Clinical Efficacy of Tissue-Bone Homeostasis Manipulation on Soft Tissue Balance and Function in Knee Osteoarthritis

Summary

Here, we present a protocol to apply tissue-bone homeostasis manipulation for knee osteoarthritis and to evaluate its effects on peripatellar soft tissue tension, knee motion, and functional outcomes.

Abstract

Knee osteoarthritis (KOA) is characterized by progressive joint degeneration and biomechanical imbalance of periarticular soft tissues, leading to pain and functional limitation. However, effective biomechanically targeted manual therapy protocols for regulating soft tissue tension remain insufficiently standardized.

In this study, a randomized controlled design was used to investigate the effects of tissue-bone homeostasis manipulation (TBHM) on peri-knee soft tissue tension and functional outcomes in patients with KOA. Sixty patients were enrolled and randomly assigned to the TBHM group or the control group. Primary outcomes included rectus femoris, vastus medialis, vastus lateralis muscle tension, patellar ligament tension, and knee flexion range of motion (ROM). Secondary outcomes included the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Timed Up and Go Test (TUGT).

The results showed that baseline characteristics were comparable between groups (all P > 0.05), and no adverse events were observed during the intervention. Repeated measures analysis revealed significant time effects for all primary and secondary outcomes (P < 0.001). Significant group × time interaction effects were observed for rectus femoris, vastus lateralis muscle tension, patellar ligament tension, knee flexion ROM, KOOS subscales (symptoms, activities of daily living, sport/recreation, and quality of life), and TUGT (P < 0.05), indicating greater improvement in the TBHM group compared with the control group. However, no significant interaction effect was found for vastus medialis muscle tension or KOOS-pain (P > 0.05), suggesting similar trends between groups in these measures.

In conclusion, TBHM demonstrates both safety and efficacy in reducing periarticular soft tissue tension and improving functional outcomes in KOA. This protocol provides a standardized and biomechanically oriented approach for manual therapy intervention and may offer a novel strategy for optimizing conservative treatment of KOA.

Introduction

Knee osteoarthritis (KOA) is a highly prevalent degenerative joint disorder in the aging population, characterized not only by progressive cartilage degeneration and osteophyte formation within the knee joint, but also by biomechanical imbalance of periarticular soft tissues, including muscles, ligaments, and fascia, which play a critical role in disease initiation and progression¹. Increasing evidence indicates that abnormal tension in the quadriceps muscle may alter patellar tracking patterns, leading to aberrant stress distribution within the patellofemoral joint and accelerating joint degeneration^2,

Protocol

This single-blind randomized controlled trial was conducted at the Rehabilitation Center of the First Affiliated Hospital of Anhui University of Chinese Medicine. The study protocol was approved by the Institutional Ethics Committee (Ref. No: 2024AH-36) and prospectively registered in the Chinese Clinical Trial Registry (ChiCTR2400090977, registered on October 17, 2024). All procedures were performed in accordance with institutional ethical guidelines. The trial was designed and reported in compliance with the Consolidated Standards of Reporting Trials (CONSORT) statement. Ensure that all procedures involving human participants comply with the institutional human rese....

Results

Baseline characteristics of patients
Table 1 summarizes the demographic and clinical baseline characteristics of the 60 enrolled patients. Comparative analysis revealed homogeneity between the two groups, with no statistically significant differences in age, gender, anthropometric measures (weight, height, BMI), disease chronicity, laterality of affected limbs, radiological parameters (K-L grade) (all P > 0.05). Critically, the intervention demonstrated a favorable safety.......

Discussion

This study demonstrated that a 6-week TBHM protocol can effectively reduce peripatellar soft tissue tension and improve functional outcomes in patients with KOA, without inducing obvious adverse events. Compared with conventional joint mobilization, TBHM produced greater reductions in rectus femoris, vastus lateralis, and patellar ligament tension, accompanied by improvements in knee flexion ROM, KOOS scores, and TUGT performance. These findings indicate that the protocol is safe, feasible, and clinically applicable for .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Electronic goniometer	Shengtai Xinyi Electronic Technology Co., Ltd. of Deqing	GJJDC01	Used to measure knee flexion range of motion (ROM) with alignment along the femur and tibia axes.
Soft tissue tension testing system	Tianjin Mingtong Century Technology Co., Ltd.	JZL-III	Used to quantify soft tissue mechanical properties by measuring tissue displacement under a standardized loading force (500 g).
Stopwatch	Shenzhen Yisheng Technology Co., Ltd.	YS-528	Used to record time-based functional performance during the Timed Up and Go Test.