The efficacy of extracorporeal shock wave therapy for knee osteoarthritis : an umbrella review

Tang P, Wen T, Lu W, Jin H, Pan L, Li H, Zeng B, Zhou Y, Xiao W, Li Y · International Journal of Surgery (London, England)

Against sham, shockwave improved the WOMAC by 2.94 points (95% CI -5.52 to -0.37, I2 60%), the visual analogue pain scale by 2.0 points (95% CI -2.5 to -1.5, I2 0%), range of motion by 17.55 degrees (95% CI 13.49 to 21.61, I2 0%) and the Lequesne index by 2.85 points (95% CI -3.64 to -2.07, I2 48%). Every pooled endpoint is symptomatic or range of motion; no cartilage or imaging measure enters the review at any level.

Population

Eight published meta-analyses of extracorporeal shockwave therapy for knee osteoarthritis, searched to September 2023 and each rated 8 to 11 on AMSTAR 2

Intervention

Extracorporeal shockwave therapy, energy levels pooled together because too few studies allowed them to be separated

Comparator

Sham shockwave or another non-shockwave treatment, depending on the underlying review

Limitations

Author-reported: the underlying reviews carry their own selection, reporting and publication bias, key primary studies appear in more than one of them so the same trials are counted repeatedly, inclusion criteria differ between the pooled reviews, many are region-specific, and only English-language meta-analyses were included. Energy levels could not be analysed separately, which the authors say may bias the result. The mechanistic claims about cartilage repair in the discussion are cited from other papers, not measured here. Funded by the Science and Technology Innovation Program of Hunan Province (2021JJ31105); no conflicts declared.