title: Extracorporeal shock wave therapy in the treatment of primary bone marrow edema syndrome of the knee: a prospective randomised controlled study.
abstract: BACKGROUND
  The aim of this prospective study was to evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) in normalizing the symptoms and imaging features of primary bone marrow edema syndrome (BMES) of the knee.
  
  
  METHODS
  This study compared the outcomes of ESWT (Group A) (n = 20) and intravenously applied prostacyclin and bisphosphonate (Group B) (n = 20) in the treatment of BMES of the knee in our department between 2011 and 2013. The Visual Analog Scale for pain (VAS, 100 mm), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the SF-36 scores and MRI scans as well as plain radiographs were obtained before and after therapy between two groups.
  
  
  RESULTS
  Compared with Group B, we found greater improvement in VAS, the WOMAC Osteoarthritis Index and SF-36 score at 1, 3 and 6 months post-treatment in Group A (P < 0.05). Furthermore, MRI scans showed a higher incidence of distinct reduction and complete regression of bone marrow edema at 6 months in Group A (95 vs. 65 %; P = 0.018). The MRI at 1 year follow-up showed complete regression in all patients in Group A. However, two cases in Group B continued to normalize over the subsequent follow-up period.
  
  
  CONCLUSIONS
  ESWT can produce rapid pain relief and functional improvement. It may be an effective, reliable, and non-invasive technique for rapid treatment of BMES of the knee.
  
  
  BACKGROUND
  Research Registry UIN 528, September 03, 2015.
authors.affiliation: Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, Department of Orthopedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China. gaofuqiang0604@163.com.|Department of Orthopedic Surgery, China Japan Friendship Hospital, Beijing, 100029, China. gaofuqiang0604@163.com.
authors.forename: Fuqiang
authors.initials: F
authors.lastname: Gao
authors.affiliation: Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, Department of Orthopedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China. 18901267995@163.com.|Department of Orthopedic Surgery, China Japan Friendship Hospital, Beijing, 100029, China. 18901267995@163.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Sun
authors.affiliation: Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, Department of Orthopedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China. lizirong0297@163.com.
authors.forename: Zirong
authors.initials: Z
authors.lastname: Li
authors.affiliation: Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, Department of Orthopedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China. guowanshou0927@163.com.
authors.forename: Wanshou
authors.initials: W
authors.lastname: Guo
authors.affiliation: Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, Department of Orthopedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China. wangweiguo1007@163.com.
authors.forename: Weiguo
authors.initials: W
authors.lastname: Wang
authors.affiliation: Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, Department of Orthopedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China. chengliming1106@163.com.
authors.forename: Liming
authors.initials: L
authors.lastname: Cheng
authors.affiliation: Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, Department of Orthopedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China. yuedebo1783@163.com.
authors.forename: Debo
authors.initials: D
authors.lastname: Yue
authors.affiliation: Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, Department of Orthopedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China. zhangnianfei1280@163.com.
authors.forename: Nianfei
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, Department of Orthopedic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China. qq276321611@163.com.
authors.forename: Amanda
authors.initials: A
authors.lastname: Savarin
mesh_terms: D000328:Adult; D001855:Bone Marrow Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D004487:Edema / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000473:pathology*; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D013577:Syndrome; D016896:Treatment Outcome