Integration of focal vibration and intra-articular oxygen–ozone therapy in rehabilitation of painful knee osteoarthritis

OBJECTIVE: To examine the pain-reducing effects of intra-articular oxygen–ozone (O(2)O(3)) injections and mechanical focal vibration (mFV) versus O(2)O(3) injections alone in patients with knee osteoarthritis. METHODS: Patients with chronic pain (>6 weeks) due to knee osteoarthritis (II–III on the Kellgren–Lawrence scale) were consecutively enrolled and divided into two groups: O(2)O(3) (n = 25) and O(2)O(3)-mFV (n = 24). The visual analog scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Medical Research Council (MRC) Manual Muscle Testing scale were administered at baseline (before treatment), after 3 weeks of treatment, and 1 month after the end of treatment. Patients received three once-weekly intra-articular injections of O(2)O(3) into the knee (20 mL O(3), 20 μg/mL). The O(2)O(3)-mFV group also underwent nine sessions of mFV (three sessions per week). RESULTS: The VAS score, KOOS, and MRC score were significantly better in the O(2)O(3)-mFV than O(2)O(3) group. The within-group analysis showed that all scores improved over time compared with baseline and were maintained even 1 month after treatment. No adverse events occurred. CONCLUSION: An integrated rehabilitation protocol involving O(2)O(3) injections and mFV for 3 weeks reduces pain, increases autonomy in daily life activities, and strengthens the quadriceps femoris.