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Ravikumar C, Sasikala B, Krishnakumar Raja VB, Elavenil P. Evaluation of the efficacy of autologous conditioned serum versus dextrose prolotherapy in internal derangement of the TMJ - A pilot study. J Craniomaxillofac Surg 2024; 52:477-483. [PMID: 38368212 DOI: 10.1016/j.jcms.2024.01.025] [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: 03/22/2023] [Revised: 11/19/2023] [Accepted: 01/16/2024] [Indexed: 02/19/2024] Open
Abstract
It was the aim of the study to compare the effectiveness of autologous conditioned serum (ACS) and dextrose prolotherapy (DP) solutions, in treating patients with TMJ internal derangement (ID). 24 participants with TMJ ID (Wilkes II-V) were recruited and randomized into study and control groups, with 12 patients each, treated with IA injection of ACS and DP, respectively. Pain, mouth opening, joint sounds, and jaw deviation were evaluated, with patients reviewed at 2 weeks, 1 month, and 2 months intervals. Based on the nature of the variables, appropriate descriptive statistics and statistical tests were applied. The pain score was zero in the study group after 2 months of treatment, which was statistically significant (p = 0.006). Deviation was also significantly reduced (p < 0.001) and mouth opening significantly improved (p = 0.004) in the ACS-treated patients. ACS demonstrated superiority over DP in the management of TMJ dysfunction. Therefore, ACS can be considered an ideal, minimally invasive treatment option for TMJ ID. Clinical trial registry number: (CTRI/2021/10/037043).
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Affiliation(s)
- C Ravikumar
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, India
| | - B Sasikala
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, India.
| | - V B Krishnakumar Raja
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, India
| | - P Elavenil
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, India
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Cheng PG, Yang KD, Huang LG, Wang CH, Ko WS. Comparisons of Cytokines, Growth Factors and Clinical Efficacy between Platelet-Rich Plasma and Autologous Conditioned Serum for Knee Osteoarthritis Management. Biomolecules 2023; 13:biom13030555. [PMID: 36979490 PMCID: PMC10046072 DOI: 10.3390/biom13030555] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/21/2023] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
This study aimed to directly compare the contents and the clinical efficacy of the two autologous blood-derived products, platelet-rich plasma (PRP) and autologous conditioned serum (ACS) for osteoarthritis (OA) treatment. The contents of standard-prepared PRP and ACS prepared at 37 °C for 1 h, 3 h, 6 h, and 24 h from healthy volunteers were compared. The clinical efficacy of pain relief in patients with Stage III knee OA was evaluated by a patient-reported visual analog scale (VAS) pain rating. PDGF-BB levels in ACS 1 h were significantly higher than those in PRP, and the levels in ACS preparations remained stable. IGF-1 level of ACS 24 h showed a significant increase compared to those of other ACS preparations and PRP. ACS 3 h showed a turning of IL-1Ra level and revealed a time-dependent increase up to 24 h. ACS 6 h showed a turning increase in TNF-α levels. ACS 3 h was chosen for clinical comparison with PRP. The reduction in pain VAS in the ACS group was significantly more compared to those of the PRP group (p = 0.028). However, PRP showed significant earlier improvement (p < 0.001). Conclusion: ACS contained higher levels of PDGF-BB and IL-1Ra and provided better improvement in pain relief compared to PRP.
