1
|
Long T, Vemaganti K, Hawes JE, Lin CY. An experimental study of the heterogeneity and anisotropy of porcine meniscal ultimate tensile strength. J Mech Behav Biomed Mater 2024; 157:106649. [PMID: 39024732 DOI: 10.1016/j.jmbbm.2024.106649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/19/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024]
Abstract
Characterizing the ultimate tensile strength (UTS) of the meniscus is critical in studying knee damage and pathology. This study aims to determine the UTS of the meniscus with an emphasis on its heterogeneity and anisotropy. We performed tensile tests to failure on the menisci of six month old Yorkshire pigs at a low strain rate. Specimens from the anterior, middle and posterior regions of the meniscus were tested in the radial and circumferential directions. Then the UTS was obtained for each specimen and the data were analyzed statistically, leading to a comprehensive view of the variations in porcine meniscal strength. The middle region has the highest average strength in the circumferential (43.3 ± 4.7 MPa) and radial (12.6 ± 2.2 MPa) directions. This is followed by the anterior and posterior regions, which present similar average values (about 34.0MPa) in circumferential direction. The average strength of each region in the radial direction is approximately one-fourth to one-third of the value in the circumferential direction. This study is novel as it is the first work to focus on the experimental methods to investigate the heterogeneity and anisotropy only for porcine meniscus.
Collapse
Affiliation(s)
- Teng Long
- Department of Mechanical and Materials Engineering, College of Engineering and Applied Science, University of Cincinnati, 2901 Woodside Drive, Cincinnati, 45221-0072, OH, USA
| | - Kumar Vemaganti
- Sandia National Laboratories, 1515 Eubank Blvd. SE, Albuquerque, 87123, NM, USA
| | - James Edward Hawes
- Department of Biomedical Engineering, College of Engineering and Applied Science, University of Cincinnati, 2901 Woodside Drive, Cincinnati, 45221-0012, OH, USA
| | - Chia-Ying Lin
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, 45267-0212, OH, USA.
| |
Collapse
|
2
|
Khandare S, Smallcomb M, Elliott J, Vidt ME, Simon JC. Focused ultrasound as an alternative to dry needling for the treatment of tendinopathies: A murine model. J Orthop Res 2024; 42:598-606. [PMID: 37804211 DOI: 10.1002/jor.25700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 05/26/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023]
Abstract
Tendinopathies account for 30% of 102 million annual musculoskeletal injuries occurring annually in the United States. Current treatments, like dry needling, induce microdamage to promote healing but produce mixed success rates. Previously, we showed focused ultrasound can noninvasively create microdamage while preserving mechanical properties in ex vivo murine tendons. This present study compared growth factor, histological, and mechanical effects after focused ultrasound or dry needling treatments in an in vivo murine tendon injury model. Partial Achilles tenotomy was performed in 26 rats. One-week postsurgery, tendons were treated with focused ultrasound (1.5 MHz, 1-ms pulses at 10 Hz for 106 s, p+ = 49 MPa, p- = 19 MPa) or dry needling (30 G needle, 5 fenestrations over 20 s) and survived for 1 additional week. Blood was collected immediately before and after treatment and before euthanasia; plasma was assayed for growth factors. Treated tendons and contralateral controls were harvested for histology or mechanical testing. No differences were found between treatments in release of insulin growth factor 1 and transforming growth factor beta; vascular endothelial growth factor A concentrations were too low for detection. Histologically, focused ultrasound and dry needling tendons displayed localized fibroblast infiltration without collagen proliferation with no detectable differences between treatments. Mechanically, stiffness and percent relaxation of dry needling tendons were lower than controls (p = 0.0041, p = 0.0441, respectively), whereas stiffness and percent relaxation of focused ultrasound tendons were not different from controls. These results suggest focused ultrasound should be studied further to determine how this modality can be leveraged as a therapy for tendinopathies.
Collapse
Affiliation(s)
- Sujata Khandare
- Biomedical Engineering, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Molly Smallcomb
- Graduate Program in Acoustics, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Jacob Elliott
- Graduate Program in Acoustics, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Meghan E Vidt
- Biomedical Engineering, Pennsylvania State University, University Park, Pennsylvania, USA
- Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Julianna C Simon
- Biomedical Engineering, Pennsylvania State University, University Park, Pennsylvania, USA
- Graduate Program in Acoustics, Pennsylvania State University, University Park, Pennsylvania, USA
| |
Collapse
|
3
|
Zheng Q, Liu M, He M, Sun S, Liu C, Li Y, Jiang L, Ta D. Low-Intensity Pulsed Ultrasound Promotes the Repair of Achilles Tendinopathy by Downregulating the JAK/STAT Signaling Pathway in Rabbits. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2024; 71:141-152. [PMID: 38060355 DOI: 10.1109/tuffc.2023.3340721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Tendinopathy is a complex tendon injury or pathology outcome, potentially leading to permanent impairment. Low-intensity pulsed ultrasound (LIPUS) is emerging as a treatment modality for tendon disorders. However, the optimal treatment duration and its effect on tendons remain unclear. This study aims to investigate the efficacy of LIPUS in treating injured tendons, delineate the appropriate treatment duration, and elucidate the underlying treatment mechanisms through animal experiments. Ninety-six three-month-old New Zealand white rabbits were divided into normal control (NC) and model groups. The model group received Prostaglandin E2 (PGE2) injections to induce Achilles tendinopathy. They were then divided into model control (MC) and LIPUS treatment (LT) groups. LT received LIPUS intervention with a 1-MHz frequency, a pulse repetition frequency (PRF) of 1 kHz, and spatial average temporal average sound intensity ( [Formula: see text]) of 100 mW/cm2. MC underwent a sham ultrasound, and NC received no treatment. Assessments on 1, 4, 7, 14, and 28 days after LT included shear wave elastography (SWE), mechanical testing, histologic evaluation, ribonucleic acid sequencing (RNA-seq), polymerase chain reaction (PCR), and western blot (WB) analysis. SWE results showed that the shear modulus in the LT group was significantly higher than that in the MC group after LT for seven days. Histological results demonstrated improved tendon tissue alignment and fibroblast distribution after LT. Molecular analyses suggested that LIPUS may downregulate the Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling pathway and regulate inflammatory and matrix-related factors. We concluded that LT enhanced injured tendon elasticity and accelerated Achilles tendon healing. The study highlighted the JAK/STAT signaling pathway as a potential therapeutic target for LT of Achilles tendinopathy, guiding future research.
Collapse
|
4
|
Li Y, Li W, Liu X, Liu X, Zhu B, Guo S, Wang C, Wang D, Li S, Zhang Z. Effects of Low-Intensity Pulsed Ultrasound in Tendon Injuries. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1923-1939. [PMID: 37079603 DOI: 10.1002/jum.16230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 05/03/2023]
Abstract
Tendon injuries are the most common soft tissue injuries, caused by tissue overuse and age-related degeneration. However, the tendon repair process is slow and inefficient due to the lack of cellular structure and blood vessels in the tendon. Low-intensity pulsed ultrasound (LIPUS) has received increasing attention as a non-invasive, simple, and safe way to promote tendon healing. This review summarizes the effects and underlying mechanisms of LIPUS on tendon injury by comprehensively examining the published literature, including in vitro, in vivo, and clinical studies. This review reviewed 24 studies, with 87.5% showing improvement. The application of LIPUS in tendon diseases is a promising field worthy of further study.
