Effect of low-intensity pulsed ultrasound on regeneration of joint cartilage in patients with second and third degree osteoarthritis of the knee
Efecto del ultrasonido terapéutico pulsátil de baja intensidad sobre la regeneración del cartílago articular en pacientes con gonartrosis de segundo y tercer grado
Adalberto Loyola Sáncheza,
, María Antonieta Ramírez Wakamatzua, Judith Vázquez Zamudiob, Julio Casasolac, Claudia Hernández Cuevasc, Amador Ramírez Gonzálezd, Jorge Galicia Tapiae
Corresponding author
a Servicio de Medicina de Rehabilitación, CMN 20 de Noviembre, ISSSTE, DF, Mexico
b Servicio de Resonancia Magnética, CMN 20 de Noviembre, ISSSTE, DF, Mexico
c Servicio de Reumatología, Hospital General de México, SSA, DF, Mexico
d Servicio de Radiología e Imagen, Departamento de Resonancia Magnética, CMN 20 de Noviembre ISSSTE, Mexico
e Departamento de Investigación, Subdirección General Médica del ISSSTE, DF, Mexico
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"tienePdf" => true "fechaRecibido" => "2008-05-23" "fechaAceptado" => "2008-09-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec112135" "palabras" => array:3 [ 0 => "Low intensity pulsed ultrasound" 1 => "Knee osteoarthritis" 2 => "Cartilage repair" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec112134" "palabras" => array:4 [ 0 => "Ultrasonido terapéutico pulsátil de baja" 1 => "intensidad" 2 => "Gonartrosis" 3 => "Reparación de cartílago" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine if the application of low intensity pulsed ultrasound (LIPUS) therapy has a positive effect over the cartilage repair, functional status, and reduction of pain in patients with grade 2 or 3 osteoarthrosis of the knee.</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This trial was an observational, before and after study without a control group, in which 10 patients (11 knees) were studied. We applied LIPUS therapy with an intensity of 0.3 W/cm<span class="elsevierStyleSup">2</span>, duty cycle of 50%, giving a total of 36 J/cm<span class="elsevierStyleSup">2</span> per session during 36 sessions (3 months). The clinical measures were obtained before the first session and at the end of the 36th session, and were: cartilage thickness by the analysis of magnetic resonance images (MRI) measured by 2 rheumatologists and a radiology specialist, pain by a visual analog scale (1–10<span class="elsevierStyleHsp" style=""></span>cm) and function/severity by the Lequesne index. We used the non parametric tests of Wilcoxon for comparing medians and the Spearmans rho for the correlation of the inter observer cartilage thickness measurements defining a <span class="elsevierStyleItalic">P</span> value of <.05 as significant.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We observed an effect on pain (VAS mean before 7.09 [2.54]; mean after 4.18 [2.22]; <span class="elsevierStyleItalic">P</span>=.005) and on the function/severity index (Lequesne mean before 10.55 [5.42]; mean after 5 [4.45]; <span class="elsevierStyleItalic">P</span>=.008). There was poor consistency regarding the cartilage thickness measures by resonance imaging between the 3 observers (2 rheumatologists and 1 radiologist) so we were not able to define the presence or absence of effect on cartilage thickness augmentation.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">LIPUS has a benefic effect over pain and functionality/severity in patients with Kellgren and Lawrence grade 2 and 3 osteoarthritis of the knee. Unfortunately in this study we did not count with a reliable measure method to conclude on its effect over cartilage thickness measured by MRI.