title: Effects of Botulinum Toxin Landmark-Guided Intra-articular Injection in Subjects With Knee Osteoarthritis.
abstract: Increasing evidence has suggested that botulinum toxin A (BoNT/A) can inhibit the release of selected neuropeptide transmitters from primary sensory neurons. Thus, intra-articular (IA) injection therapies with BoNT/A may reduce pain in patients with knee osteoarthritis (OA).
  
  
  
  To investigate the effects of landmark-guided IA injection of BoNT/A on patients with knee OA.
  
  
  
  A prospective randomized controlled trial.
  
  
  
  A rehabilitation clinic of a private teaching hospital.
  
  
  
  A total of 46 patients with symptomatic knee OA (mostly Kellgren-Lawrence grade 2-3).
  
  
  
  The patients were randomly assigned to 1 of the following groups: BoNT/A group (BoNT/A injection; n = 21) or control group (education only; n = 20). The patients in the BoNT/A group received an IA injection of 100 units of BoNT/A into the affected knee.
  
  
  
  The short-term (1 week posttreatment) and long-term (6 months posttreatment) effects were evaluated using a pain visual analogue scale (VAS) and questionnaires concerning functional status, including the Lequesne and Western Ontario and McMaster Universities (WOMAC) indexes.
  
  
  
  The between-group comparison revealed significant differences with regard to the pain VAS score at 1 week (P < .001) and at 6 months (P = .001) posttreatment. Similar findings for the between-group comparison were observed for the WOMAC and Lequesne indexes at 6 months (P < .05) posttreatment. The pain VAS score in the BoNT/A group significantly decreased from 5.05 ± 1.12 (pretreatment) to 2.89 ± 1.04 at 1 week (P < .001) and 3.45 ± 1.70 at 6 months posttreatment (P < .001) but not in the control group (P = .476).
  
  
  
  The IA injection of BoNT/A provided pain relief and improved functional abilities in patients with knee OA in both the short- and long-term follow-up.
  
  
  
  I.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Republic of China; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, Republic of China(∗).
authors.forename: Lin-Fen
authors.initials: LF
authors.lastname: Hsieh
authors.affiliation: Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Republic of China(†).
authors.forename: Chia-Wei
authors.initials: CW
authors.lastname: Wu
authors.affiliation: Neuromuscular Research Laboratory, Department of Physical Therapy, Chang Gung University, Tao-Yuan, Taiwan, Republic of China(‡).
authors.forename: Ching-Chieh
authors.initials: CC
authors.lastname: Chou
authors.affiliation: Department of Biomedical Engineering, National Yang-Ming University, No. 155, Section 2, Li-Nong Street, Taipei, Taiwan, Republic of China(§). Electronic address: swyang@ym.edu.tw.
authors.forename: Sai-Wei
authors.initials: SW
authors.lastname: Yang
authors.affiliation: Department of Physical Medicine and Rehabilitation, Cardinal Tien Hospital, Taipei, Taiwan, Republic of China(‖).
authors.forename: Shih-Hui
authors.initials: SH
authors.lastname: Wu
authors.affiliation: Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China(¶).
authors.forename: Yi-Jia
authors.initials: YJ
authors.lastname: Lin
authors.affiliation: Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China; National Defense Medical Center, Taipei, Taiwan, Republic of China(#).
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Hsu
mesh_terms: D019274:Botulinum Toxins, Type A; D006801:Humans; D007270:Injections, Intra-Articular; D020370:Osteoarthritis, Knee; D010147:Pain Measurement; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D019274:Botulinum Toxins, Type A