To observe the clinical effect of extracorporeal shock wave combined with arthroscopy in the treatment of osteoarthritis of knee joint in early and middle stage, and to observe the effect of extracorporeal shock wave combined with arthroscopy on the levels of monocyte chemoattractant protein-1 (MCP-1), superoxide dismutase (SOD) and nitric oxide (NO) in articular fluid.

According to the principle of random control, 285 patients with knee osteoarthritis were divided into three groups: extracorporeal shock wave combined with arthroscopic surgery group (combining group), extracorporeal shock wave group (shock wave group) and arthroscopic surgery group (arthroscopic group). Lysholm score and visual analogue scale (VAS) score were measured before treatment and three, six, 24 months after the treatment. The levels of MCP-1, SOD and NO in articular fluid of the groups were measured. The scores of Lysholm and VAS were statistically analyzed by repetitive measure analysis of variance, SNK-q test or chi-square test.

Three months after the treatment, the Lysholm and VAS scores in the three groups were significantly better than those before treatment, and the scores in the combining group were significantly better than those in the shock wave group and the arthroscopic group (q₁=4.091, q₂=5.562, P<0.05). The scores of the three groups six months after the treatment compared to the data three months after the treatment showed statistically significant differences. The scores of the combining group and shock wave group were still better than before the treatment (q₁=6.194, q₂=6.064, P<0.05), while the arthroscopic group was not significantly different compared to the scores before treatment (P>0.05). At 12 months after treatment, the scores of Lysholm and VAS in the combining group were still better than those before treatment, and the scores in the combining group were significantly better than the other two groups. There was no significant difference in the score of shock wave and arthroscopy group compared with that before treatment (P>0.05). Three months after treatment, the levels of MCP-1 and NO in the three groups were significantly lower than those before treatment, and SOD was higher than that before treatment. There was significant difference between the combining group and the shock and arthroscopy group (q₁=4.065, q₂=5.046, q₃=5.556, P<0.05). At six months after treatment, the levels of MCP-1 and NO in the three groups were higher than those in three month after treatment, and the levels of SOD in the combining group were significantly lower than those in the shock wave and arthroscopy group, the levels of MCP-1 and NO in the combining group were significantly lower than those in the shock wave and arthroscopy group, and the SOD level was higher than that in the shock wave group and arthroscopy group (q₁ =4.929, q₂ =6.284, q₃=5.061, P<0.05). The levels of MCP-1 and NO in arthroscopy group were not significantly different from those before treatment (P>0.05). Twelve months after treatment, the levels of MCP-1 and NO in the combined group were still lower than those before treatment, the level of SOD was higher than that before treatment, the levels of MCP-1 and NO in the combined group were lower than those in the shock wave and arthroscopy group, and the level of SOD was higher than that of shock wave and arthroscopy. The levels of MCP-1, NO and SOD in shock wave and arthroscopy group were not significantly different from those before treatment (P>0.05).

Extracorporeal shock wave combined with arthroscopy can effectively relieve the joint pain, improve joint function, reduce the levels of inflammatory mediators MCP-1 and NO, and increase the level of SOD in articular fluid. The short-term and long-term results of combining the two methods are better than that of extracorporeal shock wave or arthroscopy alone.