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Affiliation(s)
- Pen-Gang Cheng
- Department of Orthopaedics, Fu-Ya Medical Clinic, Taichung 40764, Taiwan
| | - Kuender D Yang
- Department of Medical Research, Mackay Children's Hospital, Taipei 10449, Taiwan
- Department of Medical Research, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Liang-Gie Huang
- Department of Stomatology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Chi-Hui Wang
- Department of Orthopaedics, Cheng-Ching General Hospital, Taichung 40764, Taiwan
| | - Wang-Sheng Ko
- Department of Internal Medicine, Kuang-Tien General Hospital, Taichung 43302, Taiwan
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Coşkun HS, Yurtbay A, Say F. Platelet Rich Plasma Versus Autologous Conditioned Serum in Osteoarthritis of the Knee: Clinical Results of a Five-Year Retrospective Study. Cureus 2022; 14:e24500. [PMID: 35651374 PMCID: PMC9135591 DOI: 10.7759/cureus.24500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives: There is no consensus on the effectiveness of platelet-rich plasma (PRP) and autologous conditioned serum (ACS) in the treatment of knee osteoarthritis (OA). Also, the group of patients who will benefit most from this treatment is not clear. This study aims to understand the effects of two treatment modalities: ACS and PRP on pain and clinical scores in the treatment of OA. For this reason, we compared the long-term (five-year follow up) clinical results of the patients to whom these two treatment methods were applied. Materials and methods: Eighty-two knee osteoarthritis cases, selected from a database prospectively maintained in our tertiary university hospital after institutional ethics committee approval, examined between January 2013 and September 2020 and treated with ACS and PRP by the same orthobiological treatment team, were retrospectively analyzed. The clinical results of group A (n=40) treated with ACS and group B (n=42) treated with PRP were statistically analyzed. Clinical evaluations were made pre-injection and at one, six, 12, 24 and 60 months post-treatment, using the knee injury and osteoarthritis result score (KOOS) for the evaluation of function and a visual analog scale (VAS) for the evaluation of pain. Results: Side effects were noted in two patients (5%) in group A and 16 patients (38.1%) in group B. More side effects were seen in group B compared to group A (p<0.001). The better VAS scores in both groups were detected in the sixth and 12th months. When VAS scores were examined, better results were obtained in group A in the 12th and 24th months (p<0.05). When KOOS scores were examined, the superiority of ACS to PRP at 12 and 24 months was shown in KOOS.S, KOOS.P and KOOS.ADL scores (p<0.05). There was no statistically significant difference between the two groups in terms of all scores and baseline scores at 60 months. Conclusion: The effectiveness of ACS and PRP treatments can last up to two years. After two years, the effectiveness of both treatments decreases. Comparing the two treatments, ACS treatment showed better results on VAS and KOOS scores compared to PRP treatment.
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Therapeutic efficacy observation of warm needling moxibustion plus Tuina for knee osteoarthritis. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2022. [DOI: 10.1007/s11726-022-1306-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Autologous conditioned serum applications in the treatment of musculoskeletal diseases: a narrative review. Future Sci OA 2022; 8:FSO776. [PMID: 35070358 PMCID: PMC8765110 DOI: 10.2144/fsoa-2021-0088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Aim: Autologous conditioned serum has been studied as a treatment option in musculoskeletal disorders and resulted in varying outcomes. This study aims to pool the current data on this matter. Materials & methods: Major databases were searched for the topics, and after screening the results, the final 21 papers (level of evidence I or II) were included. Results & conclusion: This study showed a major focus of the literature on the effectiveness of autologous conditioned serum in osteoarthritis, in which there is much high-quality evidence suggesting its safety and efficacy. Also, some of the available experiments are assessing its application in tendinopathies and radiculopathies which, despite positive results, recommend further evaluations on this topic. Autologous conditioned serum (ACS) is a cell-free blood product rich in anti-inflammatory components; this study aims to provide a review of the available data on its clinical applications in musculoskeletal disorders. The most studied subject was joint diseases and mainly osteoarthritis, for which some high-quality papers suggested ACS to be an effective and safe option. A few papers assessed the effectiveness of ACS in soft tissue injuries like tendinopathies and plantar fasciitis, and also cervical and lumbar radiculopathies in human subjects; despite some positive results, a further high-quality investigation is required on this matter.
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Vitali M, Ometti M, Pironti P, Salvato D, Sandrucci A, Leone O, Saliniv V. Clinical and functional evaluation of bone marrow aspirate concentrate vs autologous conditioned serum in the treatment of knee osteoarthritis. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022222. [PMID: 36300237 PMCID: PMC9686147 DOI: 10.23750/abm.v93i5.12845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/22/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIM The aim of this study was to compare the efficacy of a single Bone Marrow Aspirate Concentrate (BMAC) with a cycle of 4 Autologous Conditioned Serum (ACS) injections in the treatment of early-stage knee osteoarthritis (OA). METHODS Two groups of 12 patients with degenerative knee OA were treated with a single BMAC injection and with a cycle of 4 ACS injections respectively. Follow-up was set at baseline (t0), one-month (t1) and six-months (t2) evaluating VAS for pain, WOMAC index and range of motion (ROM). RESULTS We reported a significant improvement in WOMAC after BMAC injection both at t1 (p= 0,001) as well as t2 (p< 0,001), plus a reduction of VAS values in BMAC group at six months follow-up (p = 0,024). In contrast, no significant differences in ROM between the two groups were observed. CONCLUSIONS Both the approaches are safe and effective in the treatment of knee OA, with a major efficacy of BMAC.
