SUMMARY
Objective. This investigation aimed to pool and discuss the existed literature on the efficacy and safety of intra-articular injection of Botulinum toxin type A (BTA) for knee osteoarthritis (OA) treatment focusing on different doses and comparing with other injectable agents.
Methods. Data sources: a systematic review through PubMed, Scopus, Google Scholar and Cochrane Central Register of Controlled Trials was conducted to identify all English-language studies published before November 2019. Study Selection: eligibility included adults suffering from knee osteoarthritis with intra-articular BTA injection as intervention. Data Extraction: after removing duplications and excluding non-eligible articles, data of final included studies were extracted including outcome measures; follow up time-points; and details of interventions in all groups including dose, duration, frequency and number of sessions. Included studies were quality appraised using PEDro (Physiotherapy Evidence Database) score. Data synthesis: the gathered data was extracted and analyzed in RevMan 5.3 software using random or fixed-effect models, as effect size measures such as raw or standardized mean difference (MD or SMD). Only six studies provided suitable data for meta-analysis with a total number of 459 patients. All studies included, except for one RCT that had fair quality, obtained good and high quality scores. The present data revealed that the included patients experienced significant pain relief immediately about 2 weeks after BTA intra-articular injection and this response remained significant even after 6 months (MD = 1.53 (95% CI: 0.94-2.11) and 1.71 (95% CI: 1.35-2.07), respectively).
Results. Also, this review proved that the short-term analgesic effect of BTA-corticosteroid was better than BTA alone, not only for pain control based on VAS (MD = 3.73 (95% CI: 2.60-4.86), P < 0.0001), but also for WOMAC index (MD = 21.20 (95% CI: 14.14-28.26), P < 0.00001). Additionally, this review find supportive evidence for the analgesic effect of low-dose BTA rather than higher doses (more than 200 IU).
Conclusions. The pooled data proved that a combination of BTA-corticosteroid achieved maximum efficacy for both pain relief and functional improvement within short and long-term follow up in comparison to both alone. Also, BTA is a safe and affective choice for clinical response with the most pain-relief effects 2-3 months after injection and the most effective dose of 200u among knee OA patients.
The Efficacy of Intra-Articular Botulinum-Toxin Injection in Knee Osteoarthritis: A Systematic Review and Meta-analysis
M. Hosseini, M. Azadvari, E. Kargozar, S. Z. Emami Razavi, S. Rahimi-Dehgolan, N. Maghbouli
Review, 554-568
Keywords: Botulinum Toxins type A, conservative treatment., hyaluronic acid., knee osteoarthritis, Triamcinolone Acetonide,
Table of Content: Vol. 11 (No.3) 2021 July/September
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Postural Stability in Men with Anterior Cruciate and Bicruciate Ligament Knee Injury
E. Kamińska, T. Piontek, M. Wiernicka, M. Goliwąs, J. Lewandowski, K. AdamczewskaOriginal Article, 367-375 -
Demographic and Clinical Factors Predict Focused Shockwave Therapy Results on Patients With Plantar Fasciitis. A Multilevel Analysis
A. Vertuccio, D. Perugia, R. M. Lanzetti, A. Massimiani, A. Lacopo, S. M. Nusca, R. Baldini, F. Santoboni, E. Latini, M. Vetrano, M. C. VulpianiOriginal Article, 376-382 -
Diagnostic Accuracy of Physical Tests and Imaging Techniques in Patients with Shoulder Impingement Syndrome
M. Lorusso, E. Mastrangelo, G. Garofalo, D. Ristori, F. BrindisinoReview, 383-408 -
The Immediate Effect of Muscle Energy Technique and Whole Body Vibration on Hamstring Muscle Flexibility and Stiffness in Healthy Young Females
M. Azizi, A. Shadmehr, K. Malmir, N. Qotbi, Z. Khazaei PourOriginal Article, 409-415 -
A Single-blind Randomised Trial of Intra-Articular Hyaluronic Acid, Hypertonic Saline, and Physiotherapy in Knee Osteoarthritis
E. Taftian, S. Azizi, A. Dadarkhah, N. Maghbouli, S. Najafi, Z. Reza Soltani, A. KhavandegarOriginal Article, 416-426 -
Osseous Ankle Morphology and Recurrent Lateral Sprains: a Case-Control Study
V. Nabi, M. N. Doral, O. Bilge, G. Huri, F. Familiari, J. NylandOriginal Article, 427-432 -
