title: Therapeutic effects of intra-articular botulinum neurotoxin in advanced knee osteoarthritis.
abstract: BACKGROUND
  Osteoarthritis (OA) is a major cause of musculoskeletal pain that causes morbidity, physical limitation, and poor quality of life. The purpose of this study was to evaluate the therapeutic effects of intra-articular (IA) injection of botulinum neurotoxin A (BoNT/A) for advanced knee OA.
  
  
  METHODS
  Twenty-four patients (38 knees) were enrolled, and the subjects were radiographically verified as having stage III or IV OA according to the Kellgren-Lawrence classification. We used the Western Ontario and McMaster Universities Osteoarthritis Index to evaluate the therapeutic effects monthly for 6 months. BoNT/A (100 U) was reconstituted with 4.0 mL saline and was injected into the symptomatic knee joints after baseline evaluation and 3 months later.
  
  
  RESULTS
  The therapeutic effects of BoNT/A were clinically significant at 1 month after the first injection, but statistical significance was not noted until 3 months after the first IA injection. Pain and stiffness improved clinically; however, the effect of BoNT/A achieved statistical significance only for the pain subscale in stage III OA. There was no significant difference between the stage III and IV groups. There was no significant muscle atrophy or serious adverse effect in any group after treatment.
  
  
  CONCLUSIONS
  IA BoNT/A provides a new therapeutic option for refractory pain in patients with advanced knee OA. Although IA BoNT/A appears to be effective and safe for the management of advanced knee OA, these results cannot be generalized to patients with mild knee joint pain or nonspecific soft tissue pain in the knee joint region.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. cl_chou@vghtpe.gov.tw
authors.forename: Chen-Liang
authors.initials: CL
authors.lastname: Chou
authors.forename: Si-Huei
authors.initials: SH
authors.lastname: Lee
authors.forename: Shin-Yo
authors.initials: SY
authors.lastname: Lu
authors.forename: Ko-Lun
authors.initials: KL
authors.lastname: Tsai
authors.forename: Chung-Yu
authors.initials: CY
authors.lastname: Ho
authors.forename: Hsuan-Chu
authors.initials: HC
authors.lastname: Lai
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D010147:Pain Measurement
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A