• Zhen Shen, Zehua Chen, Zhuoting Xie, Yanfei Xu, Tao Wang, Jiao Li, Changfei Yuan, Jinqing Liu, Xiaodong Shi, Yuanliang Ai, Wei Dong, and Ying Guo.
• Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, China.
• Medicine (Baltimore). 2020 Dec 4; 99 (49): e23123.

BackgroundBisphosphonates are commonly used to treat spontaneous osteonecrosis of the knee (SONK), while there are no relevant systematic review or meta-analysis designed to evaluate the effects of bisphosphonates on SONK.MethodsWe will identify relevant randomized controlled trials from the PubMed, EMBASE, CINAHL and China National Knowledge Infrastructure, up to March 20, 2020. Data that meets the inclusion criteria will be extracted and analyzed using RevMan V.5.3 software. Two reviewers will assess quality of the included studies by using the Cochrane Collaboration risk of bias tool. Egger test and Begg test will be used to evaluate publication bias. And Grading of Recommendations Assessment, Development and Evaluation will be employed to assess the quality of evidence.ResultsIn this study, we will analyze the effect of bisphosphonates on pain intensity, physical function, biochemical including alkaline phosphatase, N-terminal propeptide of type I procollagen, and C-terminal type I collagen telopeptide, radiological outcome (evaluated by using Magnetic resonance imaging) and ratio of secondary surgery for patients with SONK.ConclusionOur findings will provide evidence for the effectiveness and potential treatment prescriptions of bisphosphonates acupuncture for patients affected by SONK.

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