Therapeutic Strategy for Knee Osteoarthritis with Subchondral Bone Lesions: Combination Therapy of Extracorporeal Shockwave Therapy and Regenerative Medicine
Source abstract
Abstract
Knee osteoarthritis (OA) is a whole-joint disease involving subchondral bone lesion (BML) that predict treatment outcomes. This retrospective, non-randomized study compared extracorporeal shockwave therapy alone (ESWT), autologous protein solution and ESWT (APS), intra-articular mesenchymal stromal cell and ESWT (MSC-A), and combined intra-articular and intra-osseous MSC and ESWT (MSC-B) for knee OA with BML. We hypothesized that combination therapies would provide superior and earlier outcomes for advanced cases. The primary outcome was the change in the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 3 and 6 months. The results showed ESWT was effective, but only in the absence of articular surface collapse (KOOS IV (pre–6M) = 18.6 ± 13.9) vs. presence of collapse (4.4 ± 6.5). APS led to earlier improvement in cases without subchondral bone plate (SBP) tear (KOOS IV (pre–3M) = 18.4 ± 12.7) vs. ESWT 12.0 ± 14.0). MSC-A with SBP tear achieved significant early gain (KOOS IV (pre–3M) = 13.9 ± 10.1) but plateaued by 6 months. MSC-B without collapse showed significant 6-month improvement (KOOS IV (pre–6M) = 15.8 ± 8.6), but failed in collapse cases (KOOS IV (pre–6M) = −4.4 ± 7.7). ESWT is effective, APS provides early benefits, and MSC-B is promising for advanced SBP tear cases, but articular surface collapse limits efficacy across all therapies.
Source: crossref · Quality: baseline
Research context
OpenAlex topics: Tendon Structure and Treatment · Osteoarthritis Treatment and Mechanisms · Periodontal Regeneration and Treatments
SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.
Affiliations
Medical Corporation N Clinic, Kishiwada City 596-0045, Osaka, Japan
Medical Corporation Honmachi N Clinic, Osaka City 550-0005, Osaka, Japan
Graduate School of Sport Sciences, Waseda University, Tokorozawa City 359-1164, Saitama, Japan
Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nangoku City 783-8505, Kochi, Japan
Department of Tissue Biochemistry, Graduate School of Medicine, The University of Osaka, Suita City 565-0871, Osaka, Japan
Institute of Advanced Clinical Medicine, Division of Cell Biology for Regenerative Medicine, Faculty of Medicine, Kinki University, Osakasayama City 589-8511, Osaka, Japan
Faculty of Sport Sciences, Waseda University, Tokorozawa City 359-1164, Saitama, Japan
References (39)
Show source-provided references
1. Osteoarthritis: A disease of the joint as an organ10.1002/art.34453 ↗
2. Osteoarthritis10.1016/S0140-6736(19)30417-9 ↗
3. Association of subchondral bone marrow lesion localization with weight-bearing pain in people with knee osteoarthritis: Data from the osteoarthritis Initiative10.1186/s13075-021-02422-0 ↗
4. Bone marrow lesions in osteoarthritis
5. Bone marrow edema pattern in osteoarthritic knees: Correlation between MR imaging and histologic findings10.1148/radiology.215.3.r00jn05835 ↗
6. Increased nerve growth factor expression and osteoclast density are associated with subchondral bone marrow lesions in osteoarthritic knees10.1016/j.ocarto.2024.100504 ↗
7. Subchondral bone in osteoarthritis: Insight into risk factors and microstructural changes10.1186/ar4405 ↗
8. The osteoarthritis bone score (OABS): A new histological scoring system for the characterisation of bone marrow lesions in osteoarthritis10.1016/j.joca.2022.01.008 ↗
9. Magnetic resonance measurement of muscle T2, fat-corrected T2 and fat fraction in the assessment of idiopathic inflammatory myopathies
10. Three-dimensional-printed customized prosthesis for pubic defect: Prosthesis design and surgical techniques10.1186/s13018-020-01766-8 ↗
11. Procedural intervention for arthrofibrosis after ACL reconstruction: Trends over two decades. Knee Surg10.1007/s00167-015-3799-x ↗
12. Sánchez, M., Delgado, D., Sánchez, P., Muiños-López, E., Paiva, B., Granero-Moltó, F., Prósper, F., Pompei, O., Pérez, J.C., and Azofra, J. (2016). combination of intra-articular and intraosseous injections of platelet rich plasma for severe knee osteoarthritis: A pilot study. Biomed Res. Int., 2016.10.1155/2016/4868613 ↗
13. Mesenchymal Stem Cells and Shock-Wave Therapy Synergistically Promote Osteochondral Regeneration
14. First-in-human autologous oral mucosal epithelial sheet transplantation to prevent anastomotic re-stenosis in congenital esophageal atresia10.1186/s13287-022-02710-9 ↗
15. Imaging for osteoarthritis10.1016/j.rehab.2015.12.003 ↗
16. The economics of treatment in early rheumatoid arthritis10.1016/j.berh.2008.11.005 ↗
17. Osteonecrosis of the Knee: Review
18. Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: A case-controlled study10.1007/s00264-014-2391-1 ↗
19. Bone marrow lesions and subchondral bone pathology of the knee joint: Review of pathophysiology and therapeutic implications
20. Subchondral Bone or Intra-Articular Injection of Bone Marrow Concentrate for Treating Knee Osteoarthritis: 15-Year Follow-Up of a Randomized Prospective Study10.1007/s00264-020-04571-4 ↗
21. Feasibility of telemedicine in maintaining follow-up of orthopaedic patients and their satisfaction: A preliminary study10.1016/j.jcot.2020.07.026 ↗
22. Sanchez, M., Delgado, D., and Sanchez, P. (2022). Combining intraosseous and intraarticular biologic therapies for knee osteoarthritis: Mechanistic insights and clinical outcomes. Front. Bioeng. Biotechnol., 10.
