The Clinical Efficacy of Traditional Chinese Medicine Topical Therapy Combined with Sodium Hyaluronate Intra-articular Injection in the Treatment of Patellar Chondromalacia: a systematic review and meta-analysis

Abstract

Background: Chondromalacia patellae (CMP) is a cartilaginous degeneration of patellofemoral joint caused by a variety of reasons. Recent studies have shown that the incidence of patellomalacia is getting higher and higher. Our meta-analysis is used to illustrate the clinical effect of external treatment of traditional Chinese medicine combined with joint cavity injection of sodium hyaluronate in the treatment of patellomalacia.

Methods: Literature searches were carried out in various databases, such as PubMed, Cochrane Library, China Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang, and Weipu, with the search timeline extending from the inception of each database until April 2024. Two investigators independently conducted literature screening, data extraction, and quality assessment of the included studies. Review Manager 5.4 software was used to perform a meta-analysis, which evaluated changes in the clinical efficacy rate, visual analogue scale (VAS) scores, and time of symptom onset before and after treatment.

Results: The study included a total of 11 randomized controlled trials (RCTs) involving 1,279 patients. The meta- analysis results indicated that compared to the standalone injection of sodium hyaluronate, the combination of TCM topical therapy significantly enhanced the clinical efficacy rate in treating CMP [RR=1.17, 95% CI=[1.12,1.22], P<0.00001]. Furthermore, the addition of TCM topical therapy lowered the VAS score in patients with CMP five weeks post-treatment compared to the control group. In comparison to the standalone injection of sodium hyaluronate, the combination of TCM topical therapy showed a quicker onset, thus reducing patients’ pain [RR=-7.44, 95% CI=(-9.86,-5.01), P<0.00001].

Conclusion: The combination of TCM topical therapy and sodium hyaluronate intra-articular injection demonstrated superior clinical efficacy over the sole intra-articular injection of sodium hyaluronate. This combination effectively mitigated pain in patients and had a faster onset.