Extracorporeal shock wave therapy in the treatment of primary bone marrow edema syndrome of the knee: a prospective randomised controlled study

Abstract

BackgroundThe aim of this prospective study was to evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) in normalizing the symptoms and imaging features of primary bone marrow edema syndrome (BMES) of the knee.MethodsThis study compared the outcomes of ESWT (Group A) (n = 20) and intravenously applied prostacyclin and bisphosphonate (Group B) (n = 20) in the treatment of BMES of the knee in our department between 2011 and 2013. The Visual Analog Scale for pain (VAS, 100 mm), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the SF-36 scores and MRI scans as well as plain radiographs were obtained before and after therapy between two groups.ResultsCompared with Group B, we found greater improvement in VAS, the WOMAC Osteoarthritis Index and SF-36 score at 1, 3 and 6 months post-treatment in Group A (P < 0.05). Furthermore, MRI scans showed a higher incidence of distinct reduction and complete regression of bone marrow edema at 6 months in Group A (95 vs. 65 %; P = 0.018). The MRI at 1 year follow-up showed complete regression in all patients in Group A. However, two cases in Group B continued to normalize over the subsequent follow-up period.ConclusionsESWT can produce rapid pain relief and functional improvement. It may be an effective, reliable, and non-invasive technique for rapid treatment of BMES of the knee.Trial registrationResearch Registry UIN 528, September 03, 2015.

Osteonecrosis in children and adolescents with acute lymphoblastic leukemia: a therapeutic challenge

“…52 ESWT is increasingly used with favorable outcome in pain and functional scores in adults with FH ON stage I to III of various etiologies. 54,55,58,59 Moreover, some data indicate that it is superior to core decompression. However, no data on the efficacy, safety, or tolerability in children with ALL are available.…”

Lower Limb Pain Attributed to Bone Marrow Edema Syndrome: A Commonly Ignored Pathology

“…Some authors have suggested treatment of BMES with bisphosphonates, a prostacyclin analog (iloprost) and desonumab in order to accelerate the regression of the symptoms [14,15]. Moreover, there are some research studeis that suggest other treatment regimes, such as extracorporeal shock wave therapy and hyperbaric oxygen [16,17]. Nevertheless, these treatments are debatable because of the fact that BMES is a reversible condition, and it is not clear if the findings of these studies are attributable to the treatments.…”

Knochenmarködemsyndrome

“…Positive Effekte auf bestimmte Subgruppen des KMÖS wurden für Glukokortikoide, Bisphosphonate und Prostaglandin-Inhibitoren beschrieben (40,47,48). Es existieren zudem positive Erfahrungen mit anderen Therapieverfahren wie der hyperbaren Sauerstofftherapie und der Stoßwellenbehandlung (49)(50)(51). In der Behandlung der frühen Osteonekrose hat die chirurgische Dekompression ihren höchsten Stellenwert, wobei hier die Kombination zusammen mit einem Prostaglandin-Inhibitor überlegen zu sein scheint (52).…”