Collapse
Affiliation(s)
- Yujie Li
- Institute of Physical Education, Southwest Medical University, Luzhou, Sichuan, China
| | - Wei Li
- Orthopaedics Department, Hejiang County People's Hospital, Luzhou, Sichuan, China
| | - Xinyue Liu
- Institute of Physical Education, Southwest Medical University, Luzhou, Sichuan, China
| | - Xueli Liu
- Institute of Physical Education, Southwest Medical University, Luzhou, Sichuan, China
| | - Bin Zhu
- Institute of Physical Education, Southwest Medical University, Luzhou, Sichuan, China
| | - Sheng Guo
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Chenglong Wang
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Dingxuan Wang
- Institute of Physical Education, Southwest Medical University, Luzhou, Sichuan, China
| | - Sen Li
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Zhongfa Zhang
- Orthopaedics Department, Hejiang County People's Hospital, Luzhou, Sichuan, China
| |
Collapse
|
5
|
Qin H, Du L, Luo Z, He Z, Wang Q, Chen S, Zhu YL. The therapeutic effects of low-intensity pulsed ultrasound in musculoskeletal soft tissue injuries: Focusing on the molecular mechanism. Front Bioeng Biotechnol 2022; 10:1080430. [PMID: 36588943 PMCID: PMC9800839 DOI: 10.3389/fbioe.2022.1080430] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Musculoskeletal soft tissue injuries are very common and usually occur during both sporting and everyday activities. The intervention of adjuvant therapies to promote tissue regeneration is of great importance to improving people's quality of life and extending their productive lives. Though many studies have focused on the positive results and effectiveness of the LIPUS on soft tissue, the molecular mechanisms standing behind LIPUS effects are much less explored and reported, especially the intracellular signaling pathways. We incorporated all research on LIPUS in soft tissue diseases since 2005 and summarized studies that uncovered the intracellular molecular mechanism. This review will also provide the latest evidence-based research progress in this field and suggest research directions for future experiments.
Collapse
Affiliation(s)
- Haocheng Qin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Du
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhiwen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhong He
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qing Wang
- Department of Orthopedics, Kunshan Hospital of Chinese Medicine, Suzhou, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu-Lian Zhu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
6
|
Effects of focused ultrasound and dry needling on tendon mechanical properties. J Biomech 2022; 132:110934. [PMID: 34995989 PMCID: PMC8860888 DOI: 10.1016/j.jbiomech.2021.110934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/11/2021] [Accepted: 12/18/2021] [Indexed: 02/03/2023]
Abstract
Tendon injuries are extremely common, resulting in mechanically weaker tendons that could lead to tendon rupture. Dry needling (DN) is widely used to manage pain and function after injury. However, DN is invasive and high inter-practitioner variability has led to mixed success rates. Focused ultrasound (fUS) is a non-invasive medical technology that directs ultrasound energy into a well-defined focal volume. fUS can induce thermal ablation or mechanical fractionation, with bioeffect type controlled through ultrasound parameters. Tendons must withstand high physiological loads, thus treatments maintaining tendon mechanical properties while promoting healing are needed. Our objective was to evaluate mechanical effects of DN and 3 fUS parameter sets, chosen to prioritize mechanical fractionation, on Achilles and supraspinatus tendons. Ex vivo rat Achilles and supraspinatus tendons (50 each) were divided into sham, DN, fUS-1, fUS-2, and fUS-3 (n = 10/group). Following treatment, tendons were mechanically tested. Elastic modulus of supraspinatus tendons treated with DN (126.64 ± 28.1 MPa) was lower than sham (153.02 ± 29.3 MPa; p = 0.0280). Stiffness and percent relaxation of tendons treated with DN (Achilles: 114.40 ± 31.6 N/mm; 49.10 ± 6.1%; supraspinatus: 109.53 ± 30.8 N/mm; 50.17 ± 7.6%) were lower (all p < 0.0334) than sham (Achilles: 141.34 ± 20.9 N/mm; 60.30 ± 7.7%; supraspinatus: 135.14 ± 30.2 N/mm; 60.85 ± 15.4%). Modulus of Achilles and supraspinatus tendons treated with fUS-1 (159.88 ± 25.7 MPa; 150.12 ± 22.0 MPa, respectively) were similar to sham (156.35 ± 23.0 MPa; 153.02 ± 29.3 MPa, respectively). These results suggest that fUS preserves mechanical properties better than DN, with fUS-1 performing better than fUS-2 and fUS-3. fUS should be studied further to fully understand its mechanical and healing effects to help evaluate fUS as an alternative, non-invasive treatment for tendon injuries.
Collapse
|
7
|
Huang S, Xiang X, Qiu L, Wang L, Zhu B, Guo R, Tang X. Transfection of TGF-β shRNA by Using Ultrasound-targeted Microbubble Destruction to Inhibit the Early Adhesion Repair of Rats Wounded Achilles Tendon In vitro and In vivo. Curr Gene Ther 2021; 20:71-81. [PMID: 32416687 DOI: 10.2174/1566523220666200516165828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/29/2020] [Accepted: 05/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Tendon injury is a major orthopedic disorder. Ultrasound-targeted microbubble destruction (UTMD) provides a promising method for gene transfection, which can be used for the treatment of injured tendons. OBJECTIVE The purpose of this study was to investigate the optimal transforming growth factor beta (TGF-β) short hairpin RNA (shRNA) sequence and transfection conditions using UTMD in vitro and to identify its ability for inhibiting the early adhesion repair of rats wounded achilles tendons in vivo. METHODS The optimal sequence was selected analyzing under a fluorescence microscope and quantitative real-time reverse transcription polymerase chain reaction in vitro. In vivo, 40 rats with wounded Achilles tendons were divided into five groups: (1) control group, (2) plasmid group (3) plasmid + ultrasound group, (4) plasmid + microbubble group, (5) plasmid + microbubble + ultrasound group, and were euthanized at 14 days post treatment. TGF-β expression was evaluated using adhesion scores and pathological examinations. RESULTS The optimal condition for UTMD delivery in vitro was 1W/cm2 of output intensity and a 30% duty cycle with 60 s irradiation time (P < 0.05). The transfection efficiency of the plasmid in group 5 was higher than that in other groups (P < 0.05). Moreover, the lowest adhesion index score and the least expression of TGF-β were shown in group 5 (P < 0.05). When compared with the other groups, group 5 had a milder inflammatory reaction. CONCLUSION The results suggested that UTMD delivery of TGF-β shRNA offers a promising treatment approach for a tendon injury in vivo.
Collapse
Affiliation(s)
- Songya Huang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
| | - Xi Xiang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
| | - Li Qiu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
| | - Liyun Wang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
| | - Bihui Zhu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
| | - Ruiqian Guo
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
| | - Xinyi Tang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
8
|
Lai WC, Iglesias BC, Mark BJ, Wang D. Low-Intensity Pulsed Ultrasound Augments Tendon, Ligament, and Bone-Soft Tissue Healing in Preclinical Animal Models: A Systematic Review. Arthroscopy 2021; 37:2318-2333.e3. [PMID: 33621647 DOI: 10.1016/j.arthro.2021.02.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To appraise the available animal and human studies investigating low-intensity pulsed ultrasound stimulation (LIPUS) on tendon, ligament, and bone-soft tissue (B-ST) junction healing. METHODS A systematic review of PUBMED, EMBASE, and the Cochrane Library was performed for animal and human studies investigating the effects of LIPUS on tendon, ligament, and B-ST junction healing. The systematic search was performed using the key term "low intensity pulsed ultrasound" and any of the following: "tendon," "ligament," "tendon-bone," and "bone-tendon." Inclusion criteria consisted of (1) randomized controlled trials assessing the effect of LIPUS on bone, tendon, and soft tissue in animals or humans and (2) English-language articles. RESULTS A total of 28 animal and 2 human studies met inclusion criteria. Animal studies utilized various models, including Achilles and patellar tendon transections, medial collateral ligament transections, and surgical repair of patellar tendon, rotator cuff tendon, and anterior cruciate ligament, to evaluate the effects of LIPUS. Animal studies demonstrated significantly improved collagen content and organization, bone formation, fibrocartilage remodeling, and mechanical strength with LIPUS treatment compared with controls. In human trials, LIPUS treatment of chronic tendinopathies did not improve clinical outcomes. CONCLUSIONS In acute injury animal models, LIPUS augmented healing of acute tendon, ligament, and B-ST junction injuries through increased collagen content and organization; increased anti-inflammatory cellular signaling; and increased angiogenesis. However, in 2 human studies investigating chronic tendinopathy, LIPUS did not lead to superior outcomes compared with controls. CLINICAL RELEVANCE Animal models suggest that LIPUS may be a promising noninvasive treatment modality for accelerating patient recovery after acute tendon and ligament injuries, as well as after surgical repair of B-ST junction injuries, but this has not been demonstrated in human studies. Randomized clinical trials evaluating LIPUS for acute tendon and ligament injuries are warranted.
