Clinical Sciences/Health Conditions
Hui-Hui Peng, MD
Resident
Department of Medical Education, Taipei Medical University Hospital, Taipei, Taiwan
Taipei, Taipei, Taiwan (Republic of China)
Mei-Sean Loh, MD
Attending Physician
Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
New Taipei, New Taipei, Taiwan (Republic of China)
Ting-Ju Kuo, MD
Attending Physician
Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
New Taipei, New Taipei, Taiwan (Republic of China)
Hung-Chou Chen, MD
Attending Physician
Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University
New Taipei, New Taipei, Taiwan (Republic of China)
Lien-Chieh Lin, MD
Attending Physician
Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University
New Taipei City, New Taipei, Taiwan (Republic of China)
Effective non-pharmacological analgesic options in knee osteoarthritis (KOA) remain limited. Cryoneurolysis (CN), which induces reversible nerve blockade via controlled cold application, has emerged as a promising intervention; however, its treatment durability remains unclear. This study aimed to clarify the short- and long-term effects of CN on pain, physical function, and quality of life (QoL) in individuals with KOA.
Design:
Two reviewers independently searched PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov from inception to October 2025. Randomized controlled trials evaluating CN in KOA were included. Standardized mean differences (SMDs) were calculated for continuous outcomes. Pain was the primary outcome, and analyses were stratified by follow-up duration. Four trials involving 421 participants were included. CN significantly reduced pain at ≤6 weeks (SMD: -0.34, 95% confidence interval [CI]: -0.54 to -0.14, p< 0.001), 2-3 months (SMD: -0.33, 95% CI: -0.54 to -0.12, p=0.002), and 6 months (SMD: -0.44, 95% CI: -0.71 to -0.16, p=0.002), with attenuation by 12 months (SMD: -0.34, 95% CI: -0.75 to 0.08, p=0.11). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores also significantly improved at 1 month (SMD: -0.49, 95% CI: -0.78 to -0.19, p=0.001) and 3 months (SMD: -0.36, 95% CI: -0.66 to -0.07, p=0.01), with a diminished effect by 6 months (SMD: -0.18, 95% CI: -0.51 to 0.15, p=0.29). These effects were consistent across studies, with no observed heterogeneity (I²=0%). However, CN did not significantly improve QoL either at 2 months or 4-6 months. CN represents a reproducible, minimally invasive analgesic option that provides predictable short-term pain relief and early functional gains for KOA, with benefits extending up to 6 and 3 months, respectively. Although QoL outcomes remain inconclusive, CN may serve as a bridge for patients who fail conservative management before progression to more invasive interventions.
Results:
Conclusion:
