Efficacy of extracorporeal shockwave therapy and lowintensity pulsed ultrasound in a rat knee osteoarthritis model: A randomized controlled trial

Abstract

Objective: This study aims to assess the efficacy of extracorporeal shockwave therapy (ESWT) and low-intensity pulsed ultrasound (LIPUS) on osteoarthritic rat knees.Material and Methods: Twenty-four rats were divided into 3 groups: group 1-control (n=8), group 2-LIPUS (n=8) and group 3-ESWT (n=8). Cartilage degeneration was provided using mono-iodo-asetate (MIA). One milligram of MIA was delivered to the right knees in group 1 and both knees in group 2 and 3. A 0.09% saline solution was delivered to the left knees in group 1 for control. Twenty-four hours after the delivery, ESWT was applied once on the right knees in the group 2 rats to the medial tibia plateu with a 1 Hz frequency and 800 impulses. LIPUS was applied to the right knees in the group 2 rats to the medial tibia plateu with a 3 mHz frequency and 40 mW/cm2 intensity for 20 minutes over a period of 15 days. Pain scores were measured with a knee bend test. Bone mineral density measurements and scintigraphic bone scans were performed. Histopathological examination was done using a modified Mankin scale.Results: There was no difference among the right knee subchondral bone osteoblastic activities (p>0.05). The left knee osteoblastic activities in the LIPUS and extracorporeal shockwave therapy (ESWT) groups were higher than those in the control group (p<0.05), but there was no difference between the LIPUS and ESWT groups. There was no difference among the groups for both knee subchondral bone BMD values (p>0.05). The modified Mankin scores of both the right and left knees of the ESWT and LIPUS groups were lower than those of the control group (p<0.05), but there was no difference between the ESWT and LIPUS groups. The pain scores of both knees of the ESWT and LIPUS groups at day 7 were higher than those of the control group (p<0.05), but there was no difference between the ESWT and LIPUS groups. There was no difference among the pain scores of the right knees at day 14 (p<0.05).Conclusion: ESWT and LIPUS have systemic proliferative and regenerative effects on cartilage and tissue.

TREKhMERNAYa MEZO MODEL'' MEKhANIChESKOGO POVEDENIYa S UChETOM POSLOYNOY STRUKTURY BIOLOGIChESKIKh TKANEY BEDRENNOGO SUSTAVA

“…Было установлено, что механические стимулы способны вызывать дифференцировку и регенерацию костной и хрящевой ткани [2]. Механическую стимуляцию регенерации костных тканей проводят путем физических упражнений, внешнего низкоэнергетического воздействия посредством экстракорпоральной ударно-волновой терапии и ультразвуковой терапии [3]. Кроме того, особенности физиологического состояния (возраст, болезни, травмы) пациента требует индивидуального подбора параметров низкоэнергетического акустического (механического) воздействия.…”

Minimally Invasive Interventional Management of Osteoarthritic Chronic Knee Pain

“…Its exact mechanism continues to be investigated, although early immunohistochemical animal studies have shown increased tissue repair and regeneration through neovascularization and angiogenesis. [60][61][62][63] In addition to this direct action, Yilmaz et al reports decreased pain scores after ESWT despite no significant change in osteoblastic activity, suggesting an additional systemic mechanism. 63 This chondroprotective effect also exhibits timedependent properties, with the greatest pain relief benefit seen at 4 weeks and continuing to 12 weeks.…”

“…[60][61][62][63] In addition to this direct action, Yilmaz et al reports decreased pain scores after ESWT despite no significant change in osteoblastic activity, suggesting an additional systemic mechanism. 63 This chondroprotective effect also exhibits timedependent properties, with the greatest pain relief benefit seen at 4 weeks and continuing to 12 weeks. 60,61 Most recently, Hsu et al identified that ESWT induces the expression of multiple major factors in the calcium homeostasis signaling pathway, upregulating osteoblast and chondrocyte activity to regulate endochondral ossification.…”

Effects of extracorporeal shock wave therapy in patients with knee osteoarthritis

“…Conservative treatment has been regarded as the first-line therapy for knee osteoarthritis, including rest, nonsteroidal anti-infammatory drugs, physiotherapy, corticosteroid injection, or dry needling. [ 10 – 12 ] However, the effectiveness of these treatments is still not well-established. Extracorporeal shockwave therapy (ESWT) appears to be a promising alternative and has been proven to be beneficial in several musculoskeletal diseases and especially enthesopathies, including plantar fasciitis, elbow epicondylitis, patella tendinitis, and achilles tendinitis.…”