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For the first time, this review aims to systematically summarize and discuss these gold standard RDP trials comparing the efficacy of Pycnogenol to placebo and giving explanations for the different effects with the help of the respective mechanisms of action

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1 Introduction Knee osteoarthritis (KOA) is a total joint disease characterised by progressive degeneration of articular cartilage, subchondral bone sclerosis, osteophyte formation, and synovial inflammation

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