Ismiarto Yoyos Dias, Prasetiyo Gregorius Thomas
Division of Pediatric Orthopaedic Surgery, Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
JB JS Open Access. 2023 Jan 20;8(1). doi: 10.2106/JBJS.OA.22.00121. eCollection 2023 Jan-Mar.
Botulinum toxin A has the potential to be used for analgesia because of its anti-inflammatory effect. The utility of intra-articular injections of botulinum toxin A for knee osteoarthritis remains unclear. The aim of this study was to analyze the utility of such injections in knees with osteoarthritis.
We conducted a literature search of 4 databases (Scopus, PubMed, ClinicalTrials.gov, and Europe PMC) up to September 10, 2022, using formulated keywords. Articles were included in the study if they had data on botulinum toxin A injection compared with the control group in patients with osteoarthritis of the knee. Results were summarized using the standardized mean difference (SMD) and accompanying 95% confidence interval (CI).
Pooled analysis of data from 6 trials involving 446 patients with knee osteoarthritis revealed that, compared with placebo, intra-articular injection of botulinum toxin A was associated with greater reductions in early visual analog scale (VAS) pain (SMD, -0.63 [95% CI, -1.08 to -0.18], p = 0.007, I = 79%), late VAS pain (SMD, -0.57 [95% CI, -1.07 to -0.08], p = 0.02, I = 81%), early Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (SMD, -0.84 [95% CI, -1.61 to -0.06], p = 0.03, I = 90%), and late WOMAC (SMD, -1.12 [95% CI, -1.91 to -0.32], p = 0.006, I = 93%) scores from baseline in patients with knee osteoarthritis.
Intra-articular injection of botulinum toxin A may offer benefits in reducing pain and improving function in patients with knee osteoarthritis, with a relatively good safety profile. Larger randomized trials are warranted to confirm the results of our study.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
A型肉毒杆菌毒素因其抗炎作用而具有用于镇痛的潜力。关节腔内注射A型肉毒杆菌毒素治疗膝骨关节炎的效用仍不明确。本研究的目的是分析这种注射在膝骨关节炎中的效用。
我们使用设定的关键词对4个数据库（Scopus、PubMed、ClinicalTrials.gov和欧洲生物医学中心）进行了文献检索，截至2022年9月10日。如果文章有关于膝骨关节炎患者中A型肉毒杆菌毒素注射与对照组比较的数据，则纳入本研究。结果使用标准化均数差（SMD）和伴随的95%置信区间（CI）进行总结。
对涉及446例膝骨关节炎患者的6项试验数据的汇总分析显示，与安慰剂相比，关节腔内注射A型肉毒杆菌毒素与膝骨关节炎患者早期视觉模拟量表（VAS）疼痛（SMD，-0.63 [95% CI，-1.08至-0.18]，p = 0.007，I² = 79%）、晚期VAS疼痛（SMD，-0.57 [95% CI，-1.07至-0.08]，p = 0.02，I² = 81%）、早期西安大略和麦克马斯特大学骨关节炎指数（WOMAC）（SMD，-0.84 [95% CI，-1.61至-0.06]，p = 0.03，I² = 90%）和晚期WOMAC（SMD，-1.12 [95% CI，-1.91至-0.32]，p = 0.006，I² = 93%）评分从基线的更大降低相关。
关节腔内注射A型肉毒杆菌毒素可能在减轻膝骨关节炎患者疼痛和改善功能方面具有益处，且安全性相对良好。需要更大规模的随机试验来证实我们的研究结果。
治疗性I级。有关证据水平的完整描述，请参阅作者须知。