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Affiliation(s)
- Matteo Vitali
- San Raffaele Scientific Institute, Department of Orthopedics and Traumatology (Milan, Italy)
| | - Marco Ometti
- San Raffaele Scientific Institute, Department of Orthopedics and Traumatology (Milan, Italy)
| | - Pierluigi Pironti
- University of Milan, Residency Program in Orthopedics and Traumatology (Milan, Italy)
| | - Damiano Salvato
- San Raffaele University, Residency Program in Orthopedics and Traumatology (Milan, Italy)
| | | | - Orlando Leone
- San Raffaele University, Residency Program in Orthopedics and Traumatology (Milan, Italy)
| | - Vincenzo Saliniv
- San Raffaele Scientific Institute, Department of Orthopedics and Traumatology (Milan, Italy)
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Raeissadat SA, Rayegani SM, Sohrabi MR, Jafarian N, Bahrami MN. Effectiveness of intra-articular autologous-conditioned serum injection in knee osteoarthritis: a meta-analysis study. Future Sci OA 2021; 7:FSO759. [PMID: 34737891 PMCID: PMC8558851 DOI: 10.2144/fsoa-2021-0069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/30/2021] [Indexed: 12/12/2022] Open
Abstract
Aim Knee osteoarthritis is a common disabling disorder, with no curative treatment. This study aims to assess autologous conditioned serum effectiveness in its treatment. Materials & methods Following a systematic search (2000-2020) on major databases and screening and filtering processes, eight articles were included in the final analyses. The pooled effect of visual analog scale (VAS) and the Western Ontario and McMaster Universities (WOMAC) variables was evaluated before and after the intervention. Results The combined standardized mean difference for the global WOMAC score was -2.44 and the combined weighted mean difference was -22.92. The combined standardized mean difference for the VAS score was -3.77 and the combined weighted mean difference was -32.37 (p < 0.000). Conclusion This meta-analysis reported that the autologous conditioned serum can reduce pain and improve function (VAS and WOMAC outcome measures) in patients with knee osteoarthritis.
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Affiliation(s)
- Seyed A Raeissadat
- Physiatrist, Associate Professor, Physical Medicine & Rehabilitation Department & Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed M Rayegani
- Physiatrist, Professor, Physical Medicine & Rehabilitation Department & Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad R Sohrabi
- Community Medicine Specialist, Professor, Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nafisseh Jafarian
- Physiatry Resident, Physical Medicine & Rehabilitation Department & Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad N Bahrami
- Orthopedic Surgeon, Pediatric Orthopedics Fellowship, Orthopedic Surgery Department & Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Khella CM, Horvath JM, Asgarian R, Rolauffs B, Hart ML. Anti-Inflammatory Therapeutic Approaches to Prevent or Delay Post-Traumatic Osteoarthritis (PTOA) of the Knee Joint with a Focus on Sustained Delivery Approaches. Int J Mol Sci 2021; 22:8005. [PMID: 34360771 PMCID: PMC8347094 DOI: 10.3390/ijms22158005] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 12/11/2022] Open
Abstract
Inflammation plays a central role in the pathogenesis of knee PTOA after knee trauma. While a comprehensive therapy capable of preventing or delaying post-traumatic osteoarthritis (PTOA) progression after knee joint injury does not yet clinically exist, current literature suggests that certain aspects of early post-traumatic pathology of the knee joint may be prevented or delayed by anti-inflammatory therapeutic interventions. We discuss multifaceted therapeutic approaches that may be capable of effectively reducing the continuous cycle of inflammation and concomitant processes that lead to cartilage degradation as well as those that can simultaneously promote intrinsic repair processes. Within this context, we focus on early disease prevention, the optimal timeframe of treatment and possible long-lasting sustained delivery local modes of treatments that could prevent knee joint-associated PTOA symptoms. Specifically, we identify anti-inflammatory candidates that are not only anti-inflammatory but also anti-degenerative, anti-apoptotic and pro-regenerative.
