Extracorporeal Shockwave Versus Phonophoresis Using Chitosan-Nanoparticles Gel on Functional and Anatomical Changes Detected With Artificial Intelligence Based Texture Analysis Algorithm in Knee Osteoarthritis Patients: A Double Blind Randomized Controlled Trial

This randomized controlled trial is comparing three treatments for knee osteoarthritis: phonophoresis (ultrasound therapy) using a chitosan nanoparticle gel, extracorporeal shockwave therapy (ECSWT), and traditional exercises to assess which best reduces pain, improves function, and favorably changes the bone structure beneath the knee joint cartilage (subchondral bone). The study also uses an AI-based image analysis tool to detect subtle changes in bone texture that conventional X-ray grading may miss. Adults aged 40 to 65 with knee osteoarthritis graded 2 or 3 on the Kellgren-Lawrence scale, knee pain for at least 3 months, and pain of at least 40mm on a visual scale are eligible; those with prior knee surgery, rheumatoid arthritis, neurological disorders, or pregnancy are excluded. Participants will be assigned to one of three groups and receive 12 (phonophoresis/exercise) or 5 (shockwave) sessions over 4 weeks, with assessments before and after treatment. This summary was prepared to help patients understand the study in plain language.