Precision repair of knee joint bone marrow edema with shock wave

Bone marrow edema of the knee is a common symptom. This symptom can be found through medical examinations. It is often caused by trauma, necrosis, tumors and other reasons. When this happens, it often causes knee pain in patients and limits joint movement. Walking will also be more difficult at this time. Currently, extracorporeal shock wave therapy is a better treatment method.

Extracorporeal shock wave therapy

With rapid development, a large amount of new treatment experience and research results have been accumulated. Because this therapy is minimally invasive, safe and effective, it has been widely used in the clinical treatment of musculoskeletal diseases. The main effects of ESWT shock waves are: ① tissue damage repair and reconstruction; ② tissue adhesion loosening; ③ vascular dilation and angiogenesis; ④ analgesia and nerve ending blocking; ⑤ high-density tissue lysis; ⑥ inflammation and infection control. In March 2017, the Chinese Expert Consensus on Extracorporeal Shock Wave Therapy for Musculoskeletal Diseases (2nd Edition) provided direction for the precise use of shock waves in the treatment of bone marrow edema syndrome.

Expert consensus on shock wave bone marrow edema

1. Indications. MRI examination confirmed that the patient had bone marrow edema.

2. Contraindications. Manifestations of bone marrow edema caused by bone infection, bone tumors, and blood system diseases.

3. Positioning. Bone marrow edema can only be detected by MRI examination. The area of ​​edema is determined based on the MRI results combined with surface landmarks, while taking care to avoid important blood vessels and nerves.

4. Treatment methods. According to the size of the edema area, select 2 to 5 treatment points. According to the patient's sensitivity to pain, gradually increase the energy level from a low level to the required level. The energy flux density is 0.18 to 0.25 mJ/mm2, and each point is impacted 800 to 1500 times. The treatment is conducted once every 3 to 5 days, and 5 times constitute a course of treatment. An MRI examination is performed 3 months after the end of the treatment to understand the progression of the lesion and to determine whether multiple courses of treatment are feasible. During treatment, avoid other factors that may aggravate bone marrow edema.

Indications for ESWT

Indications: ① Bone tissue diseases: delayed fracture healing and nonunion, adult femoral head necrosis, stress fracture; ② Chronic soft tissue injury diseases: supraspinatus tendinitis, lateral epicondylitis, medial epicondylitis, plantar fasciitis, Achilles tendinitis, long head of biceps tendinitis, greater trochanteric bursitis, etc.

Relative indications: osteoarthritis, bone marrow edema, tibial tuberosity osteochondritis, talar osteochondral injury, tenosynovitis, subacromial bursitis, prepatellar bursitis, patellar tendinitis, snapping hip, muscle spasm, muscle strain, carpal tunnel syndrome, osteonecrotic diseases (lunate necrosis, talar necrosis, scaphoid necrosis), osteoporosis, etc.