4. Discussion
suprapatellar effusion
PROLIFERATION, LEQUESNE, NEOVASCULARIZATION, COMPLICATION
As previously stated in the background section, ESWT appears to be a promising alternative option among various treatment options for early mild knee OA. When compared to other treatments, ESWT presents several advantages, including noninvasiveness, a low complication rate, no hospitalization requirement, and a low cost. Although the mechanism of ESWT on knee OA is not completely understood, several preclinical studies have previously demonstrated the ESWT mechanisms on knee OA.ESWT acts as a compressive force during the positive phase and then as a tensile force and shear stress during the negative phase, causing microbubbles in liquid molecules and cavitational effects on the treatment area. This complex etiologic forces may lead to biophysical effects on target tissues.Based on the revealing of ESWT mechanisms, several studiesRegarding the intensity of ESWT on the knee, previous research concluded that high intensity energy therapy may be beneficial, requiring only a single treatment and producing superior results.As different targets were chosen in other studies,In our study, at the posttreatment evaluation, both experimental and control group improved in clinical symptoms related to knee OA as measured by the VAS, WOMAC score, and Lequesne index. In contrast to our findings, Uysal et alAvendaño-Coy et alAccording to our findings, Doppler activity increased at medial joint space immediately following treatment. ESWT can lead to biologic response in target tissue by inducing anti-inflammatory effects, cell proliferation, and, in particular, neovascularization, which may result in tissue regeneration and repair.While other knee ROM and Doppler activity at other areas showed no change after treatment, suprapatellar effusion height decreased with time in the experimental group and showed a significant difference with the control group at 1-month follow-up. As previously stated, ESWT can induce a biologic response in target tissue by inducing anti-inflammatory processes.To conclude, some limitations of this study should be noted. First, small sample size might have affected the results of this study. However, future studies with larger groups of subjects, based on the result of this pilot study, are warranted. Second, only 1 treatment protocol was selected in our study. There has been several studies