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Indagar si la aplicación del ultrasonido terapéutico pulsátil de baja intensidad (USTPBI) produce cambios favorables en la regeneración del cartílago articular, así como beneficios clínicos en pacientes que tienen gonartrosis grado 2 o 3 según la clasificación de Kellgren y Lawrence.</p> <span class="elsevierStyleSectionTitle">Diseño</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Éste es un estudio observacional, tipo antes y después, sin grupo control, en el que se estudiaron 10 pacientes (11 rodillas) con gonartrosis grados 2 y 3 (según la clasificación de Kellgren y Lawrence), a los que se les aplicó ultrasonido terapéutico a una intensidad de 0,3 W/cm<span class="elsevierStyleSup">2</span> pulsátil al 50%, que otorgó un total de energía de 36 J/cm<span class="elsevierStyleSup">2</span> por sesión durante 36 sesiones. Las mediciones se realizaron previas al inicio del tratamiento y posteriores al término de éste (3 meses después), y consistieron en: grosor del cartílago articular mediante el análisis de imágenes tomadas por resonancia magnética (RM) por 2 reumatólogos y un experto radiólogo; dolor mediante escala visual analógica (de 1 a 10<span class="elsevierStyleHsp" style=""></span>cm) y el índice de gravedad de Lequesne. Se utilizaron pruebas estadísticas no paramétricas de Wilcoxon y pruebas de correlación de Spearman, y se definió un valor de p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05 como estadísticamente significativo.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se observó una disminució±n en la intensidad de dolor (basal media de 7,09<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2,54; final media de 4,18<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2,22; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,005) y una mejoría en cuanto a la funcionalidad (basal media de 10,55<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5,42; final media de 574,45; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,008) después del tratamiento con USTPBI. Con respecto al grosor medido en la RM, no se obtuvieron mediciones consistentes entre los observadores, por lo que se concluyó que el método de medición no fue reproducible, lo que hizo difícil definir si hubo un incremento o no en el grosor del cartílago articular.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El USTPBI tiene un efecto benéfico sobre la disminución del dolor y la mejoría de la funcionalidad. Desafortunadamente, en este estudio no se cuenta con un método de medición reproducible para arrojar una conclusión válida en cuanto al efecto del USTPBI sobre el grosor del cartílago articular</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 18 | 26 |
| 2024 October | 23 | 37 | 60 |
| 2024 September | 20 | 16 | 36 |
| 2024 August | 33 | 38 | 71 |
| 2024 July | 25 | 29 | 54 |
| 2024 June | 19 | 35 | 54 |
| 2024 May | 34 | 31 | 65 |
| 2024 April | 23 | 30 | 53 |
| 2024 March | 40 | 34 | 74 |
| 2024 February | 20 | 26 | 46 |
| 2024 January | 22 | 24 | 46 |
| 2023 December | 16 | 27 | 43 |
| 2023 November | 18 | 26 | 44 |
| 2023 October | 20 | 36 | 56 |
| 2023 September | 42 | 33 | 75 |
| 2023 August | 20 | 22 | 42 |
| 2023 July | 18 | 36 | 54 |
| 2023 June | 15 | 17 | 32 |
| 2023 May | 16 | 7 | 23 |
| 2023 April | 14 | 9 | 23 |
| 2023 March | 13 | 38 | 51 |
| 2023 February | 27 | 24 | 51 |
| 2023 January | 11 | 23 | 34 |
| 2022 December | 23 | 33 | 56 |
| 2022 November | 32 | 25 | 57 |
| 2022 October | 24 | 45 | 69 |
| 2022 September | 21 | 34 | 55 |
| 2022 August | 19 | 50 | 69 |
| 2022 July | 19 | 44 | 63 |
| 2022 June | 21 | 39 | 60 |
| 2022 May | 30 | 52 | 82 |
| 2022 April | 33 | 48 | 81 |
| 2022 March | 31 | 34 | 65 |