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Affiliation(s)
| | | | | | | | - Melanie L. Hart
- G.E.R.N. Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center—Albert-Ludwigs—University of Freiburg, 79085 Freiburg im Breisgau, Germany; (C.M.K.); (J.M.H.); (R.A.); (B.R.)
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Leone R, de Rosa A, Iudicone P, Fioravanti D, Capua G, Rossetti F, Isgro' MA, Pierelli L. Pain control and functional improvement in patients treated by autologous conditioned serum after failure of platelet rich plasma treatments in knee osteoarthritis. Transfus Med 2021; 31:357-364. [PMID: 34189774 DOI: 10.1111/tme.12801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/07/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the efficacy of autologous conditioned serum (ACS) for the treatment of patients with knee osteoarthritis after failure of medical treatments and platelet rich plasma (PRP) injections. BACKGROUND Knee osteoarthritis is the most common form of arthritis. Prior to prosthetic surgery these patients might benefit from medical treatments, physiotherapy, and in case of their ineffectiveness, from autologous blood component injections. METHODOLOGY We have treated 30 patients with Kellgren-Lawrence I-III knee osteoarthritis with ACS after failure of standard medical treatments/physiotherapy and platelet rich plasma (PRP) injections for a full cycle, within the previous year from enrollment. RESULTS ACS administration was performed in all patients with mild side effects and produced prompt (1 month) improvements of VAS and Lequesne scales in 67% of patients and this result persisted at 6 and 12 months. No relationship between the rate of response and Kellgren-Lawrence scale at enrollment was observed whilst responders had a significantly higher amount of interleukin-1 receptor antagonist (IL1-RA) in ACS as compared to nonresponders. CONCLUSION The present study confirms the efficacy of ACS in pain control and functional recovery of patients with knee osteoarthritis resistant to medical and PRP treatment. These results were obtained in a well-defined cohort of resistant patients and seem to be related with IL1-RA content in injected ACS.
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Affiliation(s)
- Rosa Leone
- Transfusion Medicine, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Paola Iudicone
- Transfusion Medicine, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Giuseppe Capua
- Sports Medicine Unit, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | - Luca Pierelli
- Transfusion Medicine, San Camillo Forlanini Hospital, Rome, Italy.,Department of Experimental Medicine, Sapienza University, Rome, Italy
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Ozer K. COVID-19-associated Cytokine Release Syndrome and Autologous Conditioned Serum: A Hypothesis. EXPLORATORY RESEARCH AND HYPOTHESIS IN MEDICINE 2021; 000:000-000. [DOI: 10.14218/erhm.2021.00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Andia I, Atilano L, Maffulli N. Moving toward targeting the right phenotype with the right platelet-rich plasma (PRP) formulation for knee osteoarthritis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211004336. [PMID: 33854574 PMCID: PMC8010808 DOI: 10.1177/1759720x211004336] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/03/2021] [Indexed: 12/14/2022] Open
Abstract
Intra-articular injections of platelet-rich plasma (PRP) and other novel blood-derived products developed specifically for osteoarthritis (OA) can provide pain relief and potential benefits in disease progression. Meta-analyses show the clinical superiority of PRP compared with other intra-articular injections, but results are modest and the effect sizes are small. PRP injections in knee OA are performed indiscriminately, but the clinical response varies enormously between patients because of an array of mixed OA phenotypes. Subgroup analyses are scarce; some studies stratify patients according to radiographic severity and found better results in early OA, without consensus for more advanced stages of the condition. Parallel identification of soluble and imaging biomarkers is essential to personalise and leverage PRP therapies. The inflammatory phenotype is most interesting from the PRP perspective because PRPs modulate inflammation by releasing a large pool of chemokines and cytokines, which interact with synovial fibroblasts and macrophages; in addition, they can modulate the innate immune response. No soluble biomarkers have been discovered that have implications for OA research and PRP interventions. Clinical examination of patients based on their inflammatory phenotype and imaging identification of pain sources and structural alterations could help discern who will respond to PRP. Synovial inflammation and bone marrow lesions are sources of pain, and intra-articular injections of PRP combined with subchondral bone injection can enhance clinical outcomes. Further refining ultrasound phenotypes may aid in personalising PRP therapies. Intra-articular delivery combined with injections in altered ligamentous structures, medial and coronal ligaments or premeniscal pes anserinus showed positive clinical outcomes. Although the evidence supporting these approaches are weak, they merit further consideration to refine PRP protocols and target the right OA phenotypes.