Collapse
Affiliation(s)
- Wilson C Lai
- Department of Orthopaedic Surgery, University of California Irvine, Orange, California, U.S.A
| | - Brenda C Iglesias
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Bryan J Mark
- Department of Orthopaedic Surgery, University of California Irvine, Orange, California, U.S.A
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California Irvine, Orange, California, U.S.A..
| |
Collapse
|
9
|
Effects of low-density pulsed ultrasound treatment on transforming growth factor-beta, collagen level, histology, biomechanics, and function in repaired rat tendons. Turk J Phys Med Rehabil 2021; 67:167-174. [PMID: 34396067 PMCID: PMC8343155 DOI: 10.5606/tftrd.2021.5118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/22/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives The aim of this study is to compare the effects of low-density pulsed ultrasound (LIPUS) treatment on growth factors/collagen production, histological, biomechanical, and function of rats with Achilles tendon injury. Materials and methods A total of 44 Wistar Albino rats were used in the study between April 2017 and June 2018. The rats were randomized to two treatment groups. Group 1 (n=6) received LIPUS treatment (0.3 Watt/cm2; 1 MHz, 1:5 pulse mode) and Group 2 (n=6)received sham ultrasound (US) treatment following Achilles tendon surgery. Transforming growth factor-beta 1 (TGF-β1) and collagen gene expression levels were evaluated using polymerase chain reaction. The histological evaluation was performed with the Bonar scoring system. The tensile strength was measured by biomechanical testing and the function was evaluated with the Achilles Functional Index (AFI). Results Although TGF-β1 expression and tensile strength evaluation showed a tendency to improve in favor of the LIPUS group, no statistically significant difference was found (p=0.065 and p=0.053, respectively). The COL3 gene expression in the LIPUS group and the COL1 expression in the sham US group were significantly higher. Bonar scores and AFI scores showed a statistically significant improvement in the LIPUS group, compared to the sham US group. Conclusion Our study results show that LIPUS yields positive effects on tendon histology and functional status in repaired Achilles tendon in rats.
Collapse
|
10
|
Khandare S, Smallcomb M, Klein B, Geary C, Simon JC, Vidt ME. Comparison between dry needling and focused ultrasound on the mechanical properties of the rat Achilles tendon: A pilot study. J Biomech 2021; 120:110384. [PMID: 33773298 PMCID: PMC8089046 DOI: 10.1016/j.jbiomech.2021.110384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 02/18/2021] [Accepted: 03/10/2021] [Indexed: 11/25/2022]
Abstract
In the U.S., approximately 14 million tendon and ligament injuries are reported each year. Dry needling (DN) is a conservative treatment introduced to alleviate pain and restore function; however, it is invasive and has mixed success. Focused ultrasound (fUS) is a non-invasive technology that directs ultrasound energy into a well-defined focal volume. fUS induces thermal and/or mechanical bioeffects which can be controlled by the choice of ultrasound parameters. fUS could be an alternative to DN for treatment of tendon injuries, but the bioeffects must be established. Thus, the purpose of this pilot study was to compare the effect of DN and fUS on the mechanical properties and cell morphology of 30 ex vivo rat Achilles tendons. Tendons were randomly assigned to sham, DN, or fUS, with 10 tendons per group. Within each group, 5 tendons were evaluated mechanically, and 5 tendons were analyzed histologically. Elastic modulus in the DN (74.05 ± 15.0 MPa) group was significantly lower than sham (149.84 ± 59.1 MPa; p = 0.0094) and fUS (128.84 ± 28.3 MPa; p = 0.0453) groups. Stiffness in DN (329.05 ± 236.8 N/mm; p = 0.0034) and fUS (315.26 ± 68.9 N/mm; p = 0.0027) groups were significantly lower than sham (786.10 ± 238.7 N/mm) group. Histologically, localized necrosis was observed in 3 out of 5 tendons exposed to fUS, with surrounding tissue unharmed; no evidence of cellular injury was observed in DN or sham groups. These results suggest that fUS preserves the mechanical properties of tendon better than DN. Further studies are needed to evaluate fUS as an alternative, noninvasive treatment modality for tendon injuries.
Collapse
Affiliation(s)
- Sujata Khandare
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Molly Smallcomb
- Graduate Program in Acoustics, Pennsylvania State University, University Park, PA, USA
| | - Bailey Klein
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Colby Geary
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Julianna C Simon
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA; Graduate Program in Acoustics, Pennsylvania State University, University Park, PA, USA
| | - Meghan E Vidt
- Biomedical Engineering, Pennsylvania State University, University Park, PA, USA; Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA, USA.
| |
Collapse
|
11
|
Horne DA, Jones PD, Adams MS, Lotz JC, Diederich CJ. LIPUS far-field exposimetry system for uniform stimulation of tissues in-vitro: development and validation with bovine intervertebral disc cells. Biomed Phys Eng Express 2020; 6:035033. [PMID: 33438678 DOI: 10.1088/2057-1976/ab8b26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Therapeutic Low-intensity Pulsed Ultrasound (LIPUS) has been applied clinically for bone fracture healing and has been shown to stimulate extracellular matrix (ECM) metabolism in numerous soft tissues including intervertebral disc (IVD). In-vitro LIPUS testing systems have been developed and typically include polystyrene cell culture plates (CCP) placed directly on top of the ultrasound transducer in the acoustic near-field (NF). This configuration introduces several undesirable acoustic artifacts, making the establishment of dose-response relationships difficult, and is not relevant for targeting deep tissues such as the IVD, which may require far-field (FF) exposure from low frequency sources. The objective of this study was to design and validate an in-vitro LIPUS system for stimulating ECM synthesis in IVD-cells while mimicking attributes of a deep delivery system by delivering uniform, FF acoustic energy while minimizing reflections and standing waves within target wells, and unwanted temperature elevation within target samples. Acoustic field simulations and hydrophone measurements demonstrated that by directing LIPUS energy at 0.5, 1.0, or 1.5 MHz operating frequency, with an acoustic standoff in the FF (125-350 mm), at 6-well CCP targets including an alginate ring spacer, uniform intensity distributions can be delivered. A custom FF LIPUS system was fabricated and demonstrated reduced acoustic intensity field heterogeneity within CCP-wells by up to 93% compared to common NF configurations. When bovine IVD cells were exposed to LIPUS (1.5 MHz, 200 μs pulse, 1 kHz pulse frequency, and ISPTA = 120 mW cm-2) using the FF system, sample heating was minimal (+0.81 °C) and collagen content was increased by 2.6-fold compared to the control and was equivalent to BMP-7 growth factor treatment. The results of this study demonstrate that FF LIPUS exposure increases collagen content in IVD cells and suggest that LIPUS is a potential noninvasive therapeutic for stimulating repair of tissues deep within the body such as the IVD.
Collapse
Affiliation(s)
- Devante A Horne
- Department of Orthopaedic Surgery, University of California, San Francisco, United States of America. The UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley, and University of California, San Francisco, United States of America. Thermal Therapy Research Group, Radiation Oncology Department, University of California, San Francisco, United States of America
| | | | | | | | | |
Collapse
|
12
|
Ghayemi N, Sarrafzadeh-Rezaei F, Malekinejad H, Behfar M, Farshid AA. Effects of rabbit pinna-derived blastema cells on tendon healing. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2020; 23:13-19. [PMID: 32395204 PMCID: PMC7206831 DOI: 10.22038/ijbms.2019.29102.7045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/21/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Tendon healing is substantially slow and often associated with suboptimal repair. Cell therapy is one of the promising methods to improve tendon repair. Blastema, a population of undifferentiated cells, represents characteristics of pluripotent mesenchymal stem cells and has the potentials to be used in regenerative medicine. The aim of this study was to investigate the use of blastema allotransplantation in rabbit tendon healing. MATERIALS AND METHODS In this study, one rabbit was used as a blastema donor, and twenty-four rabbits were divided into control and treatment groups. Blastema cells were obtained from ear pinna upon punch hole injury in the donor rabbit. Under general anesthesia, a complete transverse tenotomy was performed on the midsubstance of deep digital flexor tendon followed by suture-repair. In the treatment group, 1 × 106 blastema cells suspended in buffer saline were injected intratendinously at the repair site, while the control group received only the buffer saline. Cast coaptation was maintained for two weeks. Eight weeks after the operation, tendons were harvested, and histopathological, biomechanical, and biochemical assays were performed on samples. RESULTS Mechanical testing showed a significant increase in ultimate load, energy absorption, stiffness, yield load, stress, and strain in blastema-treated tendons compared to controls. Also, higher hydroxyproline content and improved collagen alignment along with lower inflammatory cell infiltration and decreased angiogenesis were observed in blastema-treated tendons. CONCLUSION Increased levels of hydroxyproline and improved histopathological and biomechanical parameters in the treatment group suggest that blastema cells could be considered an adjunct to tendon repair in rabbits.
