The effect of extracorporeal shock wave therapy on the treatment of moderate to severe knee osteoarthritis and cartilage lesion

Xu Y, Wu K, Liu Y, Geng H, Zhang H, Liu S, Qu H, Xing G · Medicine

Pain and function improved from baseline in the shockwave group and the effect peaked at eight weeks after treatment; gait, walking speed and stance and swing phases likewise. Against the NSAID group there was no statistically significant difference in either pain or WOMAC at four or eight weeks. Cartilage was imaged at 24 weeks in 76 injured knees: cartilage lesion score and T2 mapping in the patellar, trochlear, medial and lateral femoral and medial and lateral tibial regions were unchanged from before treatment (t -1.859, P .076).

Population

82 patients treated with shockwave between April 2016 and April 2017 and 104 treated with oral NSAIDs in the year before, all over 45 with unilateral knee osteoarthritis, Kellgren-Lawrence grade 2 or 3 and cartilage graded Recht II or III on MRI

Intervention

Radial shockwave at 2.0 bar, 0.25 mJ/mm2, 8 Hz, twice a week for four weeks

Comparator

The previous year's patients on oral NSAIDs, a historical rather than a randomised control

Limitations

Not randomised and not blinded: the comparison group is the previous year's patients on a different treatment, so allocation tracks the calendar. Single centre. The MRI endpoint was measured only in the shockwave group and only against its own baseline, which is why it can say the cartilage did not change and cannot say what it would have done untreated. The authors set out expecting the cartilage regeneration reported in animal and in-vitro work and did not find it in people. Funded by the National Natural Science Foundation of China (81873914); no conflicts of interest declared.