Extracorporeal Shockwave Therapy With a Modified Technique on Tendon and Ligament for Knee Osteoarthritis: A Randomized Controlled Trial

A systematic review of the use of shockwave therapy for knee osteoarthritis

Introduction

Previous studies assessed the effect of extracorporeal shockwave therapy (ESWT) for knee osteoarthritis (OA) among different situations. Thus, results from a meta-analysis regarding this topic may not be reliable due to heterogeneity.

Methods

A systematic review was conducted on three internet databases, namely Cochrane Library, PubMed, and Embase, gathering pertinent papers from their establishment to March 2024. The search phrases were as follows: "shockwave" OR "shock wave" OR "extracorporeal shockwave" OR "Extracorporeal Shockwave Therapy [MeSH Term]" AND "knee" AND ("osteoarthritis" OR "arthritis" OR "arthritic" OR "osteoarthritis [MeSH term]").

Results

Twenty-four articles (n = 888) were included, with the resulting conclusions demonstrating that ESWT was effective for knee OA compared with sham ESWT; however, ESWT was not effective for patients with severe knee OA. Patients receiving higher energy or higher shock number had significant improvement than those receiving lower energy or less shock number, respectively. Adding ESWT in isokinetic muscular strengthening exercises (IMSE) was more effective than IMSE alone. The efficacy of ESWT was better than other therapies, including intravenously applied prostacyclin and bisphosphonate, corticosteroid injection, kinesiotherapy, hyaluronic acid injection, platelet-rich plasma injection, and physiotherapy.

Conclusions

This review demonstrated that ESWT was effective for knee OA. Higher energy and more shock numbers could obtain better efficacy. ESWT could be used as a replacement for some other therapies.

Equine Musculoskeletal Pathologies: Clinical Approaches and Therapeutical Perspectives-A Review

Musculoskeletal injuries such as equine osteoarthritis, osteoarticular defects, tendonitis/desmitis, and muscular disorders are prevalent among sport horses, with a fair prognosis for returning to exercise or previous performance levels. The field of equine medicine has witnessed rapid and fruitful development, resulting in a diverse range of therapeutic options for musculoskeletal problems. Staying abreast of these advancements can be challenging, prompting the need for a comprehensive review of commonly used and recent treatments. The aim is to compile current therapeutic options for managing these injuries, spanning from simple to complex physiotherapy techniques, conservative treatments including steroidal and non-steroidal anti-inflammatory drugs, hyaluronic acid, polysulfated glycosaminoglycans, pentosan polysulfate, and polyacrylamides, to promising regenerative therapies such as hemoderivatives and stem cell-based therapies. Each therapeutic modality is scrutinized for its benefits, limitations, and potential synergistic actions to facilitate their most effective application for the intended healing/regeneration of the injured tissue/organ and subsequent patient recovery. While stem cell-based therapies have emerged as particularly promising for equine musculoskeletal injuries, a multidisciplinary approach is underscored throughout the discussion, emphasizing the importance of considering various therapeutic modalities in tandem.

Effect of Moxibustion Instrument Combined with Intermediate Frequency Electrostatic Therapy on Pain and Joint Function in Elderly Patients with Cold-Dampness Knee Arthritis

Objective

To explore the effect of a moxibustion instrument combined with intermediate frequency electrostatic therapy on pain and joint function in elderly patients with cold-dampness arthritis (KOA).

Method

200 patients with cold-dampness KOA treated in our hospital from May 2019 to September 2021 were selected. According to the random number table method, they were divided into the observation group (n = 100) and control group (n = 100). The observation group was treated with moxibustion combined with medium-frequency treatment, and the control group was treated with medium-frequency treatment. The clinical effects of the two groups were compared. The joint functions of the two groups were evaluated by the visualization scale of the osteoarthritis index (WOMAC index) of McMaster University in Western Ontario. The TCM symptom scores of the two groups were evaluated according to the guiding principles for clinical research of new traditional Chinese medicine. The visual analogue scale (VAS) was used to evaluate the pain degree of the two groups, and the microcirculatory blood perfusion (MBPU) and interleukin-1 were compared between the two groups, β (IL-1β) and tumor necrosis factor-α (TNF-α). The levels of matrix metalloproteinase-1 (MMP-1), serum bone morphogenetic protein-2 (BMP-2), cartilage oligomeric matrix protein (COMP), and serum type II collagen C-terminal peptide (CTX-II) were assessed by the comprehensive quality of life questionnaire-74.

Result

The total effective rate of the observation group (92.00%) was higher than that of the control group (76.00%), and the difference was statistically significant (P < 0.05) in β and TNF-α. The levels of MMP-3, BMP-2, comp, and CTX-II and the improvement of quality of life score in the control group were better than those in the control group (P < 0.05).

Conclusion

Moxibustion instrument combined with intermediate frequency electrostatic therapy can effectively improve the knee joint function, pain, blood perfusion, inflammatory reaction, and cartilage damage of the elderly patients with cold-dampness-type knee arthritis, and the therapeutic effect is good.