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The effects of systemic ozone application and hyperbaric oxygen therapy on knee osteoarthritis: an experimental study in rats



To evaluate the effects of systemic medical ozone (O3) application and hyperbaric oxygen (HBO) therapy on surgically induced knee osteoarthritis (OA) in a rat model.

Materials and methods

We performed anterior cruciate ligament transection (ACLT) in order to create experimental OA in the right knees of 27 male rats. The left knee joints of all rats were sham-operated without ACLT as the negative control group. The rats were randomly assigned into three groups: (1) control group, which received no treatment; (2) O3 group, which received intraperitoneal 30 μg medical O3; (3) HBO group, which received HBO therapy for 60 minutes twice a day. We sacrificed the rats on the tenth week after the operation. We evaluated the degree of OA using Mankin scores.


As a result of histopathological examination, the mean Mankin scores in the right knees with ACLT were 8.17 ± 2.12 in the control group, 6.22 ± 1.56 in the HBO group, and 4.72 ± 1.30 in the O3 group. The differences between the O3 group and the HBO group and the O3 group and the control group were found to be statistically significant (p 0.001, p 0.039, respectively). There was no difference between the HBO group and the control group (p 0.086).


The results of the present study show that systemic medical O3 application was more effective than HBO therapy and may reduce development of cartilage damage and prevent OA formation.

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We would like to acknowledge Fatma Nur Yürüm and Aslı Muratlı MD for their support in their pathological examination.


This work was supported by Çanakkale Onsekiz Mart University, The Scientific Research Coordination Unit, Project number: TTU-2019-3122.

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Correspondence to Onur Yılmaz.

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All animal experiments were conducted in compliance with the “Guide for the Care and Use of Laboratory Animals” published by the US National Institutes of Health (revised, 1985).

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The authors declare that they have no conflict of interest.

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Ethical approval was given by the Çanakkale Onsekiz Mart University Animal Care and Ethics Committee for animal studies. Approval number: 2019/07-01

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Yılmaz, O., Bilge, A., Erken, H.Y. et al. The effects of systemic ozone application and hyperbaric oxygen therapy on knee osteoarthritis: an experimental study in rats. International Orthopaedics (SICOT) 45, 489–496 (2021).

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  • Hyperbaric Oxygen
  • Osteoarthritis
  • Ozone