Plain language summary
Knee osteoarthritis is a chronic disease often causing joint pain, swelling and dysfunction. The current treatment options - anti-inflammatory medications, physical therapy or surgery - have been shown to respectively produce adverse side effects, only demonstrate short-term effects or are invasive. The aim of this study was to evaluate the effects of therapeutic exercise after injection of either botulinum toxin type-A (BoNT-A) or hyaluronate in patients with knee osteoarthritis. Sixty patients were randomised to receive an ultrasound-guided injection of BoNT-A, hyaluronate or saline as control, and then participate in a physical therapy session. Therapeutic exercises were then prescribed to patients to complete five times per week. Structural changes in the knee joints were evaluated using imaging tools before and after the intervention, as well as quality of life and pain assessments. While this study found both BoNT-A and hyaluronate resulted in improvements in pain and knee functioning, BoNT-A produced more effective results. The authors conclude this study may provide clinicians with a new, less invasive option for treating patients with knee osteoarthritis.
Abstract
OBJECTIVE To study the effect of therapeutic exercise on knee osteoarthritis after injection of botulinum toxin type A, hyaluronate or saline. METHODS Sixty participants with knee osteoarthritis were randomly assigned to 3 groups: injection of saline (control) (group A), botulinum toxin type A (group B), or hyaluronate (group C). All participants received therapeutic exercise. Western Ontario and McMaster Universities Osteoarthritis Index questionnaire score, visual analogue scale pain scale, and Medical Outcomes Study 36-item Health Survey were conducted at baseline, and at the end of the 4th and 8th weeks. RESULTS At end of the 4th and 8th weeks, the scores on the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire and visual analogue scale were higher in the control group. There were significant differences in Physical Component Summary-36 and Mental Component Summary-36 scores between the 3 groups (p <0.05) at the end of the 4th and 8th weeks, but not between groups A (control) and C (hyaluronate) at the end of the 4th week. No changes were seen on magnetic resonance imaging and X-ray images of the affected knees after the intervention. CONCLUSION Therapeutic exercise plus botulinum toxin type A or hyaluronate injection can significantly reduce pain and improve knee functioning. Botulinum toxin type A plus therapeutic exercise appears to be more effective.
Methodological quality
Jadad score
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3
Allocation concealment
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Yes
