Effects of low-intensity pulsed ultrasound on knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

Abstract

Objective To systemically review the effects of low-intensity pulsed ultrasound (LIPUS) on pain relief and functional recovery in patients with knee osteoarthritis (KOA). Data sources PubMed, Web of Science, Cochrane Library, Physiotherapy Evidence Database (PEDro), and China National Knowledge Infrastructure (CNKI) were used from inception to 18 March 2022. Review Methods Meta-analysis was performed to evaluate pain and function recovery between control and LIPUS groups. Standardized mean difference (SMD) or mean difference (MD) and 95% confidence interval (CI) were calculated, and data were combined using the fixed or random-effect model. Results Thirteen studies involving 807 patients with KOA were included. Patients’ outcomes treated by LIPUS were improved significantly, including Visual analog scale (VAS) score (MD = −0.95, 95% CI: −1.43 to −0.48， P < 0.001), Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) score (MD = −4.35, 95% CI: −8.30 to −0.40, P = 0.0309), Lysholm score (SMD = 1.59, 95% CI: 1.29 to 1.90, P < 0.001), Lequesne index (MD = −1.33, 95% CI: −1.69 to −0.96, P < 0.001), Range of motion (ROM) (MD = 2.43, 95% CI: 0.39 to 4.46, P = 0.0197) and 50 meter walking time (SMD = 1.48, 95% CI: 0.46 to 2.49, P = 0.0044). Subgroup analyses showed monotherapy of LIPUS produced a better effect on reducing VAS score ( P = 0.0213), and the shorter therapeutic period (≤4 weeks) produced a more significant effect on raising the WOMAC score ( P = 0.0083). Conclusion LIPUS was beneficial for pain relief and functional knee recovery and maybe as an alternative therapy in KOA rehabilitation.

Preclinical Study of Dual-Wavelength Light-Emitting Diode Therapy in an Osteoarthritis Rat Model

“…It is necessary to find the effect of the combination between LED wavelengths as well as between LED wavelengths and non-pharmacologic modality therapy, or between LED wavelengths and invasive procedure [39,40]. Furthermore, more studies should be conducted to verify the efficacy of these treatments in the parameter settings of the device and characteristics of the altered stem cell and cartilage [39,40]. Determining optimal treatment parameters and safety margins is also necessary, as cellular activity depends on wavelength, power density, and irradiation time.…”

Latest progress in low-intensity pulsed ultrasound for studying exosomes derived from stem/progenitor cells

“…LIPUS has achieved promising results in the treatment of disorders of the skeletal muscular system. Clinical studies have revealed that LIPUS contributes to accelerated bone healing ( 109 ), joint function restoration in OA ( 110 ), rapid motor recovery in patients with lumbar spondylolisthesis ( 111 ), and spinal fusion ( 112 ). In addition, studies in preclinical animal models have shown that LIPUS can promote recovery and improve functional outcomes in PNI ( 30 ) and holds great potential in the prevention and recovery of traumatic encephalopathy ( 113 – 115 ).…”

Effects of therapeutic ultrasound in patients with knee osteoarthritis: A systematic review and meta-analysis

“…Previous systematic reviews on the effectiveness of US in the treatment of KOA are outdated [ [14] , [15] , [16] , [17] , [18] , [19] , [20] ], and even the latest meta-analysis [ 18 ] published in 2022, only included trials up to December 2020, and the quality of the included trials was poor. Some systematic reviews and meta-analyses only studied the efficacy analysis of low-intensity US therapy or pulsed US for KOA and did not include other types of US [ [21] , [22] , [23] ], some only compare therapeutic US with sham US (or no intervention) without considering concurrent treatment [ 17 , 19 ]. Variations in US treatment duration, dose, mode of US, intensity of US, and follow-up time point may have a significant impact on US performance and may be important evidence to explain heterogeneity.…”