify randomized controlled trials comparing shockwave therapy and other treatments for osteoarthritis. Visual analogue scale and the Western Ontario and McMaster Universities Osteoarthritis Index were extracted and analyzed by RevMan and STATA software as outcomes of pain reduction and functional improvement. Adverse reactions were recorded to evaluate the safety of shockwave therapy. Results Shockwave therapy had significant improvement in both pain reduction and functional improvement compared with placebo, corticosteroid, hyaluronic acid, medication, and ultrasound (P < 0.05). In functional improvement, shockwave therapy showed statistical improvement compared with kinesiotherapy and moxibustion (P < 0.05) but not with acupotomy surgery (P = 0.24). A significant difference between shockwave therapy and platelet-rich plasma was observed in pain reduction (P < 0.05) but not in functional improvement (P = 0.89). Meanwhile, a statistical difference was found between shockwave therapy and fumigation in functional improvement (P < 0.05) but not in pain reduction (P = 0.26). Additionally, there was no statistically significant difference between shockwave therapy and manipulation in both pain reduction (P = 0.21) and functional improvement (P = 0.45). No serious adverse reaction occurred in all of studies. Conclusions Extracorporeal shockwave therapy could be recommended in the treatment of osteoarthritis as a noninvasive therapy with safety and effectiveness, but the grade of recommendations needs to be discussed in a further study.
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Hsieh CK, Chang CJ, Liu ZW, Tai TW. Extracorporeal shockwave therapy for the treatment of knee osteoarthritis: a meta-analysis. INTERNATIONAL ORTHOPAEDICS 2020; 44:877-884. [PMID: 31993710 DOI: 10.1007/s00264-020-04489-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/17/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE 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. METHODS We systematically searched MEDLINE, EMBASE, and other online databases. The articles comparing the outcomes between ESWT and controls were included in the analysis. RESULTS 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 2 weeks; - 1.12, p = 0.005, 95% CI - 1.89 to - 0.34 at 6 months). 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 12 months. CONCLUSION 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.
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Affiliation(s)
- Chi-Kun Hsieh
- Departments of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Chao-Jui Chang
- Departments of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Zhao-Wei Liu
- Physical Therapy Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ta-Wei Tai
- Departments of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan. .,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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The efficacy and safety of extracorporeal shockwave therapy in knee osteoarthritis: A systematic review and meta-analysis. Int J Surg 2020; 75:24-34. [PMID: 31978648 DOI: 10.1016/j.ijsu.2020.01.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Extracorporeal shockwave therapy (ESWT) has been widely applied for pain control in musculoskeletal disorders. Whether ESWT can improve pain relief and joint function for knee osteoarthritis remains controversial. Therefore, we designed a meta-analysis based on relevant studies to comprehensively analyze and determine the efficacy and safety of ESWT for knee osteoarthritis. METHODS We identified relevant studies by an electronic search consisting of five English language databases: MEDLINE (1966 to July 2019), the Cochrane Central Register of Controlled Trials (2019 Issue 2), EMBASE (1980 to July 2019), and PubMed (1946 to July 2019). The methodological quality of randomized controlled trials (RCTs) was independently evaluated by two reviewers according to the criteria in the Cochrane Collaboration for Systematic Reviews. The quality of cohort and case-control studies was assessed by the Newcastlee-Ottawa scale (NOS). We performed statistical analysis by the Stata software, version 15. RESULTS Three RCTs and three cohort studies involving 589 patients were included. The present meta-analysis indicated that ESWT was associated a significant reduction of pain score at 4 weeks (WMD = -0.436; 95% CI = -0.604 to -0.269), 8 weeks (WMD = -0.234; 95% CI = -0.447 to -0.022) and 12 weeks (WMD = -0.239; 95% CI = -0.436 to -0.043). There were significant differences between the two groups in terms of the Western Ontario and McMaster Universities Osteoarthritis Index at 4 weeks (WMD = -3.107; 95% CI = -5.073 to -1.142), 8 weeks (WMD = -3.617; 95% CI = -5.760 to -1.475) and 12 weeks (WMD = -2.271; 95% CI = -3.875 to -0.667). CONCLUSION The ESWT was efficacious and safe for reducing pain and improving knee function in patients with knee osteoarthritis, without increasing the risk of adverse effects.