Collapse
Affiliation(s)
- Nooshin Ghayemi
- Department of Surgery and Diagnostic Imaging, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Farshid Sarrafzadeh-Rezaei
- Department of Surgery and Diagnostic Imaging, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Hassan Malekinejad
- Department of Pharmacy and Toxicology, Faculty of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| | - Mehdi Behfar
- Department of Surgery and Diagnostic Imaging, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Amir-Abbas Farshid
- Department of Pathology, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| |
Collapse
|
13
|
Abstract
The principles of hand therapy for proximal interphalangeal joint disorders include protecting injured structures, minimizing patient discomfort, and optimizing patient recovery. Comprehension of hand anatomy, the nature of the injury being treated, and the phases of healing are critical when designing a safe and effective hand therapy program. Hand therapists use a combination of orthoses, guided exercises, and modalities to improve edema, sensitivity, range of motion, and function.
Collapse
Affiliation(s)
- Nathan P Douglass
- Department of Orthopedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Pavilion C, Redwood City, CA 94063, USA
| | - Amy L Ladd
- Department of Orthopedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Pavilion C, Redwood City, CA 94063, USA.
| |
Collapse
|
14
|
Santos-Júnior L, Oliveira TVDC, Cândido JF, Santana DSD, Pereira RN, Pereyra BBS, Gomes MZ, Lima SO, Albuquerque-Júnior RLCD, Cândido EAF. Effects of the essential oil of Alpinia zerumbet (Pers.) B.L. Burtt & R.M. Sm. on healing and tissue repair after partial Achilles tenotomy in rats. Acta Cir Bras 2017; 32:449-458. [PMID: 28700006 DOI: 10.1590/s0102-865020170060000005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/24/2017] [Indexed: 11/22/2022] Open
Abstract
Purpose: To investigate the cellular response to injury, analyzing histopathologic changes associated with increased cellularity, degeneration and disorganization of collagen fibers. Methods: Thirty wistar rats were divided in two groups after partial Achilles tenotomy: the right hind paw were treated with the essential oil of Alpinia zerumbet (EOAz), diluted to 33% (0.3 mL kg-1), and the left hind paw received sunflower oil for 3, 14, 30 and 90 days. Statistical significance was determined using a Chi-square and Pearson Correlation qualitative variables test. Moreover, Mann-Whitney U-test test for comparison between different groups of the same cell, one-way ANOVA, and Tukey's test of quantitative measurement. Results: A decrease hyperemia (p < 0.001) was observed in the acute phase of inflammatory cell number (p < 0.001), whereas sub-acute phase was marked by significant correlation with macrophages in fibroblasts (r = 0.17, p = 0.03), with probable induction a dense and modeled tissue. At chronic phase, it was found an increase in the number of fibroblasts and a higher percentage of type I collagen fibers (78%) compared with control collagen fibers (55%). Conclusion: Oil of Alpinia zerumbet stimulated the process of maturation, organization and tissue repair which gave it greater resistance.
Collapse
Affiliation(s)
- Luciano Santos-Júnior
- Master, Postgraduate Program in Health and Environment, Department of Morphology and Structural Biology and Laboratory of Biological Studies and Natural Products, Institute of Technology and Research Natural Produtcts, Universidade Tiradentes (UNIT), Aracaju-SE, Brazil. Scientific and intellectual content of the study; conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; statistical analysis; manuscript preparation
| | - Tassia Virgínia de Carvalho Oliveira
- Master, Postgraduate Program in Health and Environment, Department of Morphology and Structural Biology and Laboratory of Biological Studies and Natural Products, Institute of Technology and Research Natural Produtcts, Universidade Tiradentes (UNIT), Aracaju-SE, Brazil. Scientific and intellectual content of the study; conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; statistical analysis; manuscript preparation
| | - Janaína Farias Cândido
- Master, Postgraduate Program in Health and Environment, Department of Morphology and Structural Biology and Laboratory of Biological Studies and Natural Products, Institute of Technology and Research Natural Produtcts, Universidade Tiradentes (UNIT), Aracaju-SE, Brazil. Scientific and intellectual content of the study; conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; statistical analysis; manuscript preparation
| | - Danielle Souza de Santana
- Master, Postgraduate Program in Health and Environment, Department of Morphology and Structural Biology and Laboratory of Biological Studies and Natural Products, Institute of Technology and Research Natural Produtcts, Universidade Tiradentes (UNIT), Aracaju-SE, Brazil. Scientific and intellectual content of the study; conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; statistical analysis; manuscript preparation
| | - Rose Nely Pereira
- Master, Postgraduate Program in Health and Environment, Department of Morphology and Structural Biology and Laboratory of Biological Studies and Natural Products, Institute of Technology and Research Natural Produtcts, Universidade Tiradentes (UNIT), Aracaju-SE, Brazil. Scientific and intellectual content of the study; conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; statistical analysis; manuscript preparation
| | - Beatriz Benny Sungaila Pereyra
- Master, Postgraduate Program in Health and Environment, Department of Morphology and Structural Biology and Laboratory of Biological Studies and Natural Products, Institute of Technology and Research Natural Produtcts, Universidade Tiradentes (UNIT), Aracaju-SE, Brazil. Scientific and intellectual content of the study; conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; statistical analysis; manuscript preparation
| | - Margarete Zanardo Gomes
- PhD, Full Professor, Institute of Technology and Research, Postgraduate Program in Health and Environment, UNIT, Aracaju-SE, Brazil. Scientific and intellectual content of the study; acquisition, analysis and interpretation of data; technical procedures; statistical analysis; manuscript writing, critical revision, final approval
| | - Sônia Oliveira Lima
- PhD, Full Professor, Institute of Technology and Research, Postgraduate Program in Health and Environment, UNIT, Aracaju-SE, Brazil. Scientific and intellectual content of the study; acquisition, analysis and interpretation of data; technical procedures; statistical analysis; manuscript writing, critical revision, final approval
| | - Ricardo Luiz Cavalcanti de Albuquerque-Júnior
- PhD, Full Professor, Institute of Technology and Research, Postgraduate Program in Health and Environment, UNIT, Aracaju-SE, Brazil. Scientific and intellectual content of the study; acquisition, analysis and interpretation of data; technical procedures; statistical analysis; manuscript writing, critical revision, final approval
| | - Edna Aragão Farias Cândido
- PhD, Full Professor, Institute of Technology and Research, Postgraduate Program in Health and Environment, UNIT, Aracaju-SE, Brazil. Scientific and intellectual content of the study; acquisition, analysis and interpretation of data; technical procedures; statistical analysis; manuscript writing, critical revision, final approval
| |
Collapse
|
15
|
Chan KOW, Tong HHY, Ng GYF. Topical Fish Oil Application Coupling with Therapeutic Ultrasound Improves Tendon Healing. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2983-2989. [PMID: 27692307 DOI: 10.1016/j.ultrasmedbio.2016.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 06/06/2023]
Abstract
Fish oil has been shown to promote collagen synthesis, and hence, connective tissue healing. Therapeutic ultrasound is commonly used to treat soft tissue injuries. This study aimed to investigate the therapeutic effect of topical fish oil on the management of Achilles tendon rupture, comparing normal therapeutic ultrasound with a combination of ultrasound and fish oil. Eighty-five Sprague-Dawley rats underwent surgical hemitenotomy of the right medial Achilles tendon. The rats received daily treatment of either topical placebo ointment (control group [CON]), topical fish oil (FO), therapeutic ultrasound (US) or ultrasound with fish oil as the coupling medium (FU). The treatment started on post-surgical day 2 over a 2-wk or 4-wk period. On days 15 and 29, the rats were sacrificed and their Achilles tendons were tested for structural stiffness, ultimate tensile strength (UTS) and energy absorption capacity. At 2 wk, only US showed higher normalized UTS compared with CON (p < 0.05). At 4 wk, both US and FU demonstrated better UTS (p < 0.05), while both FO and FU had improved in structural stiffness (p < 0.05). Four wk of treatment with ultrasound using fish oil as coupling medium showed improvement in both structural stiffness and UTS (p < 0.05).
