## 3 Results (Table 2)  
The average KOOS values were 39.5 \(\pm\) 11.5 before the APS therapy, 51.6 \(\pm\) 20.8 after 3 months, and 39.5 \(\pm\) 20.5 after 6 months in the A-alone group. In contrast, in the A + E group, the values were 45.0 \(\pm\) 12.7 before the APS therapy, 52.5 \(\pm\) 15.3 at 3 months, and 55.5 \(\pm\) 13.2 after 6 months. The average KOOS decreased from 3 to 6 months in the A-alone group but increased in the A + E group (Figure 1). The mean KOOS pain subscore was 46.0 \(\pm\) 13.6 before the APS therapy, 59.6 \(\pm\) 23.6 after 3 months, and 44.0 \(\pm\) 24.2 after 6 months in the A-alone group. In contrast, in the A + E group, the values were 53.8 \(\pm\) 16.3 before the APS therapy, 63.6 \(\pm\) 19.0 at 3 months, and 66.0 \(\pm\) 12.8 after 6 months (Figure 2A). The mean other symptoms subscore was 47.6 \(\pm\) 15.0 before the APS therapy, 63,2 \(\pm\) 21.4 after 3 months, and 46.9 \(\pm\) 29.0 after 6 months in the A-alone group. In contrast, in the A + E group, the values were 51.6 \(\pm\) 13.1 before the APS therapy, 57.5 \(\pm\) 17.9 at 3 months, and 62.4 \(\pm\) 11.3 after 6 months (Figure 2B). The mean activities of daily living (ADL) subscore was 57.7 \(\pm\) 16.2 before the APS therapy, 65.5 \(\pm\) 20.9 after 3 months, and 55.6 \(\pm\) 20.4 after 6 months in the A-alone group. In contrast, in the A + E group, the values were 67.9 \(\pm\) 15.1 before the APS therapy, 74.6 \(\pm\) 17.8 at 3 months, and 72.7 \(\pm\) 15.7 after 6 months (Figure 2C). The mean sports and recreation subscore was 24.3 \(\pm\) 30.9 before the APS therapy, 33. Figure 1: The average KOOS decreased in the APS-alone group after 3–6 months but increased in the APS + ESWT group. APS, autologous protein solution; ESWT, extracorporeal shock wave therapy; KOOS, Knee Injury and Osteoarthritis Outcome Score. The average KOOS decreased from 3 to 6 months in the A-alone group but increased in the A + E group. and 25.0 \(\pm\) 30.7 after 6 months in the A-alone group. In contrast, in the A + E group, the values were 30.3 \(\pm\) 25.7 before the APS therapy, 34.8 \(\pm\) 25.8 at 3 months, and 29.1 \(\pm\) 24.0 after 6 months (Figure 2D). The mean quality of life (QOL) subscore was 22.8 \(\pm\) 15.4 before the APS therapy, 38.9 \(\pm\) 20.3 after 3 months, and 26.0 \(\pm\) 14.5 after 6 months in the A-alone group. In contrast, in the A + E group, the values were 26.8 \(\pm\) 14.3 before the APS therapy, 37.7 \(\pm\) 15.7 at 3 months, and 44.3 \(\pm\) 21.9 after 6 months (Figure 2E). Most KOOS subscores decreased from 3 months to 6 months in the A-alone group but increased in the A + E group. Regarding success rates, in the A-alone group, six patients (46.2%) had an improvement of \(\geq\)20% in their KOOSs after 3 months and five (38.5%) had an improvement of \(\geq\)50%. In contrast, in the A + E group, 11 patients (55.0%) had an improvement of \(\geq\)20% in their KOOSs and 4 (20.0%) had an improvement of \(\geq\)50% in their KOOSs. After 6 months, two (28.6%) patients had an improvement of \(\geq\)20% in their KOOSs in the A-alone group and one (14.3%) had an improvement of \(\geq\)50%. In the A + E group, seven (58.3%) patients had an improvement of \(\geq\)20% in their KOOSs and five (35.7%) of \(\geq\)50%. The success rate in the A-alone group was higher at 3 months than at 6 months for both 50% and 20% improvements. In the A + E groups, the success rate was higher at 6 months than at 3 months (Table 3). Regarding the duration, the IVs at Pre-3M were 12.1 \(\pm\) 18.4 and 7.5 \(\pm\) 12.6 in the A-alone and A + E groups, respectively, and \(-\)5.6 \(\pm\) 8.1 and 5.1 \(\pm\) 12.1 at 3-6M, respectively. The mean KOOS at Pre-3M showed no significant difference in improvement between the two groups; however, the improvement was significant in the A + E group compared with that in the A-alone group at 3-6M (unpaired \(t\)-test, \(p\) = 0.026; Figure 3). There were no complications or side effects in the two study groups.