Clinical and Functional Comparison between Anatomical and Non-Anatomical Acute Repair of Tears of the Distal Tendon of Biceps Brachii
A. De Carli, E. Gaj, S. M. Pagnotta, O. Picconi, A. FerrettiOriginal Article, 433-438 -
Immediate Effects of a Novel Lumbar Support Device on Pain Modulation and Core Muscle Function in Patients with Chronic Non-Specific Low Back Pain: a Randomized Controlled Trial
D. Dissanguan, P. Sitilertpisan, L. H. Joseph, A. PaungmaliOriginal Article, 439-448 -
Association of Regional Bioelectrical Phase Angle with Physical Performance: a Pilot Study in Elite Rowers
F. Campa, G. Mascherini, G. Polara, D. Chiodo, L. StefaniOriginal Article, 449-456 -
Neutrophil-Reduced Platelet Rich Plasma with Optimal Platelets Concentrations for Epicondylitis of the Elbow
M. Yoshida, M. SaitoCase report, 457-462 -
Photobiomodulation in Temporomandibular Dysfunction: a Systematic Review
A. M. Pimentel de França, A. Gonçalves Borges, R. Boff Daitx, R. M. Ferrer, M. Baptista Dohnert, J. L. Q. DuriganReview, 463-474 -
The 2019 Cameroon University Games: Prevention Strategies for Musculoskeletal Injuries
D. Maurice, L. Giordani, S. Sobze Martin, B. Yagaï, V. Colizzi, C. FotiOriginal Article, 475-483 -
Combining Platelet Rich Plasma and Concentrated Bone Marrow with a Demineralized Bone Matrix Scaffold Enhances Growth Factor Release Over Time
J. M. Brewer, M. B. McCarthy, L. Pauzenburger, M. P. Cote, A. D. MazzoccaOriginal Article, 484-493 -
Post-Activation Potentiation Effect after Acute Plyometric Exercises on the Performance of Long Jumpers
D. dos Santos Silva, A. R. P. Ferreira, F. J. Aidar, D. Gama de Matos, E. Kalinine, M. E. Da Silva-Grigoletto, R. F. de SouzaOriginal Article, 494-499 -
Arthroscopic Management of Tibial Spine Avulsion in Children: a Retrospective Study with a Minimum Four Year Follow-Up
G. F. Trinchese, A. Oliviero, F. Oliva, N. MaffulliOriginal Article, 500-506 -
Between-Day Reliability of DIERS Formetric 4D® Measurements and the Effects of Prolonged Sitting on Five Standing Positions in Healthy University Students
A. Arumugam, A. M. Javed, S. F. Mohammad, R. M. Mallash, L. A. Aoni, M. K. Aljannan, M. Alkandri, T. M. ShoushaOriginal Article, 507-516 -
Short-Term Outcome of Focused Shock Wave Therapy for Sural Myofascial Pain Syndrome associated with Plantar Fasciitis: a Randomized Controlled Trial
E. Carlisi, F. Manzoni, G. Maestri, L. M. R. Boschi, C. LisiOriginal Article, 517-524 -
Impact of the Location of Myometric Measurement Points on Skeletal Muscle Mechanical Properties Outcomes
J. Mencel, J. Marusiak, A. Jaskólska, A. Jaskólski, K. Kisiel-SajewiczOriginal Article, 525-535 -
Static Stretching at Pain-Tolerated Intensity Is Not Necessary to Increase Knee Range of Motion in Amateur Soccer Players: a Randomized Trial
R. R. V. Melo, M. S. Cerqueira, G. M. Barbosa, A. L. B. A. Laurentino, I. M. Franca, T. O. Souza, W. H. Brito VieiraOriginal Article, 536-546 -
Investigating the Effects of Physical Therapy Timing, Intensity and Duration on Post-Traumatic Joint Contracture in a Rat Elbow Model
A. J. Reiter, R. M. Castile, H. R. Schott, G. J. Kivitz, A. M. Chamberlain, S. P. LakeOriginal Article, 547-553 -
The Efficacy of Intra-Articular Botulinum-Toxin Injection in Knee Osteoarthritis: A Systematic Review and Meta-analysis
M. Hosseini, M. Azadvari, E. Kargozar, S. Z. Emami Razavi, S. Rahimi-Dehgolan, N. MaghbouliReview, 554-568 -
Coordination of the Sub-Regions of the Supraspinatus and Deltoid Muscles During Shoulder Scaption: a Shear Wave Elastography Study
K. Hoshikawa, T. Yuri, N. Mura, H. Giambini, Y. KiyoshigeOriginal Article, 569-576 -
No Effect of Intra-Articular Platelet-Rich Plasma Injections after Arthroscopic Repair of Rotator Cuff Tears: a Prospective Randomized Study
J. R. Almoguera Sánchez-Villacañas, A. Almoguera-Martinez, G. H. Seoane, Á. Sutil Blanco, C. I. Godinho-Soares, F. García De LucasOriginal Article, 577-583 -
Factors Associated to Return to Sport after Surgical Repair of Achilles Tendon Ruptures. A Clinical and Functional Retrospective Study
R. Tanaka, T. Imaya, S. Katsuki, T. Sanada, A. Fukai, E. Honda, H. YoshitomiOriginal Article, 584-591 -
Injury Risk and Maturity Status in Italian Elite Young Football Player
S. Toselli, L. Benedetti, R. Di Miceli, P. Aiello, G. NanniOriginal Article, 592-599