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Clinical efficacy of individual extracorporeal shockwave treatment. DER ORTHOPADE 2019; 48:610-617. [DOI: 10.1007/s00132-018-03682-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Liu SC, Qiao XF, Tang QX, Li XG, Yang JH, Wang TQ, Xiao YJ, Qiao JM. Therapeutic efficacy of extracorporeal shock wave combined with hyaluronic acid on knee osteoarthritis. Medicine (Baltimore) 2019; 98:e14589. [PMID: 30813181 PMCID: PMC6408132 DOI: 10.1097/md.0000000000014589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This retrospective study investigated the efficacy and safety of extracorporeal shock wave (EPSW) combined with hyaluronic acid (HA) for patients with knee osteoarthritis (KOA).This retrospective study included 70 patients with KOA. Of those subjects, 35 of them received EPSW combined HA, and were allocated to a treatment group, while the other 35 participants received HA alone and were allocated to a control group. Patients in both groups were treated for a total of 8 weeks. The primary outcome was measured by visual analog scale (VAS). The secondary outcomes were measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and knee injury and osteoarthritis outcome score (KOOS). In addition, adverse events (AEs) were also evaluated. All outcomes were measured before and after the treatment.After the treatment, patients in the treatment group exhibited better efficacy in VAS (P < .01), WOMAC scale (pain, P < .01; function, P < .01; and stiffness, P < .01), and KOOS scores (pain, P < .01; function in daily living, P < .01; symptoms, P < .01; sport and recreation, P < .01; and quality of life, P < .01), than patients in the control group. In addition, no significant differences regarding the AEs were found between 2 groups.The findings of this study demonstrated that the efficacy of EPSW combined with HA is superior to the HA alone for patients with KOA.
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Affiliation(s)
| | | | - Qing-Xi Tang
- Department of Emergency Surgery, First Affiliated Hospital of Jiamusi University
| | - Xiao-Guang Li
- Department of Orthodonitics, Affiliated Stomatological Hospital of Jiamusi University, Jiamusi
| | - Jian-Hua Yang
- Department of Orthopedics, People's Hospital of Longgang District, Shenzhen, Guangdong, China
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Ghasemi RA, Sadeghi S, Rahimee N, Tahmasebi M. Technologies in the Treatment of Bone Marrow Edema Syndrome. Orthop Clin North Am 2019; 50:131-138. [PMID: 30477703 DOI: 10.1016/j.ocl.2018.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Bone marrow edema syndrome is a rare and self-limited syndrome with an unknown cause. The natural time course for improvement of clinical symptoms and normalization in MRI lasts from 3 to 18 months. This entity must be distinguished from other causes of marrow abnormality, such as stress fractures and osteonecrosis, for the best treatment options. Various treatments from conservative to surgical have been made to provide pain relief and accelerate the natural course of the disease. This article reviews bone marrow edema syndrome with a focus on treatment in the foot and ankle.
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Affiliation(s)
- Reza A Ghasemi
- Tehran University of Medical Science, Number 21, Dameshgh Street, Vali-e Asr Avenue, Tehran 1416753955, Iran.
| | - Saleh Sadeghi
- Tehran University of Medical Science, Number 21, Dameshgh Street, Vali-e Asr Avenue, Tehran 1416753955, Iran
| | - Narges Rahimee
- Tehran University of Medical Science, Number 21, Dameshgh Street, Vali-e Asr Avenue, Tehran 1416753955, Iran
| | - Mohamadnaghi Tahmasebi
- Tehran University of Medical Science, Number 21, Dameshgh Street, Vali-e Asr Avenue, Tehran 1416753955, Iran
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