Extracorporeal shockwave treatment in knee osteoarthritis: therapeutic effects and possible mechanism

Abstract

Osteoarthritis (OA), the most common degenerative joint disease, is characterized by the cardinal symptoms of chronic pain and restricted joint activity. The complicated pathological changes associated with OA and unclear mechanistic etiology have rendered existing non-surgical OA management options unsatisfactory. Increasing clinical and experimental evidence suggests that extracorporeal shockwave therapy (ESWT) is beneficial in OA treatment. ESWT is found to have modifying effects on cartilage and subchondral bone alterations in OA progression, as well as the clinical complaints of patients, including chronic pain and limited joint activities. However, the specific treatment strategy regarding the dosage and frequency of ESWT is still underdetermined. This review discusses the existing evidence regarding the therapeutic indications and possible mechanism of ESWT for OA treatment.

Numerical Modeling of Shockwave Treatment of Knee Joint

“…With an increase in the amplitude of the exposure, the volume in which conditions for tissue regeneration are fulfilled increases. Conditions for chondrogenesis are formed in the cartilage plates, which in turn is consistent with the experimental data on shockwave treatment of the knee joint [15,[48][49][50]. In addition, conditions for chondrogenesis are observed in the tissues of the meniscus, which is also consistent with experimental data [51].…”

Shock Waves and Radial Pressure Waves: Time to Put a Clear Nomenclature into Practice

“…In many publications, authors repor t cer tain "intensity levels," without mentioning the type of device used. Grave errors have appeared in peer-reviewed journals, such as a figure of a pneumatic radial pressure-wave source being shown next to an image of the pressure variation of a shock wave emitted by other types of generators, along with an explanation that the shock wave was produced by a ballistic device [30].…”

Best practices for extracorporeal shockwave therapy in musculoskeletal medicine: Clinical application and training consideration

“…Animal models have illustrated the positive effects of F‐SWT on subchondral bone development and neovascularization 25 . F‐SWT may have a greater impact on ossification, whereas R‐SWT may preferentially target surrounding soft tissues (such as articular cartilage) 16,25 . R‐SWT has been theorized to positively affect soft tissue healing in joints given the success of R‐SWT in other soft‐tissue pathologies 19 .…”

“…25 F-SWT may have a greater impact on ossification, whereas R-SWT may preferentially target surrounding soft tissues (such as articular cartilage). 16,25 R-SWT has been theorized to positively affect soft tissue healing in joints given the success of R-SWT in other soft-tissue pathologies. 19 Given the presence of multiple anatomic structures within joints as well as the difficulty to preferentially target individual structures, C-SWT may be a more appropriate treatment for joint pathology although research would be helpful to quantify how this affects outcomes.…”