Topic 11 · Treatment options
Extracorporeal Shockwave Therapy (ESWT)
A small positive signal as an add-on to microfracture. Not a standalone answer.
2025 Study: ESWT + Microfracture + HA
→ High-energy sound waves (tiny sonic booms) directed at the damaged area. Stimulates healing by increasing blood flow and reducing inflammation. Non-invasive, done in office visits. Like jump-starting your body's healing response.
A July 2025 study evaluated combined therapy for OLT [95]:
- ESWT synergizes with HA injections to reduce post-microfracture pain
- Promotes early joint function recovery
- Anti-inflammatory, pro-angiogenic, and analgesic effects
2024 Research: Mechanism of Action
A 2024 study in Bone & Joint Research [96]:
- ESWT reduced fibrosis and promoted hyaline cartilage formation
- Increased type II collagen (good) and decreased type I collagen (bad)
- Enhanced TGF-β/BMP signaling for cartilage regeneration
- Stimulated subchondral bone regeneration in a bottom-to-top pattern
ESWT vs PRP After Microfracture
A 2023 study comparing MF+ESWT vs MF+PRP [97]:
- MF+ESWT had higher AOFAS scores at 2-year follow-up
- Lower T2 mapping values (indicating more hyaline-like cartilage)
- Better cartilage quality on MRI assessment
ISMST Recognition
OLT has been recognized as an indication for ESWT by the International Society for Medical Shockwave Treatment since 2008 [98].
Best for: Non-invasive adjunct therapy, especially combined with microfracture. Can reduce pain and improve outcomes without additional surgery.