Collapse
Affiliation(s)
- Karly O W Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Henry H Y Tong
- School of Health Sciences, Macao Polytechnic Institute, Macau SAR, China
| | - Gabriel Y F Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| |
Collapse
|
16
|
Kim BS, Joo YC, Choi BH, Kim KH, Kang JS, Park SR. The effect of dry needling and treadmill running on inducing pathological changes in rat Achilles tendon. Connect Tissue Res 2015; 56:452-60. [PMID: 26076317 DOI: 10.3109/03008207.2015.1052876] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Achilles tendinopathy is a common degenerative condition without a definitive treatment. An adequate chronic animal model of Achilles tendinopathy has not yet been developed. The purpose of this study was to evaluate the individual and combined effects of dry needling and treadmill running on the Achilles tendon of rats. Percutaneous dry needling, designed to physically replicate microrupture of collagen fibers in overloaded tendons, was performed on the right Achilles tendon of 80 Sprague-Dawley rats. The rats were randomly divided into two groups: a treadmill group, which included rats that underwent daily uphill treadmill running (n = 40), and a cage group, which included rats that could move freely within their cages (n = 40). At the end of weeks 1 and 4, 20 rats from each group were sacrificed, and bilateral Achilles tendons were collected. The harvested tendons were subjected to mechanical testing and histological analysis. Dry needling induced histological and mechanical changes in the Achilles tendons at week 1, and the changes persisted at week 4. The needled Achilles tendons of the treadmill group tended to show more severe histological and mechanical changes than those of the cage group, although these differences were not statistically significant. Dry needling combined with free cage activity or treadmill running produced tendinopathy-like changes in rat Achilles tendons up to 4 weeks after injury. Dry needling is an easy procedure with a short induction period and a high success rate, suggesting it may have relevance in the design of an Achilles tendinopathy model.
Collapse
Affiliation(s)
- Bom Soo Kim
- a Department of Orthopaedic Surgery , Inha University College of Medicine , Incheon , Korea
| | - Young Chae Joo
- b Department of Pathology , Inha University College of Medicine , Incheon , Korea
| | - Byung Hyune Choi
- c Division of Biomedical and Bioengineering Sciences , Inha University College of Medicine , Incheon , Korea , and
| | - Kil Hwan Kim
- d Department of Physiology , Inha University College of Medicine , Incheon , Korea
| | - Joon Soon Kang
- a Department of Orthopaedic Surgery , Inha University College of Medicine , Incheon , Korea
| | - So Ra Park
- d Department of Physiology , Inha University College of Medicine , Incheon , Korea
| |
Collapse
|
17
|
Rigby JH, Taggart RM, Stratton KL, Lewis GK, Draper DO. Intramuscular Heating Characteristics of Multihour Low-Intensity Therapeutic Ultrasound. J Athl Train 2015; 50:1158-64. [PMID: 26509683 PMCID: PMC4732395 DOI: 10.4085/1062-6050-50.11.03] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The heating characteristics of a stationary device delivering sustained acoustic medicine with low-intensity therapeutic ultrasound (LITUS) are unknown. OBJECTIVE To measure intramuscular (IM) heating produced by a LITUS device developed for long-duration treatment of musculoskeletal injuries. DESIGN Controlled laboratory study. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 26 healthy volunteers (16 men, 10 women; age = 23.0 ± 2.1 years, height = 1.74 ± 0.09 m, mass = 73.48 ± 14.65 kg). INTERVENTION(S) Participants were assigned randomly to receive active (n = 20) or placebo (n = 6) LITUS at a frequency of 3 MHz and an energy intensity of 0.132 W/cm(2) continuously for 3 hours with a single transducer or dual transducers on the triceps surae muscle. We measured IM temperature using thermocouples inserted at 1.5- and 3-cm depths into muscle. Temperatures were recorded throughout treatment and 30 minutes posttreatment. MAIN OUTCOME MEASURE(S) We used 2-sample t tests to determine the heating curve of the LITUS treatment and differences in final temperatures between depth and number of transducers. RESULTS A mild IM temperature increase of 1 °C was reached 10 ± 5 minutes into the treatment, and a more vigorous temperature increase of 4 °C was reached 80 ± 10 minutes into the treatment. The maximal steady-state IM temperatures produced during the final 60 minutes of treatment at the 1.5-cm depth were 4.42 °C ± 0.08 °C and 3.92 °C ± 0.06 °C using 1 and 2 transducers, respectively. At the 3.0-cm depth, the maximal steady-state IM temperatures during the final 60 minutes of treatment were 3.05 °C ± 0.09 °C and 3.17 °C ± 0.05 °C using 1 and 2 transducers, respectively. We observed a difference between the temperatures measured at each depth (t78 = -2.45, P = .02), but the number of transducers used to generate heating was not different (t78 = 1.79, P = .08). CONCLUSIONS The LITUS device elicited tissue heating equivalent to traditional ultrasound but could be sustained for multiple hours. It is a safe and effective alternative tool for delivering therapeutic ultrasound and exploring dosimetry for desired physiologic responses.
Collapse
Affiliation(s)
- Justin H. Rigby
- Department of Human Performance and Health Promotions, Weber State University, Ogden, UT
| | | | | | | | - David O. Draper
- Department of Exercise Science, Brigham Young University, Provo, UT. Dr Rigby is now with the Department of Athletic Training and Nutrition, Weber State University
| |
Collapse
|
18
|
Best TM, Moore B, Jarit P, Moorman CT, Lewis GK. Sustained acoustic medicine: wearable, long duration ultrasonic therapy for the treatment of tendinopathy. PHYSICIAN SPORTSMED 2015; 43:366-74. [PMID: 26468991 DOI: 10.1080/00913847.2015.1095617] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The effectiveness of sustained acoustic medicine to alleviate pain and improve function in subjects with elbow or Achilles tendinopathy was evaluated through a level IV case series study. Subjects were trained to self-apply the wearable, long-duration, low-intensity ultrasonic device on their affected body part at home for 4 hours a day, at least 5 times per week over 6 weeks. Twenty-five subjects with clinician-diagnosed tendinopathy of the elbow (medial or lateral epicondyle) or Achilles tendon were enrolled. METHODS Pain measurements were recorded before, during, and after daily intervention using an 11-point numeric rating scale (NRS). Function of the injured limb was assessed biweekly using dynamometry. Repeated measures ANOVAs and paired-samples t-tests were used to examine the effect of treatment over time. RESULTS Among subjects with elbow tendinopathy (n = 20), a 3.94 ± 2.15 point reduction in pain (p = 0.002) was observed over the 6-week study and a 2.83 ± 5.52 kg improvement in grip strength (p = 0.04) was observed over the first two weeks. In addition, a significant reduction in pain was observed within the 4-h treatment sessions (p < 0.001). Among 5 subjects with Achilles tendinopathy, a reduction in pain and improvement in strength was also observed. CONCLUSIONS Daily multi-hour ultrasonic therapy was associated with improved pain and increased function in subjects with chronic tendon injuries. This trial showed the safety and feasibility of self-administration of sustained acoustic medicine, and suggests that this therapy may be clinically beneficial in the treatment of tendinopathies of the elbow and Achilles tendon. A randomized controlled trial appears warranted to more definitively investigate the therapeutic potential of this treatment modality. Registered at www.ClinicalTrials.gov, NCT02466308.
