Extracorporeal shockwave treatment in knee osteoarthritis: therapeutic effects and possible mechanism

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Abstract

Osteoarthritis (OA), the most common degenerative joint disease, is characterized by the cardinal symptoms of chronic pain and restricted joint activity. The complicated pathological changes associated with OA and unclear mechanistic etiology have rendered existing non-surgical OA management options unsatisfactory. Increasing clinical and experimental evidence suggests that extracorporeal shockwave therapy (ESWT) is beneficial in OA treatment. ESWT is found to have modifying effects on cartilage and subchondral bone alterations in OA progression, as well as the clinical complaints of patients, including chronic pain and limited joint activities. However, the specific treatment strategy regarding the dosage and frequency of ESWT is still underdetermined. This review discusses the existing evidence regarding the therapeutic indications and possible mechanism of ESWT for OA treatment.

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Risk factors and burden of osteoarthritis.

Christelle Nguyen, Clémence Palazzo, Marie-Martine Lefèvre-Colau … (2016)

Osteoarthritis (OA) is one of the most common joint disorders worldwide. Its prevalence is increasing because of the growing aging of the population in developed and developing countries as well as an increase in risk factors leading to OA, particularly obesity and a sedentary lifestyle. Risk factors of OA can be divided into person-level factors (age, gender, obesity, genetics and diet) and joint-level factors (injury, malalignment and abnormal loading of the joints) that interact in a complex manner. OA is the 11th cause of disability in the world. It is responsible for activity limitations, particularly walking, and affects participation and quality of life. Patients with OA are at greater risk of all-cause mortality, particularly for cardiovascular diseases, than the general population. This excess mortality is closely associated with disability level. Consequently, strategies to reduce burden through primary and secondary prevention programs are increasingly important.

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Knee replacement

Andrew J Price, Abtin Alvand, Anders Troelsen … (2018)

Knee replacement surgery is one of the most commonly done and cost-effective musculoskeletal surgical procedures. The numbers of cases done continue to grow worldwide, with substantial variation in utilisation rates across regions and countries. The main indication for surgery remains painful knee osteoarthritis with reduced function and quality of life. The threshold for intervention is not well defined, and is influenced by many factors including patient and surgeon preference. Most patients have a very good clinical outcome after knee replacement, but multiple studies have reported that 20% or more of patients do not. So despite excellent long-term survivorship, more work is required to enhance this procedure and development is rightly focused on increasing the proportion of patients who have successful pain relief after surgery. Changing implant design has historically been a target for improving outcome, but there is greater recognition that improvements can be achieved by better implantation methods, avoiding complications, and improving perioperative care for patients, such as enhanced recovery programmes. New technologies are likely to advance future knee replacement care further, but their introduction must be regulated and monitored with greater rigour to ensure patient safety.

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Inhibition of TGF–β signaling in subchondral bone mesenchymal stem cells attenuates osteoarthritis

Gehua Zhen, Chunyi Wen, Xiaofeng Jia … (2013)

Osteoarthritis is a highly prevalent and debilitating joint disorder. There is no effective medical therapy for osteoarthritis due to limited understanding of osteoarthritis pathogenesis. We show that TGF–β1 is activated in the subchondral bone in response to altered mechanical loading in an anterior cruciate ligament transection (ACLT) osteoarthritis mouse model. TGF–β1 concentrations also increased in human osteoarthritis subchondral bone. High concentrations of TGF–β1 induced formation of nestin+ mesenchymal stem cell (MSC) clusters leading to aberrant bone formation accompanied by increased angiogenesis. Transgenic expression of active TGF–β1 in osteoblastic cells induced osteoarthritis. Inhibition of TGF–β activity in subchondral bone attenuated degeneration of osteoarthritis articular cartilage. Notably, knockout of the TGF–β type II receptor (TβRII) in nestin+ MSCs reduced development of osteoarthritis in ACLT mice. Thus, high concentrations of active TGF–β1 in the subchondral bone initiated the pathological changes of osteoarthritis, inhibition of which could be a potential therapeutic approach.

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Author and article information

Contributors

Yusheng Li

Yihe Hu:

ORCID: http://orcid.org/0000-0001-6781-885X

Journal

Journal ID (nlm-ta): Biosci Rep

Journal ID (iso-abbrev): Biosci Rep

Journal ID (publisher-id): bsr

Title: Bioscience Reports

Publisher: Portland Press Ltd.

ISSN (Print): 0144-8463

ISSN (Electronic): 1573-4935

Publication date Collection: 27 November 2020

Publication date (Electronic): 13 November 2020

Volume: 40

Issue: 11

Electronic Location Identifier: BSR20200926

Affiliations

[1 ]Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China 250021

[2 ]Department of Orthopaedics, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, Hunan, P.R. China 410008

[3 ]Department of Clinical Medicine (8-Year Program), Xiangya Medicine School, Central South University, Changsha, Hunan, P.R. China 410013

[4 ]National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China 410008

Author notes

Correspondence: Yusheng Li ( liyusheng@ 123456csu.edu.cn ) and Yihe Hu ( huyh1964@ 123456163.com )

Author information

Yihe Hu http://orcid.org/0000-0001-6781-885X

Article

Publisher ID: BSR20200926

DOI: 10.1042/BSR20200926

PMC ID: 7670564

PubMed ID: 33074309

SO-VID: 25a504fd-dce9-4e29-87fc-32cca58eae88

License:

This is an open access article published by Portland Press Limited on behalf of the Biochemical Society and distributed under the Creative Commons Attribution License 4.0 (CC BY).

History

Date received : 25 March 2020

Date revision received : 08 October 2020

Date accepted : 13 October 2020

Date: 19 October 2020

Page count

Pages: 8

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Extracorporeal shockwave treatment in knee osteoarthritis: therapeutic effects and possible mechanism

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Most cited references 65

Risk factors and burden of osteoarthritis.

Knee replacement

Inhibition of TGF–β signaling in subchondral bone mesenchymal stem cells attenuates osteoarthritis

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