A Comparison Between Low-Level Laser Therapy and Intra-articular Ozone Injection in Knee Osteoarthritis Treatment: A Randomized Clinical Trial

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.

Minimal clinically important change of knee flexion in people with knee osteoarthritis after non-surgical interventions using a meta-analytical approach

BACKGROUND

Minimal clinically important change (MCIC) represents the minimum patient-perceived improvement in an outcome after treatment, in an individual or within a group over time. This study aimed to determine MCIC of knee flexion in people with knee OA after non-surgical interventions using a meta-analytical approach.

METHODS

Four databases (MEDLINE, Cochrane, Web of Science and CINAHL) were searched for studies of randomised clinical trials of non-surgical interventions with intervention duration of ≤ 3 months that reported change in (Δ) (mean change between baseline and immediately after the intervention) knee flexion with Δ pain or Δ function measured using tools that have established MCIC values. The risk of bias in the included studies was assessed using version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). Bayesian meta-analytic models were used to determine relationships between Δ flexion with Δ pain and Δ function after non-surgical interventions and MCIC of knee flexion.

RESULTS

Seventy-two studies (k = 72, n = 5174) were eligible. Meta-analyses included 140 intervention arms (k = 61, n = 4516) that reported Δ flexion with Δ pain using the visual analog scale (pain-VAS) and Δ function using the Western Ontario and McMaster Universities Osteoarthritis Index function subscale (function-WOMAC). Linear relationships between Δ pain at rest-VAS (0-100 mm) with Δ flexion were - 0.29 (- 0.44; - 0.15) (β: posterior median (CrI: credible interval)). Relationships between Δ pain during activity VAS and Δ flexion were - 0.29 (- 0.41, - 0.18), and Δ pain-general VAS and Δ flexion were - 0.33 (- 0.42, - 0.23). The relationship between Δ function-WOMAC (out of 100) and Δ flexion was - 0.15 (- 0.25, - 0.07). Increased Δ flexion was associated with decreased Δ pain-VAS and increased Δ function-WOMAC. The point estimates for MCIC of knee flexion ranged from 3.8 to 6.4°.

CONCLUSIONS

The estimated knee flexion MCIC values from this study are the first to be reported using a novel meta-analytical method. The novel meta-analytical method may be useful to estimate MCIC for other measures where anchor questions are problematic.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022323927.

Effects of joint irrigation combined with ozone injection on bone metabolism, inflammatory factors, and joint function in knee osteoarthritis

OBJECTIVE

To explore the effects of joint irrigation combined with ozone injection on bone metabolism, inflammatory factors, and joint function in patients with knee osteoarthritis (KOA).

METHOD

In this retrospective study, a total of 132 KOA patients admitted to No. 215 Hospital of Shaanxi Nuclear Industry from October 2019 to July 2021 were enrolled. Among them, 62 patients received arthroscopic irrigation alone were assigned into a control group, and the remaining 70 patients who received arthroscopic irrigation combined with ozone injection were assigned into an observation group. Therapeutic efficacy and adverse reactions during the treatment were compared in the two groups. Bone metabolism, inflammatory factor levels and joint function of patients before and after treatment were observed; patients were further divided into a good prognosis group and a poor prognosis group regarding their prognosis. Multivariate analysis was performed to explore the independent risk factors affecting prognosis.

RESULTS

After treatment, compared to the control group, the total effective rate of the observation group was higher (P<0.05), and there was no notable difference in the incidence of adverse reactions between the two groups (P>0.05). The bone metabolism indexes, osteocalcin (OC) and osteoprotegerin (OPG), in the observation group were also significantly higher (P<0.05), while the level of nuclear transcription factor κB receptor activator ligand (RANKL) in the observation group was markedly lower. The inflammation level in the observation group was lower (P<0.05). Lysholm score in the observation group was strikingly higher (P<0.05), while its Western Ontario McMaster (WOMAC) score and visual analogue scale (VAS) were lower (P<0.05). The observation group had a lower rate of poor prognosis (P<0.05). Age (OR: 1.786, 95% CI: 1.347-2.370), disease duration (OR: 1.132, 95% CI: 1.002-1.279), VAS after treatment (OR: 2.316, 95% CI: 1.089-4.925), and post-treatment IL-6 (OR: 1.186, 95% CI: 1.017-1.382) were all independent risk factors for poor prognosis.

CONCLUSION

Joint irrigation combined with ozone injection shows good efficacy in the treatment of KOA, and could effectively relieve the clinical symptoms of patients, improve their bone metabolism indexes, and help the recovery of knee joint function.