Knee osteoarthritis: low-dose shock wave therapy shows benefit, mild toxicity

  • Arch Phys Med Rehabil

  • de Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Low-dose extracorporeal shock wave therapy (ESWT) improves pain and disability, but slightly damages articular cartilage, in patients with knee osteoarthritis (KOA).

Why this matters

  • ESWT is a promising treatment option, but effects on articular cartilage need further study.

Study design

  • Randomized, placebo-controlled trial of 4-week course of low-dose ESWT vs sham ESWT in 63 patients with Kellgren-Lawrence grade II or III KOA.
  • Pain was assessed by visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); function was assessed by WOMAC and the Lequesne index.
  • Cartilage integrity was assessed by MRI, using T2 transverse relaxation time mapping.
  • Funding: Shanghai Qingpu District Science and Technology Development Fund Project.

Key results

  • ESWT (vs sham ESWT) was associated with improvement in all pain and function outcomes (all Ps <.001>
  • VAS at weeks 5 and 12.
  • WOMAC pain at weeks 5 and 12.
  • WOMAC stiffness at weeks 5 and 12.
  • WOMAC function at weeks 5 and 12.
  • Lequesne index at weeks 5 and 12.
  • ESWT group at 12 weeks (vs baseline) was associated with increase in T2 values (P=.004), indicating some damage to articular cartilage, but values at 12 weeks were still in the normal range.
  • Limitations

    • Small sample sizes.