Changes of articular cartilage and subchondral bone after extracorporeal shockwave therapy in osteoarthritis of the knee

Wang CJ, Cheng JH, Chou WY, Hsu SL, Chen JH, Huang CY · International Journal of Medical Sciences

Treating the medial femoral and medial tibial condyles together protected cartilage best: smallest osteoarthritic area, least osteophyte and sclerotic bone, best modified Mankin score, largest sectional cartilage area, least surface damage and proteoglycan loss, least TUNEL-marked cell death, most PCNA-marked proliferation and least CD31-marked vascular invasion. Micro-CT showed subchondral bone repair improved in every shockwave group against untreated osteoarthritis. The ranking of target sites was both medial condyles, then medial tibia, then both tibial condyles, then medial femur alone.

Population

Forty-eight Sprague-Dawley rats in six groups of eight: sham surgery, untreated osteoarthritis, and four shockwave target sites, with osteoarthritis induced by anterior cruciate ligament transection plus medial meniscectomy

Intervention

One session of 800 focused shockwave impulses at 0.22 mJ/mm2, ultrasound-guided to the medial tibial condyle, the medial femoral condyle, both, or the medial and lateral tibial condyles

Comparator

Osteoarthritic knees given no shockwave, and sham-operated knees

Limitations

Rat knees destabilised by ligament transection and meniscectomy, eight animals per group, one session, one energy level, a single laboratory. The dose was taken from previous small-animal work rather than scaled to a human joint, and the shockwave was ultrasound-guided onto a target a few millimetres across, which is not how a clinic aims at a human knee. Funded by the Chang Gung Research Fund; one author sits on the advisory committee of Sanuwave, which made the OssaTron device used, and the paper states the study was performed independently of that appointment.