Extracorporeal Shock Wave Therapy in the Treatment of Knee Osteoarthritis: A Review of Mechanism of Action and Clinical Efficacy

Knee osteoarthritis (KOA) is the most common form of arthritis and one of the leading causes of disability. OA is characterized by cartilage damage, subchondral bone changes, and synovial tissue inflammation, with clinical symptoms of pain, decreased range of motion (ROM) and functional impairment. Recently, extracorporeal shockwave therapy (ESWT) has been introduced in the treatment of OA and there is increasing evidence of the therapeutic effects of ESWT on patients with KOA. For decades, there have been multiple attempts to understand the mechanisms of these therapeutic effects. So far, it is appreciated that cellular mechanotransduction through the cytoskeleton into the nuclei can regulate gene expression and cause biological changes. The purpose of this article is to provide current evidence on the physical and biological principles, mechanism of action and clinical efficacy of ESWT on KOA.