OBJECTIVE: This study determined the clinical efficacy of extracorporeal shockwave therapy and the predictors of its efficacy for knee osteoarthritis. DATA SOURCES: Electronic databases and search engines, namely Medline, PubMed, Embase, Cochrane Library Database, Physiotherapy Evidence Database (PEDro), China Academic Journals Full-text Database, and Google Scholar, were searched until 5 March 2019, for randomized controlled trials without restrictions on language and publication year. REVIEW METHODS: Eligible trials and extracted data were identified by two independent investigators. The included articles were subjected to a meta-analysis and risk of bias assessment. Outcomes of interest included treatment success rate, pain, and physical function outcomes. A meta-regression analysis was performed to determine the predictors of treatment outcomes following shockwave therapy. RESULTS: We included 50 trials (4,844 patients) with a median (range) PEDro score of 6 (5 to 9). Meta-analyses results revealed an overall significant effect favoring shockwave therapy on the treatment success rate (odds ratio 3.22, 95% confidence interval (CI) 2.21 to 4.69, p < 0.00001; heterogeneity (I2) = 62%), pain reduction (standardized mean difference (SMD) -2.02, 95% CI -2.38 to -1.67, p < 0.00001; I2 = 95%), and Western Ontario and McMaster Universities Osteoarthritis Index function outcome (SMD -2.71, 95% CI -3.50 to -1.92, p < 0.00001; I2 = 97%). Follow-up duration and energy flux density were independent significant predictors of shockwave efficacy. CONCLUSION: Shockwave therapy is beneficial for knee osteoarthritis. Shockwave dosage, particularly the energy level and intervention duration, may have different contributions to treatment efficacy.

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