Collapse
Affiliation(s)
- Thomas M Best
- a Division of Sports Medicine, Department of Family Medicine , The Ohio State University , Columbus , OH , USA.,b Biomedical Engineering , The Ohio State University , Columbus , OH , USA
| | | | - Paddy Jarit
- d Sport and Orthopaedic Physical Therapy , Fairfield , CT , USA
| | - Claude T Moorman
- e Department of Orthopaedic Surgery, Duke Sports Medicine Center, Duke University , Durham , NC , USA
| | | |
Collapse
|
19
|
Use of ultrasound-targeted microbubble destruction to transfect IGF-1 cDNA to enhance the regeneration of rat wounded Achilles tendon in vivo. Gene Ther 2015; 22:610-8. [PMID: 25840275 DOI: 10.1038/gt.2015.32] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 03/06/2015] [Accepted: 03/25/2015] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to determine whether using ultrasound-targeted microbubble destruction (UTMD) to transfect rat wounded Achilles tendon with insulin-like growth factor-1 (IGF-1) cDNA would enhance tissue regeneration. Forty rats with injured Achilles tendons were transfected with IGF-1 cDNA and divided into: (1) control group, (2) plasmid-only group, (3) plasmid+ultrasound group and (4) plasmid+microbubbles+ultrasound group. The IGF-1 cDNA expression of the Achilles tendons was evaluated by histological adhesion finding, quantitative real-time reverse transcription PCR examination and biomechanical test. The adhesion scores in group 4 were lowest at weeks 2 and 8 (P<0.05). The IGF-1 expression in the Achilles tendons was highest in group 4 at weeks 2 and 8 (P<0.05). Compared with those of other three groups, the granulation tissues and inflammatory-cell infiltration were lighter in group 4 at week 2, and the scars on the tendons in group 4 were less evident at week 8. The messenger RNA (mRNA) of IGF-1 of group 4 was upregulated at weeks 2 and 8 (P<0.01). Groups 4 and 3 showed a greater maximum load, stiffness and ultimate stress (P<0.05). Maximum load, stiffness and ultimate stress of healing Achilles tendons in group 4 were highest at weeks 2 and 8 (P<0.05).
Collapse
|
20
|
Ruiz-Molinero C, Jimenez-Rejano JJ, Chillon-Martinez R, Suarez-Serrano C, Rebollo-Roldan J, Perez-Cabezas V. Efficacy of therapeutic ultrasound in pain and joint mobility in whiplash traumatic acute and subacute phases. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2089-2095. [PMID: 25023094 DOI: 10.1016/j.ultrasmedbio.2014.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/31/2014] [Accepted: 04/26/2014] [Indexed: 06/03/2023]
Abstract
To determine if ultrasound (US) is effective in reducing pain and mobility limitation in the treatment of traumatic cervical sprain, we performed an experimental study. The sample comprised 54 diagnosed subjects with a mean age of 36.54 y (standard deviation = 12.245), assigned by simple random selection to an experimental group with ultrasound treatment and a control group with placebo ultrasound. Treatment consisted of 10 sessions of an ultrasound treatment protocol, followed by 15 sessions of a protocol identical for both groups without ultrasound. The variables assessed were pain and joint mobility. There was no significant difference (p > 0.05) between groups in the first 10 sessions of treatment. However, there was a statistically significant difference (p < 0.05) between groups on the pain variable, 20 days after completion of the US. High-active ultrasound treatment is more effective than placebo in reducing pain.
Collapse
|
21
|
Chao CYL, Ng GYF, Cheung KK, Zheng YP, Wang LK, Cheing GLY. In vivo and ex vivo approaches to studying the biomechanical properties of healing wounds in rat skin. J Biomech Eng 2014; 135:101009-8. [PMID: 23897493 DOI: 10.1115/1.4025109] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 07/29/2013] [Indexed: 11/08/2022]
Abstract
An evaluation of wound mechanics is crucial in reflecting the wound healing status. The present study examined the biomechanical properties of healing rat skin wounds in vivo and ex vivo. Thirty male Sprague-Dawley rats, each with a 6 mm full-thickness circular punch biopsied wound at both posterior hind limbs were used. The mechanical stiffness at both the central and margins of the wound was measured repeatedly in five rats over the same wound sites to monitor the longitudinal changes over time of before wounding, and on days 0, 3, 7, 10, 14, and 21 after wounding in vivo by using an optical coherence tomography-based air-jet indentation system. Five rats were euthanized at each time point, and the biomechanical properties of the wound tissues were assessed ex vivo using a tensiometer. At the central wound bed region, the stiffness measured by the air-jet system increased significantly from day 0 (17.2%), peaked at day 7 (208.3%), and then decreased progressively until day 21 (40.2%) as compared with baseline prewounding status. The biomechanical parameters of the skin wound samples measured by the tensiometer showed a marked reduction upon wounding, then increased with time (all p < 0.05). On day 21, the ultimate tensile strength of the skin wound tissue approached 50% of the normal skin; while the stiffness of tissue recovered at a faster rate, reaching 97% of its prewounded state. Our results suggested that it took less time for healing wound tissues to recover their stiffness than their maximal strength in rat skin. The stiffness of wound tissues measured by air-jet could be an indicator for monitoring wound healing and contraction.
Collapse
|
22
|
Liang JI, Lin PC, Chen MY, Hsieh TH, Chen JJJ, Yeh ML. The effect of tenocyte/hyaluronic acid therapy on the early recovery of healing Achilles tendon in rats. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:217-227. [PMID: 24072390 DOI: 10.1007/s10856-013-5036-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 08/23/2013] [Indexed: 06/02/2023]
Abstract
The aim of this study was to explore the potential for a better recovery outcome for the Achilles tendon at an early healing stage when a mixed biomaterial-tenocyte injection is used. The experimental animals underwent single limb Achilles tendon transection followed by suturing repair. A solution of either hyaluronic acid with or without tenocytes or normal saline was randomly chosen to be injected around the injury site after surgery. To obtain the comprehensive recovery condition of the rats on different management protocols, the animals were evaluated histologically, mechanically, and functionally. A significant difference in the recovery condition was found in the injured tendon injected with the hyaluronic acid solution with tenocytes compared with the other groups. Tendon stiffness and the locomotion abilities of the rats with healing Achilles tendons were improved in the hyaluronic acid with tenocyte transplantation group. The acceleration of the inflammatory phase in rats with the hyaluronic acid with tenocyte injections might be the major reason for the better functional outcomes.
Collapse
Affiliation(s)
- Jen-I Liang
- Department of Biomedical Engineering, National Cheng Kung University, No. 1, University Road, Tainan, 701, Taiwan
| | | | | | | | | | | |
Collapse
|
23
|
Ravanbod R, Torkaman G, Esteki A. Comparison between pulsed ultrasound and low level laser therapy on experimental haemarthrosis. Haemophilia 2012; 19:420-5. [PMID: 23167284 DOI: 10.1111/hae.12061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 12/26/2022]
Abstract
The use of pulsed ultrasound (PUS) and low level laser therapy (LLLT) in patients with haemophilia has been recommended for supportive treatment of acute and chronic phases of haemarthrosis but its role has not been supported by experimental evidence. The purpose of the present study was to evaluate the effect of these modalities on joint swelling, friction and biomechanical parameters of articular cartilage. An experimental rabbit knee haemarthrosis model was used to test the hypothesis that LLLT and PUS favourably impacted on the biotribological and biomechanical properties of cartilage after joint bleeding. To test this, 35 male albino rabbits weighing 1.5-2 kg were used. The left knee of 30 rabbits was injected with 1 mL of fresh autologous blood two times per week for four consecutive weeks to simulate recurrent haemarthrosis; five rabbits served as non-bleeding controls. Ten rabbits were treated with PUS and 10 with LLLT and the remaining 10 were not treated. The treatments were started after 2 days and the treatment duration was planned for 5 days (sessions) in ultrasound and laser groups. A low level Ga-Al-As laser was applied with an 810 nm wavelength, 25 mW power, and 1 J cm(-2) dosage for 200 s duration. The PUS treatment was applied with a duty cycle of 1/9, frequency of 1 MHz, and power of 0.4 W cm(-2) for 150 s. Joint perimeter was measured before the procedure at the beginning of therapies and after cessation of the procedure. Friction and biomechanical parameters were measured immediately after the killing of the animals. The results demonstrate that PUS was more effective in reducing knee joint swelling than LLLT. Moreover, PUS had the unique ability of reducing the joint friction below normal values. However, it was not successful in returning the articular cartilage force and stiffness to normal state. LLLT was more effective in increasing equilibrium force of the articular cartilage than PUS, however, neither therapy normalized this parameter. From these data, we conclude that PUS is more effective than LLLT in reducing joint swelling and articular joint friction after experimental haemarthrosis.
