# Combined low-intensity pulsed ultrasound and extracorporeal shock wave therapy reduces pain and inflammation in knee osteoarthritis patients

## TL;DR

Combining low-intensity pulsed ultrasound with shock wave therapy improves pain and inflammation in knee osteoarthritis patients more than shock wave therapy alone.

## Contribution

This study is the first to directly compare ESWT alone with its combination with LIPUS for knee osteoarthritis.

## Key findings

- The LESWT group had a higher clinical effective rate (87.3%) compared to the ESWT group (73.6%).
- LESWT showed greater improvements in pain and mobility scores and more significant reductions in inflammatory markers.
- No significant difference in adverse events was observed between the two treatment groups.

## Abstract

Knee Osteoarthritis (KOA) is a degenerative joint condition that leads to pain and limited mobility. Non-invasive treatments like Low-Intensity Pulsed Ultrasound (LIPUS) and Extracorporeal Shockwave Therapy (ESWT) help manage symptoms and support recovery. While both methods are effective, no studies have directly compared ESWT alone to its combination with LIPUS (LESWT, low-intensity pulsed ultrasound + ESWT) for KOA. This study aims to assess their efficacy and provide evidence for treatment choices. The study included 110 patients with KOA who underwent LESWT, forming the LESWT group, and another 110 KOA patients who were treated with ESWT, constituting the ESWT group. Evaluations were conducted to compare clinical outcomes, levels of inflammatory markers in joint synovial fluid, and the occurrence of adverse events before and after the treatment. The LESWT group showed a higher clinical effective rate (87.3%) compared to the ESWT group (73.6%, p < 0.01), with greater improvements in LKSS, Lequesne index, VAS, WOMAC, and ROM scores (p < 0.05). Levels of inflammatory markers (NO, IL-1β, TNF-α, MMP-3) declined, whereas SOD and TGF-β1 levels rose, with the LESWT group exhibiting more pronounced changes (p < 0.01). The occurrence of adverse events showed no significant difference between the groups (p > 0.05). LESWT demonstrates significant efficacy in alleviating pain and reducing inflammatory markers in patients with KOA, making it a promising therapeutic option deserving of further clinical consideration.

Trial registration: The study protocol was registered on Chinese Clinical Trial Registry, ChiCTR2457249805. Registered 03/08/2022, https://www.chictr.org.cn/.