Evaluation of treatment parameters for focused-extracorporeal shock wave therapy in knee osteoarthritis patients with bone marrow lesions: a pilot study.
Hani Al-Abbad, Jacqueline E Reznik, Erik Biros and 5 others
PMID 38470167WHAT IT FOUND
In this small pilot, knee osteoarthritis pain and function improved most with 3000 shocks over 6 sessions, while 4-session groups showed worsening or inconclusive trends.
However, bone marrow lesions, bone density, and inflammatory blood markers did not change. This suggests symptom relief without altering underlying joint pathology.
Key findings
01Participants receiving 3000 shocks over 6 sessions showed consistent improvement in pain, function, and pressure pain threshold, whereas those receiving 4 sessions showed worsening or inconclusive trends.
02Focused-ESWT did not significantly change bone marrow lesion scores, subchondral bone mineral density, or serum inflammatory biomarkers compared to baseline.
03The study used a single-case experimental design with only 12 participants allocated to four different dose groups, limiting the certainty of any dose-response conclusions.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study is a pilot with only 12 participants, making it very underpowered and unable to draw firm conclusions about dose-response relationships. The single-case experimental design with visual inspection and Tau-U statistics is less robust than a large randomized controlled trial for comparing groups. There was no control group receiving sham treatment or standard care only, so the natural history of knee osteoarthritis cannot be separated from the treatment effect. The 3-month follow-up may be too short to detect changes in bone mineral density or bone marrow lesions, which are slow to alter. Participants were older (mean 70 years) with chronic symptoms, which may limit generalizability to younger patients or those with acute flare-ups.
Declared interests
The study was conducted at a physiotherapy practice. The device manufacturer's guidelines influenced dose parameters, but no specific financial conflicts of interest or funding sources are explicitly detailed in the provided text beyond the ethics approval.
The easy way to misread this
Do not interpret the improvement in pain and function as evidence that focused-ESWT heals the joint or reduces inflammation. The study found no change in bone marrow lesions, bone density, or blood inflammatory markers, indicating that any benefit was likely symptomatic rather than structural or anti-inflammatory.