Histopathologic examination showed the cartilage damages in osteoarthritis of the knee, as shown in arrows with and without ESWT (A). Mankin score (B) and safranin O (C) score significantly increased in OA and OA + OP groups, as compared with sham with and without ESWT (indicated as *P < 0.05). ESWT significantly reduced Mankin and safranin O scores (indicated as #P < 0.05). Mankin and safranin O scores were significantly higher in the OA + OP group than in the OA group. ESWT, significantly decreased Mankin and safranin O scores in OA and OA + OP group (indicated as ※P < 0.05). The scale bar represents 200 μm; n = 8. Arrow indicates cartilage injury. Arrowhead indicates spongy bone.