23. Extracorporeal shock wave treatment can normalize painful bone marrow edema in knee osteoarthritis: A comparative historical cohort study10.1097/MD.0000000000009796 ↗
24. Zang, X., Ma, Y., Wu, J., Zhang, Y., and Ma, J. (2024). Efficacy of extracorporeal shock wave therapy for bone marrow lesions and pain in knee osteoarthritis: A meta-analysis. Pain Res. Manag., 11970530.
25. Jo, Y.H., and Lee, C.H. (2022). Ultrasonic properties of a stone architectural heritage and weathering evaluations based on provenance site. Appl. Sci., 12.10.3390/app12031498 ↗
26. Intra-articular delivery of extracellular vesicles secreted by chondrogenic progenitor cells from MRL/MpJ superhealer mice enhances articular cartilage repair in a mouse injury model10.1186/s13287-020-01594-x ↗
27. Conservative treatments for bone marrow lesions in knee osteoarthritis: A systematic review
28. Ko, N.Y., Chang, C.N., Cheng, C.H., Yu, H.K., and Hu, G.C. (2022). Comparative Effectiveness of Focused Extracorporeal versus Radial Extracorporeal Shockwave Therapy for Knee Osteoarthritis-Randomized Controlled Study. Int. J. Environ. Res. Public Health, 19.10.3390/ijerph19159001 ↗
29. Extracorporeal shockwave therapy improves pain and function in subjects with knee osteoarthritis: A systematic review and meta-analysis of randomized clinical trials10.1016/j.ijsu.2020.07.055 ↗
30. Trabecular bone microarchitecture and characteristics in different regions of the glenoid10.3928/01477447-20150305-52 ↗
31. Layilin, a talin-binding hyaluronan receptor, is expressed in human articular chondrocytes and synoviocytes and is down-regulated by interleukin-1β10.3109/s10165-012-0686-x ↗
32. Nakasato, S., Kumai, T., Mitsuoka, T., Teramura, T., and Akagi, M. (2024). Combination therapy of autologous protein solution and extracorporeal shock wave therapy for severe knee osteoarthritis. Appl. Sci., 14.10.3390/app14041498 ↗
33. Mesenchymal stem cells for subchondral bone marrow lesions: From bench to bedside
34. Ganguly, P., Fiz, N., Beitia, M., Owston, H.E., Delgado, D., Jones, E., and Sánchez, M. (2022). Effect of combined intraosseous and intraarticular infiltrations of autologous platelet-rich plasma on subchondral bone marrow mesenchymal stromal cells from patients with hip osteoarthritis. J. Clin. Med., 11.10.3390/jcm11133891 ↗
35. The use of extracorporeal shock wave therapy (ESWT) in treating osteonecrosis of the femoral head (AVNFH): A retrospective study10.1007/s00264-023-05904-9 ↗
36. International Society for Medical Shock Wave Treatment (2016). Consensus statement on indications and contraindications for extracorporeal shock wave treatment (ESWT): Osteochondritis dissecans and avascular necrosis without articular derangement only (ISMST guidelines). ISMST, ISMST Office.
37. Intraosseous versus MSCA: Enhanced subchondral bone MSC abundance and repair potential following intraosseous plus intraarticular administration
38. Combined intraosseous and intraarticular platelet-rich plasma injection for the treatment of hip osteoarthritis: Effects on subchondral bone marrow mesenchymal stem cells
39. Subchondral bone microenvironment in osteoarthritis and pain10.1038/s41413-021-00147-z ↗