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Affiliation(s)
- Isabel Andia
- Regenerative Therapies, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Plaza Cruces 12, Barakaldo, Bizkaia, 48903, Spain
| | - Leire Atilano
- Regenerative Therapies, Biocruces Bizkaia Health Research Institute, Interventionist Radiology Unit, Department of Radiology, Cruces University Hospital, Barakaldo, Bizkaia, 48903, Spain
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Dentristry, Salerno, Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
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Shakouri SK, Dolati S, Santhakumar J, Thakor AS, Yarani R. Autologous conditioned serum for degenerative diseases and prospects. Growth Factors 2021; 39:59-70. [PMID: 34886733 DOI: 10.1080/08977194.2021.2012467] [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] [Indexed: 12/15/2022]
Abstract
Autologous conditioned serum (ACS) is a blood-derived product that is prepared by the incubation of whole blood with medical-grade glass beads, resulting in serum enrichment in interleukin-1 receptor antagonist (IL-1Ra), anti-inflammatory cytokines (IL-4, IL-10, and IL-13), and high concentrations of growth factors. ACS has shown qualitatively and quantitatively better therapeutic effects than most established pharmacological treatments and surgery for joint diseases given its ability to both target the inflammatory cascade to decrease cartilage destruction as well as improve endogenous repair mechanisms. ACS application is simple and safe with limited adverse effects. This article reviews the role of ACS in degenerative joint disease, in addition to other inflammatory and autoimmune diseases, given its regenerative and immune-modulating properties.
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Affiliation(s)
- Seyed Kazem Shakouri
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanam Dolati
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jessica Santhakumar
- Interventional Regenerative Medicine and Imaging Laboratory, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Avnesh S Thakor
- Interventional Regenerative Medicine and Imaging Laboratory, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Reza Yarani
- Interventional Regenerative Medicine and Imaging Laboratory, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
- Translational Type 1 Diabetes Research, Department of Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
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Effectiveness of Traditional Chinese Exercise for Symptoms of Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217873. [PMID: 33121082 PMCID: PMC7662219 DOI: 10.3390/ijerph17217873] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 12/11/2022]
Abstract
Background: Growing evidences have advocated the potential benefits of traditional Chinese exercise (TCE) on symptomatic improvement of knee osteoarthritis (KOA). However, most of them have been derived from cross-sectional studies or case reports; the effectiveness of TCE therapies has not been fully assessed with a randomized control trial (RCT). In order to evaluate the combined clinical effectiveness of TCE for KOA, we conducted a systematic review and meta-analysis on the existing RCTs on KOA. Methods: A systematic search was performed in four electronic databases: PubMed, Web of Science, Cochrane Library, and EMBASE from the time of their inception to February 2020. All eligible RCTs were included in which TCE was utilized for treating KOA as compared to a control group. Two reviewers independently extracted the data and evaluated the risk of bias following the Cochrane Risk of Bias Tool for RCT. The symptoms of KOA evaluated by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were regarded as the primary outcomes in this study. Each outcome measure was pooled by a standardized mean difference (SMD) with 95% confidence intervals (CI). A meta-analysis was applied with a random or fixed effect model for the collected data to calculate the summary SMD with 95% CI based on different statistical heterogeneity. In addition, subgroup analyses were used to investigate heterogeneity and sensitivity analysis was carried out for the results of the meta-analysis. Egger’s test and the funnel plots were used to examine the potential bias in the RCTs. Results: A total of 14 RCTs involving 815 patients with KOA were included. Compared with a control group; the synthesized data of TCE showed a significant improvement in WOMAC/KOOS pain score (SMD = −0.61; 95% CI: −0.86 to −0.37; p < 0.001), stiffness score (SMD = −0.75; 95% CI: −1.09 to −0.41; p < 0.001), and physical function score (SMD = −0.67; 95% CI: −0.82 to −0.53; p < 0.001). Conclusions: Our meta-analysis suggested that TCE may be effective in alleviating pain; relieving stiffness and improving the physical function for patients with KOA. Yet; given the methodological limitations of included RCTs in this meta-analysis; more high-quality RCTs with large sample size and long-term intervention are required to further confirm the effectiveness and underlying mechanisms of TCE for treating KOA.
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