Collapse
Affiliation(s)
- R Ravanbod
- Department of Physical Therapy, Biomechanical Research Laboratory, Tarbiat Modares University, Tehran, Iran
| | | | | |
Collapse
|
24
|
Bertolini GRF, Silva TSD, Ciena AP, Artifon EL. Comparação do ultrassom pulsado e contínuo no reparo tendíneo de ratos. FISIOTERAPIA E PESQUISA 2012. [DOI: 10.1590/s1809-29502012000300009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
No tratamento de lesões tendíneas, o uso do ultrassom surge como possibilidade terapêutica, apesar de lacunas sobre seus efeitos clínicos. O objetivo foi avaliar dois protocolos de ultrassom terapêutico sobre dor e edema após trauma tendíneo. Vinte e um ratos Wistar foram submetidos a trauma no tendão calcâneo e divididos em três grupos: sham (GS); ultrassom contínuo (GUC); e ultrassom pulsado (GUP). O trauma ocorreu sobre a face lateral do tendão calcâneo direito, com energia de 0,40 J. A dor foi avaliada pelo teste de incapacidade funcional e o edema, pelo diâmetro laterolateral. Foram realizadas avaliações previamente à lesão; após 1 hora da indução da lesão; após o 1º tratamento; 2, 8 e 24 horas após lesão; e após o 5º dia. O tratamento ocorreu em 5 dias, com transdutor de 1 MHz, durante 3 minutos, sobre o local do trauma, com dose de 0,4 W/cm² SATA. Os resultados da incapacidade funcional para GS mostraram aumento da nocicepção. Para GUC houve aumento ao comparar a avaliação 1 (AV1) com as avaliações 2 (AV2), 3 (AV3) e 4 (AV4); ao comparar AV2 com as avaliações 5 (AV5) e 6 (AV6) houve diminuição de valores. Para GUP houve aumento ao comparar AV1 com AV2 e AV3, mas ao comparar AV2 com as seguintes, houve diminuição significativa a partir de AV4. Para o edema, os grupos tratados produziram aumento inicial, com redução nas últimas avaliações. O ultrassom terapêutico produziu diminuição de dor e edema, mais precocemente para a forma pulsada.
Collapse
|
25
|
Aiyegbusi AI, Duru FIO, Akinbo SRA. The morphology of the healing tendon: a comparison of the effects of intrasound therapy and therapeutic pulsed ultrasound. Connect Tissue Res 2012; 53:478-84. [PMID: 22574701 DOI: 10.3109/03008207.2012.690793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE This study investigated the effects of low- and high-intensity intrasound therapy (LITR and HITR) and low-intensity pulsed ultrasound (LIPUS) on the morphology of the healing tendon. METHODS Forty-five male Sprague-Dawley albino rats, randomized into five groups, were further subdivided into groups A and B except Group 1. Groups 2-5 underwent an induced crush injury to the Achilles tendon. The groups were allocated to serve as controls (Group 1), received no treatment (Group 2), LIPUS once daily (Group 3), LITR twice daily (Group 4), and HITR twice daily (Group 5). Treatment commenced 24 hr post-injury over the first 14 days. Subgroup A animals were killed on day 15 and those in subgroup B were killed on day 31. The tendons were excised and processed for histological studies. RESULTS LITR and HITR given twice daily caused a significant (p < 0.05) proliferation of tenoblasts in the proliferative phase and enhanced their terminal differentiation to tenocytes in the remodeling phase compared with the untreated and LIPUS-treated groups. LITR and HITR also resulted in a significant increase in the volume fraction of collagen fibers compared with LIPUS. CONCLUSION Intrasound therapy has a better morphological effect on the healing tendon than LIPUS and may be an option to consider in the treatment of acute tendon injuries.
Collapse
|
26
|
Video-based Gait Analysis for Functional Evaluation of Healing Achilles Tendon in Rats. Ann Biomed Eng 2012; 40:2532-40. [DOI: 10.1007/s10439-012-0619-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 07/04/2012] [Indexed: 10/28/2022]
|
27
|
Hartzell TL, Rubinstein R, Herman M. Therapeutic modalities--an updated review for the hand surgeon. J Hand Surg Am 2012; 37:597-621. [PMID: 22305724 DOI: 10.1016/j.jhsa.2011.12.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 12/27/2011] [Indexed: 02/02/2023]
Abstract
The number of therapeutic modalities available to the hand surgeon has greatly increased over the past several decades. A field once predicated only on heat, massage, and cold therapy now uses electrical stimulators, ultrasound, biofeedback, iontophoresis, phonophoresis, mirror therapy, lasers, and a number of other modalities. With this expansion in choices, there has been a concurrent effort to better define which modalities are truly effective. In this review, we aim to characterize the commonly used modalities and provide the evidence available that supports their continued use.
Collapse
Affiliation(s)
- Tristan L Hartzell
- Department of Orthopedic Surgery, Box 9569902, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-6902, USA.
| | | | | |
Collapse
|
28
|
Abstract
Ultrasound is a therapeutic agent commonly used to treat sports-related musculoskeletal conditions, including tendon injuries or tendinopathy. Despite the widespread popularity of therapeutic ultrasound, few clinical studies have proved its efficacy. Several animal studies have been conducted to explore its effectiveness. In addition, a number of in vitro studies investigating the mechanisms underlying the ability of this physical modality to enhance tendon healing or to treat tendinopathy are in progress. There is strong supporting evidence from animal studies about the positive effects of ultrasound on tendon healing. In vitro studies have also demonstrated that ultrasound can stimulate cell migration, proliferation, and collagen synthesis of tendon cells that may benefit tendon healing. These positive effects of therapeutic ultrasound on tendon healing revealed by in vivo and in vitro studies help explain the physiologic responses to this physical modality and could serve as the foundation for clinical practice.
Collapse
|
29
|
Gurovich AN. Controlled Re-Injury of a Thigh Muscle Tear in a Soccer Player: a Case Study. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alvaro N Gurovich
- School of Kinesiology and Physical Therapy, Pontificia Universiadad Catolica de Valparasio
| |
Collapse
|
30
|
Abstract
STUDY DESIGN Controlled laboratory study. OBJECTIVE To evaluate the effect of low-intensity therapeutic ultrasound on the murine calcaneus tendon healing process. BACKGROUND Therapeutic ultrasound promotes formation and maturation of scar tissue. METHODS Calcaneus tendon tenotomy and tenorrhaphy was performed on 28 Wistar rats. After the procedure, the animals were randomly divided into 2 groups. The animals in the experimental group received a 5-minute ultrasound application, once a day, at a frequency of 1 MHz, a spatial average temporal average intensity of 0.1 W/cm2, and a spatial average intensity of 0.52 W/cm2 at a 16-Hz frequency pulse mode (duty cycle, 20%). Data for the injured side were normalized in relation to the data from the contralateral healthy calcaneus tendon (relative values). The animals in the control group received sham treatment. After a 28-day treatment period, the animals were sacrificed and their tendons surgically removed and subjected to mechanical stress testing. The parameters analyzed were cross-sectional area (mm2), ultimate load (N), tensile strength (MPa), and energy absorption (mJ). RESULTS A significant difference between groups was found for the relative values of ultimate load and tensile strength. The mean ± SD ultimate load of the control group was -3.5% ± 32.2% compared to 33.3% ± 26.8% for the experimental group (P = .005). The mean tensile strength of the control group was -47.7% ± 19.5% compared to -28.1% ± 24.1% for the experimental group (P = .019). No significant difference was found in cross-sectional area and energy absorption. CONCLUSION Low-intensity pulsed ultrasound produced by a conventional therapeutic ultrasound unit can positively influence the calcaneus tendon healing process in rats.
Collapse
|
31
|
Ng GYF. Comparing therapeutic ultrasound with microamperage stimulation therapy for improving the strength of Achilles tendon repair. Connect Tissue Res 2011; 52:178-82. [PMID: 20672987 DOI: 10.3109/03008207.2010.500752] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In exploring the effects of therapeutic ultrasound (US) and microamperage stimulation (MAS) on the biomechanical performance of repairing Achilles tendon in rats, 35 Sprague-Dawley rats receiving surgically induced injury to their right medial Achilles tendon were studied. The rats were divided into four groups of low-dose US (group 1, n = 10), high-dose US (group 2, n = 11), MAS (group 3, n = 7), and control (group 4, n = 7). The treatment started on day 6 after injury. Groups 1 and 2 received 4 min of daily US treatment at 1.0 and 2.0 W/cm(2), respectively. Group 3 received 30 min of daily transcutaneous MAS treatment. Group 4 received 30 min of daily sham MAS treatment. On day 31, the Achilles tendons were mechanically tested. Data on the right side were normalized to the left side and analyzed with MANOVA with α = 0.05. Results of MANOVA was significant and post hoc tests revealed that the normalized strength of groups 1, 2, and 3 were higher than that of group 4 (p = 0.003) but no significant difference was found among the treatment groups. The ANOVA result of the normalized load relaxation and stiffness was p = 0.06 and p = 0.07, respectively. These findings suggested that both low/high doses of US and MAS therapies could improve the strength of Achilles tendon but in view of its short treatment time, US is considered to be more efficient than MAS for improving the strength of the repairing tendons.