| 2022 February | 27 | 36 | 63 |
| 2022 January | 16 | 32 | 48 |
| 2021 December | 24 | 42 | 66 |
| 2021 November | 22 | 54 | 76 |
| 2021 October | 26 | 69 | 95 |
| 2021 September | 28 | 56 | 84 |
| 2021 August | 19 | 50 | 69 |
| 2021 July | 27 | 43 | 70 |
| 2021 June | 29 | 59 | 88 |
| 2021 May | 35 | 54 | 89 |
| 2021 April | 101 | 79 | 180 |
| 2021 March | 58 | 23 | 81 |
| 2021 February | 21 | 28 | 49 |
| 2021 January | 26 | 30 | 56 |
| 2020 December | 23 | 35 | 58 |
| 2020 November | 37 | 31 | 68 |
| 2020 October | 24 | 22 | 46 |
| 2020 September | 25 | 30 | 55 |
| 2020 August | 21 | 21 | 42 |
| 2020 July | 20 | 23 | 43 |
| 2020 June | 25 | 13 | 38 |
| 2020 May | 26 | 22 | 48 |
| 2020 April | 18 | 14 | 32 |
| 2020 March | 11 | 9 | 20 |
| 2020 February | 1 | 0 | 1 |
| 2019 April | 1 | 0 | 1 |
| 2018 May | 1 | 3 | 4 |
| 2018 April | 19 | 36 | 55 |
| 2018 March | 13 | 23 | 36 |
| 2018 February | 6 | 14 | 20 |
| 2018 January | 8 | 15 | 23 |
| 2017 December | 12 | 23 | 35 |
| 2017 November | 9 | 6 | 15 |
| 2017 October | 9 | 14 | 23 |
| 2017 September | 9 | 18 | 27 |
| 2017 August | 11 | 11 | 22 |
| 2017 July | 15 | 24 | 39 |
| 2017 June | 20 | 26 | 46 |
| 2017 May | 30 | 32 | 62 |
| 2017 April | 10 | 15 | 25 |
| 2017 March | 13 | 36 | 49 |
| 2017 February | 5 | 16 | 21 |
| 2017 January | 10 | 4 | 14 |
| 2016 December | 33 | 23 | 56 |
| 2016 November | 20 | 9 | 29 |
| 2016 October | 31 | 24 | 55 |
| 2016 September | 37 | 25 | 62 |
| 2016 August | 29 | 14 | 43 |
| 2016 July | 14 | 12 | 26 |
| 2016 May | 3 | 19 | 22 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 7 | 0 | 7 |
| 2015 October | 4 | 0 | 4 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 3 | 0 | 3 |
| 2015 July | 12 | 4 | 16 |
| 2015 June | 32 | 19 | 51 |
| 2015 May | 44 | 28 | 72 |
| 2015 April | 35 | 27 | 62 |
| 2015 March | 20 | 28 | 48 |
| 2015 February | 23 | 29 | 52 |
| 2015 January | 8 | 35 | 43 |
| 2014 December | 22 | 34 | 56 |
| 2014 November | 14 | 44 | 58 |
| 2014 October | 19 | 43 | 62 |
| 2014 September | 14 | 52 | 66 |
| 2014 August | 30 | 39 | 69 |
| 2014 July | 30 | 53 | 83 |
| 2014 June | 35 | 48 | 83 |
| 2014 May | 50 | 49 | 99 |
| 2014 April | 30 | 55 | 85 |
| 2014 March | 38 | 40 | 78 |
| 2014 February | 28 | 31 | 59 |
| 2014 January | 27 | 36 | 63 |
| 2013 December | 23 | 38 | 61 |
| 2013 November | 16 | 36 | 52 |
| 2013 October | 30 | 24 | 54 |
| 2013 September | 29 | 36 | 65 |
| 2013 August | 21 | 35 | 56 |
| 2013 July | 19 | 17 | 36 |
| 2013 June | 25 | 23 | 48 |
| 2013 May | 21 | 25 | 46 |
| 2013 April | 27 | 20 | 47 |
| 2013 March | 13 | 30 | 43 |
| 2013 February | 17 | 18 | 35 |
| 2013 January | 16 | 20 | 36 |
| 2012 December | 14 | 21 | 35 |
| 2012 November | 10 | 18 | 28 |
| 2012 October | 4 | 9 | 13 |
| 2012 September | 9 | 4 | 13 |
| 2012 June | 1 | 0 | 1 |
| 2012 May | 1 | 0 | 1 |
| 2012 April | 5 | 0 | 5 |
| 2012 March | 4 | 0 | 4 |
| 2012 February | 1 | 0 | 1 |
| 2012 January | 6 | 0 | 6 |
| 2011 December | 5 | 0 | 5 |
| 2011 November | 5 | 0 | 5 |
| 2011 October | 2 | 0 | 2 |
| 2011 September | 4 | 0 | 4 |
| 2011 August | 1 | 0 | 1 |
| 2011 June | 4 | 0 | 4 |
| 2011 May | 1 | 0 | 1 |
| 2011 April | 1 | 0 | 1 |
| 2011 March | 3 | 0 | 3 |
| 2011 February | 3 | 0 | 3 |
| 2011 January | 3 | 0 | 3 |
| 2010 December | 5 | 0 | 5 |
| 2010 November | 5 | 0 | 5 |
| 2010 October | 4 | 0 | 4 |
| 2010 September | 7 | 0 | 7 |
| 2010 August | 2 | 0 | 2 |
| 2010 July | 6 | 0 | 6 |
| 2010 June | 2 | 0 | 2 |
| 2010 May | 3 | 0 | 3 |
| 2010 April | 5 | 0 | 5 |
| 2010 March | 6 | 0 | 6 |
| 2010 February | 3 | 0 | 3 |
| 2010 January | 14 | 0 | 14 |
| 2009 December | 17 | 0 | 17 |
| 2009 November | 19 | 0 | 19 |
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