💬In plain words
What the trial is, and whether it could suit you
Subchondral bone marrow lesions (BMLs) in knee osteoarthritis (OA) are strongly associated with presence and severity of knee pain, structural deterioration, disease progression with an increased risk of total knee arthroplasty. OA-related BMLs may regress or resolve within 30 months which could be associated with long lasting disability. It has been reported that BMLs persist in the majority of knee OA patients. Different treatment strategies have been proposed including rest and protected weight-bearing, bisphosphonates, subchondroplasty and intraosseous orthobiologic injection. However, conservative treatment response takes a long time and other interventions may be considered invasive procedures that show varying results with several side effects. Focused extracorporeal shockwave therapy (f-ESWT) has been established as a safe non-invasive treatment with positive results in different
Sign in to get the eligibility rules as simple questions to take to your doctor.
📋 Eligibility rules (as published)
Inclusion Criteria:
1. Males and females 30-80 years old, inclusive.
2. Kellgren-Lawrence (KL) score grade 2-4 as diagnosed on X-Ray.
3. Presence of BML(s) on MRI in a weight-bearing region of the knee (medial/lateral femoral condyle or tibial plateau).
4. Knee pain for more than 2 months.
5. Knee pain intensity during the week leading up to the screening visit is at least 4 out of 10 on an 11-point numerical rating scale (NRS; 0, no pain; 10, maximum pain imaginable).
6. Patient pain confined to the same compartment as the BML(s).
7. Subjects would have failed a minimum of 4 weeks of conservative treatment including rest, analgesics, limited weight-bearing with or without an assistive device.
Exclusion Criteria:
1. Traumatic BMLs.
2. Primary cause of patient pain and loss of function is due to pathology other than BML(s), according to patient history and clinical evaluation.
3. Presence of bilateral BML(s).
4. Systemic autoimmune diseases, such as systemic lupus erythematosus and rheumatoid arthritis.
5. Participants receiving glucocorticoids due to any other underlying disease.
6. Prior treatment for BMLs including:
1. Subchondroplasty in the involved knee.
2. Intraosseous and/or intra-articular injection of orthobiologics in the past 6 months, such as platelet rich plasma (PRP), bone marrow aspirate concentrates, micro-fragmented adipose tissue (MFAT) or stromal vascular fraction.
7. Prior use of bisphosphonates, except according to the washout schedule:
1. 2 years (if use \> 48 weeks).
2. 1 year (if used \> 8 weeks but \< 48 weeks)
3. 6 months (if used \> 2 weeks but \< 8 weeks)
4. 2 months (if used \< 2 weeks)
5. Any intravenous bisphosphonate within the prior 2 years.
8. Intra-articular steroid injection in the prior 3 months.
9. Previous knee surgery in the past 6 months.
10. Tumors
11. Infection or fracture on ipsilateral lower limb.
12. Pregnancy.
13. Contraindications to f-ESWT, such as severe coagulopathy, malignant tumor in the treatment area.
14. Contraindications to MRI scanning including:
* Presence of metal implants such as implanted pacemaker, metal sutures, metallic protheses (including metal pins and rods, heart valves), presence of shrapnel or iron filings in the eye, magnetic dental implants, cochlear implants, cerebral aneurysm clip, and deep brain stimulator.
* Claustrophobia.
* The patient has been informed by his/her doctor that it is medically unsafe to receive regular MRI as part of his/her medical care.
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