Extracorporeal Shock Wave Therapy as Regenerative Medicine in
Knee Osteoarthritis: Pre-Experiment for Matrix Metalloproteinase-3
Evaluation

Amandha Boy Timor      Randita; Indrayuni Lukitra      Wardhani; Andriati      Andriati; Nurul Kusuma      Wardani; Petrina Theda      Philothra; Imam      Subadi; Soenarnatalina      Melaniani

doi:10.2174/0115733971230928230919053949

Abstract

Background: Knee osteoarthritis (KOA) is currently treated by regenerative therapies that aim to inhibit arthritic degeneration. Extracorporeal shock wave therapy (ESWT) is one of the physical regenerative approaches used for KOA management. However, little is known regarding the impact of shock wave treatment on matrix metalloproteinase-3 (MMP-3), which is one of the enzymes mediating cartilage degradation.

Objectives: To evaluate the effect of ESWT on MMP-3 levels and pain intensity in patients with KOA.

Methods: Fourteen patients diagnosed with Kellgren Lawrence, grades 2 and 3 KOA were recruited for the study. ESWT piezo shockwave was applied once a week for six weeks. MMP-3 levels in the blood were measured pre-test, mid-test (three weeks after therapy) and post-test (one week after the last session) by enzyme-linked immunosorbent assay (ELISA). The perceived pain was recorded at each session by the Wong Becker Face Scale.

Results: The median pre-test, mid-test and post-test MMP-3 levels were 19.92 ng/mL, 15.89 ng/mL and 18.82 ng/mL, respectively, and there were significant differences between the pre-test and mid-test, and the pre-test and post-test values (p < 0.05). The pain scores also decreased significantly over the period of intervention.

Conclusion: MMP-3 levels decreased significantly in KOA patients after ESWT, and the decline was most obvious after 3 weeks of therapy. Therefore, EWST should be considered as a suitable treatment option for KOA.

Keywords: Knee osteoarthritis, extracorporeal shock wave therapy, matrix metalloproteinase-3, degenerative diseases, regenerative medicine, kellergren lawrence.

« Previous Next »

Graphical Abstract

[1]
Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine  2020; 29-30: 100587.
 [http://dx.doi.org/10.1016/j.eclinm.2020.100587] [PMID: 34505846]

[2]
van Tunen JAC, Dell’Isola A, Juhl C, et al. Association of malalignment, muscular dysfunction, proprioception, laxity and abnormal joint loading with tibiofemoral knee osteoarthritis: A systematic review and meta-analysis. BMC Musculoskelet Disord  2018; 19(1): 273.
 [http://dx.doi.org/10.1186/s12891-018-2202-8] [PMID: 30055600]

[3]
Alisiya A, Sulistiawati S, Kurniawati PM, Wardhani RRIL. Risk factors of body mass index (BMI), age of menarche, parity and hormonal contraception of genu osteoarthritis in female patients. Folia Medica Indonesiana  2021; 57(2): 104.
 [http://dx.doi.org/10.20473/fmi.v57i2.23029]

[4]
Susanti A, Wardhani RIL, Pawana IPA. Relationship between quadriceps muscle atrophy and proprioception function in knee osteoarthritis patients  2019; 2: 6.

[5]
Kolasinski SL, Neogi T, Hochberg MC, et al. American college of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol  2020; 72(2): 220-33.
 [http://dx.doi.org/10.1002/art.41142] [PMID: 31908163]

[6]
Gönen C, Yalın C. Long-term efficiency of extracorporeal shockwave therapy on lateral epicondylitis. Acta Orthop Belg  2017; 83(3): 438-44.

[7]
Rini LA, Damayanti T. The effect of dexterity and perturbation exercise on knee osteoarthritis through functional balance and power improvement of quadriceps and hamstring. IJFMT 2020. Available From:  http://medicopublication.com/index.php/ijfmt/article/ view/3372(Accessed on 2022 Sep 28).

[8]
Haake M, Böddeker I, Decker T, et al. Side-effects of extracorporeal shock wave therapy (ESWT) in the treatment of tennis elbow. Arch Orthop Trauma Surg  2002; 122(4): 222-8.
 [http://dx.doi.org/10.1007/s00402-001-0362-7] [PMID: 12029512]

[9]
Xie X, Zhu J, Zhang H. Effects of extracorporeal shock wave therapy in patients with knee osteoarthritis. Medicine  2020; 99(35): e21749.
 [http://dx.doi.org/10.1097/MD.0000000000021749] [PMID: 32871895]

[10]
Xu Y, Wu K, Liu Y, et al. The effect of extracorporeal shock wave therapy on the treatment of moderate to severe knee osteoarthritis and cartilage lesion. Medicine  2019; 98(20): e15523.
 [http://dx.doi.org/10.1097/MD.0000000000015523] [PMID: 31096453]

[11]
Ma H, Zhang W, Shi J, Zhou D, Wang J. The efficacy and safety of extracorporeal shockwave therapy in knee osteoarthritis: A systematic review and meta-analysis. Int J Surg  2020; 75: 24-34.
 [http://dx.doi.org/10.1016/j.ijsu.2020.01.017] [PMID: 31978648]

[12]
Jenei-Lanzl Z, Meurer A, Zaucke F. Interleukin-1β signaling in osteoarthritis: Chondrocytes in focus. Cell Signal  2019; 53: 212-23.
 [http://dx.doi.org/10.1016/j.cellsig.2018.10.005] [PMID: 30312659]

[13]
Blom AB, van Lent PL, Libregts S, et al. Crucial role of macrophages in matrix metalloproteinase–mediated cartilage destruction during experimental osteoarthritis: Involvement of matrix metalloproteinase 3. Arthritis Rheum  2007; 56(1): 147-57.
 [http://dx.doi.org/10.1002/art.22337] [PMID: 17195217]

