A systematic review of randomized controlled trials depicted that by controlling the release of neurotransmitters, peripheral nociceptive transduction, and regulating chronic pain resulting from central sensitization, Botulinum toxin (BTX) exhibits positive short-term outcomes, particularly in people with pain sensitization. The goal of Cristiano Sconza et al. was to examine the data on intra-articular BTX injection in the management of knee osteoarthritis and to contrast it with other conservative intervention alternatives.

Utilizing electronic databases such as Research Gate, Pedro, Web of Science, Cochrane Library, Scopus, and, PubMed, a systematic review of the literature was carried out. Randomized controlled trials (RCTs) addressing the usage of BTX injection for knee osteoarthritis management that were written in the English language, and issued in the indexed journals in the last twenty years were incorporated. For evaluating the risk of bias, the Cochrane Risk of Bias tool for RCTs was utilized.

Overall, 9 studies involving 811 subjects were included. In the control groups, subjects were given a variety of therapies, including traditional physiotherapy, hyaluronic acid injection or prolotherapy or a combination of these in 5 trials, local anesthetic therapy in 1 trial, steroid infiltrative therapy (triamcinolone) in 1 trial, and a placebo in 2 trials. When compared to the quality of the available literature, 2 of the incorporated studies met the "Good quality" criteria, 3 received the "Fair" rating, and the other studies were considered "Poor".

After intra-articular BTX, which offered promising pain alleviation, better motor function, and enhanced quality of life, no significant problems or serious adverse events were noted. Based on the available information, BTX's comparison to other well-known knee osteoarthritis therapies did not provide any conclusive results. According to the analysis of the available RCTs, the intra-articular injection of BTX for the management of knee osteoarthritis had low methodological quality. Thus, intra-articular injection of BTX displays promising potential to combat knee osteoarthritis.