Alternatives to Biologics in Management of Knee Osteoarthritis: A Systematic Review

Hassan, Fadi; Murrell, William; Refalo, Andrew; Maffulli, Nicola

doi:10.1097/jsa.0000000000000190

Cited by 13 publications

(12 citation statements)

References 35 publications

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“…Numerous non-surgical treatments basically aim to achieve symptom alleviation and functional restriction relief. [17,18] In 2012, the ACR guideline [19] recommends that drug therapy combined with non-drug therapy is the ideal therapeutic scheme for KOA. ESWT is a mechanical stimulation, which also has great potential in treating KOA.…”

Section: Discussionmentioning

confidence: 99%

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

Liu

et al. 2019

Medicine

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Background: Knee osteoarthritis (KOA) is a major cause leading to chronic bone and muscle pain. Extracorporeal shock wave therapy (ESWT) has been applied in treating KOA in recent years. Methods: From April 2016 to April 2017, 82 patients were diagnosed with KOA that received ESWT were selected as the ESWT group. The treatment parameters were as follows, 2.0 bar, 0.25 mJ/mm 2 , and 8 Hz/s for twice a week for 4 weeks continuously. In addition, 104 patients receiving oral administration of nonsteroidal anti-inflammatory drugs (NSAIDs) from April 2015 to April 2016 were also selected as the NSAIDs group. At 4, 8, 12, and 16 weeks upon the completion of treatment, the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were adopted to evaluate the changes in pain and function of patients in both groups. For the ESWT group, the 50-m quick walk time and gait analysis were applied to observe the functional recovery at 4, 8, 12, and 16 weeks upon the completion of treatment; meanwhile, patients were followed up by magnetic resonance imaging (MRI) at 24 weeks upon the completion of treatment, so as to observe the cartilage changes. Results: Differences in VAS, 4, 8, and 12 weeks after treatment were statistically significant compared with that before treatment (4.59 ± 0.5, P < .05; 2.55 ± 0.5, P < .05; 4.39 ± 0.49, P < .05). Differences in 4, 8, and 12 weeks after treatment were statistically significant compared with that before treatment (90.41 ± 6.64, P < .05; 59.94 ± 3.19, P < .05; 90.49 ± 6.87, P < .05). Gait analysis suggested differences in 50 m walk time, walking speed, swing phase, and stance phase 8 weeks after treatment were statistically significant compared with that before treatment (36.23 ± 4.08, P < .05; 1.25 ± 0.09, P < .05; 58.56 ± 0.87, P < .05; 41.44 ± 0.87, P < .05). Differences in the VAS and WOMAC at 4 and 8 weeks after treatment between ESWT group and NASIDs group were not statistically significant. Conclusions: The ESWT has potential in reducing pain and improving knee function, and the therapeutic effects may peak at 8 weeks after the completion of treatment. Further research is needed to arrive at a definitive conclusion.

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Section: Discussionmentioning

confidence: 99%

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

Liu

et al. 2019

Medicine

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“…The intra-articular use of botulinum was introduced to reduce pain. Indeed, its neurotoxin is able to inhibit the release of neuropeptides (acetylcholine) in the terminal axon, limiting the activity of nociceptive fibers 115–117. Several studies tried to prove the effectiveness of intra-articular injection of botulinum, but with poor results.…”

Section: Resultsmentioning

confidence: 99%

Osteoarthritis of the Knee in Middle-age Athletes: Many Measures are Practiced, but Lack Sound Scientific Evidence

Quaranta

Riccio

Oliva

et al. 2022

Sports Medicine and Arthroscopy Review

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Osteoarthritis of the knee generally affects individuals from the fifth decade, the typical age of middle-age athletes. In the early stages, management is conservative and multidisciplinary. It is advisable to avoid sports with high risk of trauma, but it is important that patients continue to be physically active. Conservative management offers several options; however, it is unclear which ones are really useful. This narrative review briefly reports the conservative options for which there is no evidence of effectiveness, or there is only evidence of short-term effectiveness.

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“…Pharmacologic treatments are believed to be useful in OA-related pain management; moreover, the adverse events, including gastrointestinal complications of non-steroidal anti-inflammatory drugs (NSAIDs) and cardiovascular complications of cyclooxygenase-2 (COX-2) inhibitors, are of importance for clinicians (6,7). Other conservative treatments usually include therapeutic exercises, lifestyle modification, different intra-articular injections, and supplements such as chondroitin sulfate and glucosamine (8,9). Furthermore, studies approved the effectiveness of Transcutaneous electrical nerve stimulation (TENS) and therapeutic ultrasound (10,11).…”

Section: Introductionmentioning

confidence: 99%

A Single-blind Randomised Trial of Intra-Articular Hyaluronic Acid, Hypertonic Saline, and Physiotherapy in Knee Osteoarthritis

Taftain¹,

Azizi²,

Dadarkhah³

et al. 2021

Muscle Ligaments and Tendons J

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Background. Knee osteoarthritis (OA) is an age-related progressive condition that has resulted in a significant burden worldwide. In this survey, we aimed to compare intra-articular hypertonic saline (HS) and hyaluronic acid (HA) safety and efficacy in the pain and function improvement of patients suffering from knee OA. Eventually, we made a comparison with physical therapy (PH), in a six-month follow-up. Methods. This study is a three-arm single-blinded randomized clinical trial evaluating 130 radiographically confirmed knee osteoarthritis patients suffering from chronic knee pain. A group of participants received three weekly injections of HA (Hyalgan ® ), while the other group experienced an injection of five milliliters of 5% HS and the third group engaged in ten-session physiotherapy. Patients assessed before intervention, one, three, and six months post-intervention using the visual analogue scale (VAS) for pain and Knee injury and osteoarthritis outcome score (KOOS) for function and quality of life (QOL). Results. In this study, We did not identify any remarkable adverse effects. All KOOS subscales scores decreased in the HA and HS group significantly. A similar trend was detected in pain improvement, considering VAS. PH group experienced only pain reduction but not function improvement. Comparing two injected agents, HS group obtained better scores not only in pain and symptom reduction, but also in function and QOL improvement. Conclusions. However, both HS and HA can be effectively used for improving function and reducing pain and unpleasant symptoms in knee OA patients, HS prolotherapy demonstrated more acceptable outcomes through six-month follow-up.

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Alternatives to Biologics in Management of Knee Osteoarthritis: A Systematic Review

Cited by 13 publications

References 35 publications

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

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

Osteoarthritis of the Knee in Middle-age Athletes: Many Measures are Practiced, but Lack Sound Scientific Evidence

A Single-blind Randomised Trial of Intra-Articular Hyaluronic Acid, Hypertonic Saline, and Physiotherapy in Knee Osteoarthritis

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