Extracorporeal Shock Wave Therapy in Knee Osteoarthritis: A Mechanistic Narrative Review of Neurogenic Inflammation and the MMP/ADAMTS Axis

Guo Z, Yuan Y, Su H, Dong J · International Journal of General Medicine

The authors' own summary of where the evidence stands: the most consistent human evidence is symptomatic. Mechanistically they collect work suggesting shockwave lowers sensory nerve excitability, substance P and CGRP signalling, and changes inflammatory mediators, MMP expression, the TIMP balance and ADAMTS-driven aggrecan loss. They state plainly that evidence for structural cartilage regeneration comes mainly from animal models, small biomarker studies and heterogeneous protocols, and that long-term human imaging evidence is scarce.

Population

The clinical and experimental literature on shockwave for knee osteoarthritis, read for two candidate mechanisms

Intervention

Extracorporeal shockwave therapy

Comparator

None; a narrative review

Limitations

A narrative review with no systematic search, no pooling and no risk-of-bias assessment, so it is a map of proposed mechanisms rather than evidence for any of them. Funded by the Department of Education of Hunan Province (25A0737) and a Heilongjiang Province project on traditional Chinese medicine classics (ZYW2024-040); the authors report no conflicts of interest.