[14]
Lohmander LS, Brandt KD, Mazzuca SA, et al. Use of the plasma stromelysin (matrix metalloproteinase 3) concentration to predict joint space narrowing in knee osteoarthritis. Arthritis Rheum  2005; 52(10): 3160-7.
 [http://dx.doi.org/10.1002/art.21345] [PMID: 16200596]

[15]
Mehana ESE, Khafaga AF, El-Blehi SS. The role of matrix metalloproteinases in osteoarthritis pathogenesis: An updated review. Life Sci  2019; 234: 116786.
 [http://dx.doi.org/10.1016/j.lfs.2019.116786] [PMID: 31445934]

[16]
Tetlow LC, Adlam DJ, Woolley DE. Matrix metalloproteinase and proinflammatory cytokine production by chondrocytes of human osteoarthritic cartilage: Associations with degenerative changes. Arthritis Rheum  2001; 44(3): 585-94.
 [http://dx.doi.org/10.1002/1529-0131(200103)44:3<585::AID-ANR107>3.0.CO;2-C] [PMID: 11263773]

[17]
Wan J, Zhang G, Li X, et al. Matrix metalloproteinase 3: A promoting and destabilizing factor in the pathogenesis of disease and cell differentiation. Front Physiol  2021; 12: 663978.
 [http://dx.doi.org/10.3389/fphys.2021.663978] [PMID: 34276395]

[18]
Chen JJ, Huang JF, Du WX, Tong PJ. Expression and significance of MMP3 in synovium of knee joint at different stage in osteoarthritis patients. Asian Pac J Trop Med  2014; 7(4): 297-300.
 [http://dx.doi.org/10.1016/S1995-7645(14)60042-0] [PMID: 24507680]

[19]
Ji Q, He C. Extracorporeal shockwave therapy promotes chondrogenesis in cartilage tissue engineering: A hypothesis based on previous evidence. Med Hypotheses  2016; 91: 9-15.
 [http://dx.doi.org/10.1016/j.mehy.2016.03.013] [PMID: 27142133]

[20]
Waugh C, Jones E, Riley G, Langberg H, Morrissey D, Screen H. The effects of extracorporeal shockwave therapy on matrix metalloprotease activity in tendinopathy (1046.8). FASEB J  2014; 28(S1): 1046-8.
 [http://dx.doi.org/10.1096/fasebj.28.1_supplement.1046.8]

[21]
Wang CJ, Cheng JH, Chou WY, Hsu SL, Chen JH, Huang CY. Changes of articular cartilage and subchondral bone after extracorporeal shockwave therapy in osteoarthritis of the knee. Int J Med Sci  2017; 14(3): 213-23.
 [http://dx.doi.org/10.7150/ijms.17469] [PMID: 28367081]

[22]
Chou WY, Cheng JH, Wang CJ, Hsu SL, Chen JH, Huang CY. Shockwave targeting on subchondral bone is more suitable than articular cartilage for knee osteoarthritis. Int J Med Sci  2019; 16(1): 156-66.
 [http://dx.doi.org/10.7150/ijms.26659] [PMID: 30662339]

[23]
Avendaño-Coy J, Comino-Suárez N, Grande-Muñoz J, Avendaño-López C, Gómez-Soriano J. Extracorporeal shockwave therapy improves pain and function in subjects with knee osteoarthritis: A systematic review and meta-analysis of randomized clinical trials. Int J Surg  2020; 82: 64-75.
 [http://dx.doi.org/10.1016/j.ijsu.2020.07.055] [PMID: 32798759]

[24]
Simplicio CL, Purita J, Murrell W, Santos GS, dos Santos RG, Lana JFSD. Extracorporeal shock wave therapy mechanisms in musculoskeletal regenerative medicine. J Clin Orthop Trauma  2020; 11 (3): S309-18.
 [http://dx.doi.org/10.1016/j.jcot.2020.02.004] [PMID: 32523286]

[25]
Wang YC, Huang HT, Huang PJ, Liu ZM, Shih CL. Efficacy and safety of extracorporeal shockwave therapy for treatment of knee osteoarthritis: A systematic review and meta-analysis. Pain Med  2020; 21(4): 822-35.
 [http://dx.doi.org/10.1093/pm/pnz262] [PMID: 31626282]

[26]
Subadi I, Nugraha B, Laswati H, Josomuljono H. Pain relief with wet cupping therapy in rats is mediated by heat shock protein 70 and ß-Endorphin. Iran J Med Sci  2017; 42(2): 384-91.

[27]
Schmitz C, DePace R. Pain relief by extracorporeal shockwave therapy: an update on the current understanding. Urol Res  2009; 37(4): 231-4.
 [http://dx.doi.org/10.1007/s00240-009-0190-8] [PMID: 19444437]

[28]
Li W, Pan Y, Yang Q, Guo Z, Yue Q, Meng QG. Extracorporeal shockwave therapy for the treatment of knee osteoarthritis. Medicine  2018; 97(27): e11418.
 [http://dx.doi.org/10.1097/MD.0000000000011418] [PMID: 29979441]

Rights & Permissions Print Cite

Article Metrics

23

2

Journal Information

For Authors

For Editors

For Reviewers

Explore Articles

Open Access

Open Access Articles

For Visitors

DOI https://dx.doi.org/10.2174/0115733971230928230919053949	Print ISSN 1573-3971
Publisher Name Bentham Science Publisher	Online ISSN 1875-6360

Current Rheumatology Reviews

Extracorporeal Shock Wave Therapy as Regenerative Medicine in Knee Osteoarthritis: Pre-Experiment for Matrix Metalloproteinase-3 Evaluation

Abstract

Graphical Abstract

Related Books

Related Articles