The Efficacy of Intra-Articular Botulinum-Toxin Injection in Knee Osteoarthritis: A Systematic Review and Meta-Analysis Publisher



Hosseini M¹ ; Azadvari M¹ ; Kargozar E² ; Razavi SZE¹ ; Rahimidehgolan S¹ ; Maghbouli N^{1, 2} Show Affiliations
Source: Muscles# Ligaments and Tendons Journal Published:2021

Abstract

Objective. This investigation aimed to pool and discuss the existed literature on the efficacy and safety of intra-articular injection of Botulinum toxin type A (BTA) for knee osteoarthritis (OA) treatment focusing on different doses and comparing with other injectable agents. Methods. Data sources: a systematic review through PubMed, Scopus, Google Schol-ar and Cochrane Central Register of Controlled Trials was conducted to identify all English-language studies published before November 2019. Study Selection: eligibility included adults suffering from knee osteoarthritis with intra-articular BTA injection as intervention. Data Extraction: after removing duplications and excluding non-eligible articles, data of final included studies were extracted including outcome measures; follow up time-points; and details of interventions in all groups including dose, dura-tion, frequency and number of sessions. Included studies were quality appraised using PEDro (Physiotherapy Evidence Database) score. Data synthesis: the gathered data was extracted and analyzed in RevMan 5.3 software using random or fixed-effect models, as effect size measures such as raw or standardized mean difference (MD or SMD). Only six studies provided suitable data for meta-analysis with a total number of 459 patients. All studies included, except for one RCT that had fair quality, obtained good and high quality scores. The present data revealed that the included patients experienced significant pain relief immediately about 2 weeks after BTA intra-articular injection and this response remained significant even after 6 months (MD = 1.53 (95% CI: 0.94-2.11) and 1.71 (95% CI: 1.35-2.07), respectively). Results. Also, this review proved that the short-term analgesic effect of BTA-cortico-steroid was better than BTA alone, not only for pain control based on VAS (MD = 3.73 (95% CI: 2.60-4.86), P < 0.0001), but also for WOMAC index (MD = 21.20 (95% CI: 14.14-28.26), P < 0.00001). Additionally, this review find supportive evidence for the analgesic effect of low-dose BTA rather than higher doses (more than 200 IU). Conclusions. The pooled data proved that a combination of BTA-corticosteroid achieved maximum efficacy for both pain relief and functional improvement within short and long-term follow up in comparison to both alone. Also, BTA is a safe and affective choice for clinical response with the most pain-relief effects 2-3 months after injection and the most effective dose of 200u among knee OA patients. © 2021, CIC Edizioni Internazionali s.r.l.. All rights reserved.