Background: An umbrella review was conducted to compare the effectiveness of extracorporeal shock wave therapy (ESWT) versus non-ESWT in the treatment of knee osteoarthritis (KOA). Materials and methods: Three databases including PubMed, Embase and Web of science were searched up to September 2023. Literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. Meta-analysis of outcome indicators was performed using Revman 5.4 software. Results: A total of eight meta-analysis were included in this umbrella review. All meta-analysis were graded against a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) and scored between 8 and 11. Compared to the sham group, the ESWT group showed better results in WOMAC (Western Ontario and McMaster Universities Arthritis Index) [mean difference (MD)=−2.94, 95% CI: −5.52, −0.37, P=0.03, I²=60%], Visual Analog Scale (VAS) (MD=−2.0, 95% CI: −2.5, −1.5, P<0.01, I²=0%), range of motion (ROM) (MD=17.55, 95% CI: 13.49, 21.61, P<0.00001, I²=0%), and Lequesne index (MD=−2.85, 95% CI: −3.64, −2.07, P<0.00001, I²=48%). Conclusion: Based on the results of our analysis, ESWT is now an effective therapy for improving pain and function in patients with KOA.

Background: Extracorporeal shockwave therapy (ESWT) is a traditional noninvasive therapy to treat osteonecrosis of the femur head (ONFH). This systematic review aims to investigate whether ESWT can improve the clinical function of ONFH and whether differences in improvement can be observed in radiographic outcomes. Materials and methods: Two authors independently searched PubMed, Embase, Cochrane Library, and Web of Science for English articles until 21 October 2023. After screening and reading the literature, the two authors independently used corresponding scales to evaluate the quality of the included articles and extracted data. The key data extracted included the Harris Hip Score (HHS), Visual Analog Scale (VAS), changes in lesion size, the change in the Association Research Circulation Osseous (ARCO) stage, and bone marrow edema (BME) stage. Results: Nine articles included 468 males and 248 females. The average age was 43.29 years and the mean follow-up time was 15.19 months. After receiving ESWT, five studies involving 146 hips showed a higher HHS (MD=−33.38; 95% CI: −46.31, −20.45), and the difference was statistically significant ( P <0.00001). The average VAS before treatment was above 5, but it dropped to 1.2 after ESWT (MD=4.64; 95% CI: 3.63–5.64), and the difference was statistically significant ( P <0.00001). Three studies found no significant differences in the areas of femoral head necrosis before and after treatment with ESWT(MD=9.66; 95% CI: −0.36, 19.67; P =0.06; I ² =84%). Two articles showed that the use of ESWT had no significant effect on the change in the ARCO stage (MD=1.11; 95% CI: 0.76–1.62; P =0.60; I ² =0%). Three studies indicated that using ESWT could improve the BME symptom in the early stage of ONFH (MD=4.35; 95% CI: 1.32–14.37; P =0.02; I ² =62%). Conclusion: Based on the current evidence, ESWT shows promise as a therapy to enhance hip function and alleviate pain in the early stage of ONFH. With the advancement of more precise imaging techniques, ESWT can potentially reduce the area affected by ONFH. However, such reduction was not found to be statistically significant at the imaging level. Additionally, ESWT could improve symptoms of BME in the early stage. However, no significant change in ARCO grade was observed with ESWT treatment.

Background: The effectiveness of bone marrow mononuclear cells (BMMCs) combined with core decompression (CD) in the treatment of femoral head necrosis is controversial. The purpose of this study was to conduct a meta-analysis and systematic review of the evaluation of BMMCss combined with CD in the treatment of femoral head necrosis and to compare the therapeutic effect of this method with that of CD alone so as to provide a basis for subsequent research and clinical treatment. Methods: We conducted detailed searches across four databases in Embase, PubMed, Web of Science, and the Cochrane Library (up to October 2023), including eight studies with a total of 370 participants and 491 hip cases. This meta-analysis followed the Preferred Reporting Project (PRISMA) guidelines. Review Manager 5.4 was used to summarize and analyze the outcome indicators and the quality and reliability of the MAs were graded against a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Results: Eight studies were included in the inclusion criteria. The results of meta-analysis showed that the therapeutic effect of CD combined with BMMC on visual analog scale was better than that of CD alone [mean difference (MD)=−5.32, 95% confidence interval (CI): −9.90, −0.74, P=0.02, I ²=98%], and there was no statistically significant difference between CD combined with BMMC and CD alone in the treatment of Harris hip score (MD=2.73, 95% CI: −2.63, 8.09, P=0.32, I ²=82%). We conducted a sensitivity analysis. The results showed that the CD joint BMMC treatment effect on the Harris hip score is superior to the single CD (MD=5.57, 95% CI: 1.94, 9.20, P=0.003, I ²=0%), both no significant differences in visual analog scale (MD=0.47, 95% CI: −1.74, 0.79, P=0.46, I ²=83%). Conclusion: In this study, we found that CD combined with bone marrow monocyte therapy improved femoral head necrosis better than CD alone.

Background: Arthroscopic rotator cuff repair faces high retear risks in multi-tendon injuries due to insufficient biological healing; leukocyte-rich PRP may enhance tendon–bone integration through inflammatory modulation and growth factor release. Methods: Four databases including PubMed, Embase, Cochrane Library, and Web of Science were searched until March 2025. Literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. GRADE was used to grade the strength of the evidence and the results. Results: The main finding of this study was that leukocyte-rich platelet-rich plasma combined with arthroscopic surgery for rotator cuff injuries can improve the Constant Score (MD = 1.13, 95% CI: 0.19, 2.07, p = 0.02, I² = 47%), American Shoulder and Elbow Surgeons score (MD = 6.02, 95% CI: 4.67, 7.36, p < 0.01, I² = 0%), and University of California, Los Angeles score (MD = 1.20, 95% CI: 0.34, 2.06, p < 0.01, I² = 0%) of patients with rotator cuff tear after treatment, and reduce the postoperative Visual Analog Scale score (MD = −0.62, 95% CI: −1.16, −0.08, p = 0.02, I² = 83%) of patients. However, there were no statistical differences regarding the Simple Shoulder Test (MD = 0.08, 95% CI: −0.23, 0.39, p = 0.61, I² = 5%). Conclusions: Based on current evidence, the use of LR-PRP in arthroscopic rotator cuff repair could lessen postoperative pain and improve postoperative functional scores in individuals with rotator cuff injuries.