Clinical efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a systematic review and meta-regression of randomized controlled trials

Abstract

Objective: This study determined the clinical efficacy of extracorporeal shockwave therapy and the predictors of its efficacy for knee osteoarthritis. Data Sources: Electronic databases and search engines, namely MEDLINE, PubMed, EMBASE, Cochrane Library Database, Physiotherapy Evidence Database (PEDro), China Academic Journals Full-text Database, and Google Scholar, were searched until 5 March 2019, for randomized controlled trials without restrictions on language and publication year. Review Methods: Eligible trials and extracted data were identified by two independent investigators. The included articles were subjected to a meta-analysis and risk of bias assessment. Outcomes of interest included treatment success rate, pain, and physical function outcomes. A meta-regression analysis was performed to determine the predictors of treatment outcomes following shockwave therapy. Results: We included 50 trials (4844 patients) with a median (range) PEDro score of 6 (5–9). Meta-analyses results revealed an overall significant effect favoring shockwave therapy on the treatment success rate (odds ratio 3.22, 95% confidence interval (CI) 2.21–4.69, P < 0.00001; heterogeneity ( I2) = 62%), pain reduction (standardized mean difference (SMD) −2.02, 95% CI −2.38 to −1.67, P < 0.00001; I2 = 95%), and Western Ontario and McMaster Universities Osteoarthritis Index function outcome (SMD −2.71, 95% CI −3.50 to −1.92, P < 0.00001; I2 = 97%). Follow-up duration and energy flux density were independent significant predictors of shockwave efficacy. Conclusion: Shockwave therapy is beneficial for knee osteoarthritis. Shockwave dosage, particularly the energy level and intervention duration, may have different contributions to treatment efficacy.

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

“…Furthermore, ESWT treatment can alleviate OA pain and improve motor function both in animal models and clinical trials [7,20,21]. These reports indicate the potential clinical application of ESWT as a novel treatment for OA.…”

Extracorporeal Shock Wave Therapy for the Treatment of Osteoarthritis: A Systematic Review and Meta‐Analysis

“…More and more attention has been paid to the application of ESWT on OA because of its noninvasive nature, low rate of complications, and low cost compared with other surgical or conservative treatments in recent studies [15,16]. Despite some systematic reviews focusing on the effect of ESWT on knee OA [17][18][19], there was no systematic review to confirm the value of EWST in the treatment of all types of OA (including knee OA and carpometacarpal joint OA) and compare ESWT with other traditional therapies (especially traditional Chinese medicine). Thus, this meta-analysis was performed, and the latest randomized controlled trials were included, which would contribute to the treatment of OA.…”

Efficacy and safety of treating symptomatic, primary focal osteochondral lesions of the patella with a combination of intra-articular injection of hyaluronic acid (HAi) and radial extracorporeal shock wave therapy (rESWT) or HAi alone: A retrospective two-cohort study

“…rESWT appears more suitable for treating sPFOLP than fESWT. The well known negative correlation between increasing EFD of fESWs/rESWs and decreasing VAS pain score and decreasing WOMAC function index [23,28,35,36] does not require to treat sPFOLP with fESWs (which can reach higher EFDs than rESWs) but to treat sPFOLP with adequate rESWT technology that can reach the necessary EFD (as applied in the present study as well as in [23] in the treatment of knee OA).…”