Methods: Sixty SD rats were divided into five groups. Group I was the control and received sham surgery without anterior cruciate ligament transection (ACLT) and medial meniscectomy (MM) and no ESWT. Group II received ACLT þ MM, but no ESWT. Group III received ACLT þ MM and ESWT at distal femur. Group IV received ACLT þ MM and ESWT at proximal tibia. Group V received ACLT þ MM and ESWT at distal femur and proximal tibia. Each ESWT session consisted of 800 impulses at 14 kV (1⁄4 0.219 mJ/mm2 energy flux density). The evaluations included radiograph, bone mineral density (BMD), histomorphologic examination, and immunohistochemical analysis.