Collapse
Affiliation(s)
- Gabriel Y F Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University , Hong Kong, SAR , China.
| |
Collapse
|
32
|
Joensen J, Gjerdet NR, Hummelsund S, Iversen V, Lopes-Martins RAB, Bjordal JM. An experimental study of low-level laser therapy in rat Achilles tendon injury. Lasers Med Sci 2011; 27:103-11. [PMID: 21547473 PMCID: PMC3254871 DOI: 10.1007/s10103-011-0925-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 04/06/2011] [Indexed: 12/27/2022]
Abstract
The aim of this controlled animal study was to investigate the effect of low-level laser therapy (LLLT) administered 30 min after injury to the Achilles tendon. The study animals comprised 16 Sprague Dawley male rats divided in two groups. The right Achilles tendons were injured by blunt trauma using a mini guillotine, and were treated with LLLT or placebo LLLT 30 min later. The injury and LLLT procedures were then repeated 15 hours later on the same tendon. One group received active LLLT (λ = 904 nm, 60 mW mean output power, 0.158 W/cm2 for 50 s, energy 3 J) and the other group received placebo LLLT 23 hours after LLLT. Ultrasonographic images were taken to measure the thickness of the right and left Achilles tendons. Animals were then killed, and all Achilles tendons were tested for ultimate tensile strength (UTS). All analyses were performed by blinded observers. There was a significant increase in tendon thickness in the active LLLT group when compared with the placebo group (p < 0.05) and there were no significant differences between the placebo and uninjured left tendons. There were no significant differences in UTS between laser-treated, placebo-treated and uninjured tendons. Laser irradiation of the Achilles tendon at 0.158 W/cm2 for 50 s (3 J) administered within the first 30 min after blunt trauma, and repeated after 15 h, appears to lead to edema of the tendon measured 23 hours after LLLT. The guillotine blunt trauma model seems suitable for inflicting tendon injury and measuring the effects of treatment on edema by ultrasonography and UTS. More studies are needed to further refine this model.
Collapse
Affiliation(s)
- Jon Joensen
- Department of Physiotherapy, Faculty of Health and Social Science, Bergen University College, Bergen, Norway.
| | | | | | | | | | | |
Collapse
|
33
|
Effect of Pulsed Electromagnetic Fields on Human Tenocyte Cultures From Supraspinatus and Quadriceps Tendons. Am J Phys Med Rehabil 2011; 90:119-27. [DOI: 10.1097/phm.0b013e3181fc7bc7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Wood VT, Pinfildi CE, Neves MAI, Parizoto NA, Hochman B, Ferreira LM. Collagen changes and realignment induced by low-level laser therapy and low-intensity ultrasound in the calcaneal tendon. Lasers Surg Med 2010; 42:559-65. [PMID: 20662033 DOI: 10.1002/lsm.20932] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE The treatment of calcaneal tendon injuries requires long-term rehabilitation. Ultrasound (US) and low-level laser therapy (LLLT) are the most used and studied physical agents in the treatment of tendon injuries; however, only a few studies examined the effects of the combination of US and LLLT. Therefore, the purpose of this study was to investigate which treatment (the exclusive or combined use of US and LLLT) most effectively contribute to tendon healing. STUDY DESIGN/MATERIALS AND METHODS This was a controlled laboratory study with 50 rats whose Achilles tendon was injured by direct trauma. The rats were randomly divided into five groups and treated for 5 consecutive days, as follows: group 1 (control) received no treatment; group 2 was treated with US alone; group 3 was treated with LLLT alone; group 4 was treated first with US followed by LLLT; and group 5 was treated first with LLLT followed by US. On the sixth post-injury day, the tendons were removed and examined by polarized light microscopy. The organization of collagen fibers was assessed by birefringence measurements. Picrosirius-stained sections were examined for the presence of types I and III collagen. RESULTS There was a significantly higher organization of collagen fibers in group 2 (US) than in the control group (P = 0.03). The amount of type I collagen found in groups 2 (US), 3 (LLLT), and 5 (LLLT + US) was significantly higher than that in the control group (P <or= 0.01), but no significant differences were found between treatment groups. There were no differences in the amount of type III collagen between groups. CONCLUSION Ultrasound, LLLT, and the combined use of LLLT and US resulted in greater synthesis of type I collagen; US was also effective in increasing collagen organization in the early stages of the healing process.
Collapse
Affiliation(s)
- Viviane T Wood
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), CEP 04023-002 Sao Paulo, SP, Brazil.
| | | | | | | | | | | |
Collapse
|
35
|
Gurkan I, Ranganathan A, Yang X, Horton WE, Todman M, Huckle J, Pleshko N, Spencer RG. Modification of osteoarthritis in the guinea pig with pulsed low-intensity ultrasound treatment. Osteoarthritis Cartilage 2010; 18:724-33. [PMID: 20175971 PMCID: PMC2873836 DOI: 10.1016/j.joca.2010.01.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 12/21/2009] [Accepted: 01/18/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The Hartley guinea pig develops articular cartilage degeneration similar to that seen in idiopathic human osteoarthritis (OA). We investigated whether the application of pulsed low-intensity ultrasound (PLIUS) to the Hartley guinea pig joint would prevent or attenuate the progression of this degenerative process. METHODS Treatment of male Hartley guinea pigs was initiated at the onset of degeneration (8 weeks of age) to assess the ability of PLIUS to prevent OA, or at a later age (12 months) to assess the degree to which PLIUS acted to attenuate the progression of established disease. PLIUS (30 mW/cm(2)) was applied to stifle joints for 20 min/day over periods ranging from 3 to 10 months, with contralateral limbs serving as controls. Joint cartilage histology was graded according to a modified Mankin scale to evaluate treatment effect. Immunohistochemical staining for interleukin-1 receptor antagonist (IL-1ra), matrix metalloproteinase (MMP)-3, MMP-13, and transforming growth factor (TGF)-beta1 was performed on the cartilage to evaluate patterns of expression of these proteins. RESULTS PLIUS did not fully prevent cartilage degeneration in the prevention groups, but diminished the severity of the disease, with the treated joints showing markedly decreased surface irregularities and a much smaller degree of loss of matrix staining as compared to controls. PLIUS also attenuated disease progression in the groups with established disease, although to a somewhat lesser extent as compared to the prevention groups. Immunohistochemical staining demonstrated a markedly decreased degree of TGF-beta1 production in the PLIUS-treated joints. This indicates less active endogenous repair, consistent with the marked reduction in cartilage degradation. CONCLUSIONS PLIUS exhibits the ability to attenuate the progression of cartilage degeneration in an animal model of idiopathic human OA. The effect was greater in the treatment of early, rather than established, degeneration.
Collapse
Affiliation(s)
- Ilksen Gurkan
- National Institute on Aging, National Institutes of Health, Baltimore, MD
| | | | - Xu Yang
- Hospital for Special Surgery, New York, NY
| | - Walter E. Horton
- Northeastern Ohio Universities College of Medicine, Rootstown, Ohio
| | - Martin Todman
- Smith and Nephew Group Research Centre, York Science Park, Heslington, York, UK
| | - James Huckle
- Smith and Nephew Group Research Centre, York Science Park, Heslington, York, UK
| | | | - Richard G. Spencer
- National Institute on Aging, National Institutes of Health, Baltimore, MD
| |
Collapse
|
36
|
Romano CVG, Barbieri CH, Mazzer N, Volpon JB, Shimano AC, Roncaglia FB. O ultra-som terapêutico não aumentou as propriedades mecânicas de tendões flexores após reparo. ACTA ORTOPEDICA BRASILEIRA 2010. [DOI: 10.1590/s1413-78522010000100001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Estudo experimental idealizado para investigar as propriedades mecânicas de tendões flexores profundos de coelhos submetidos à tenotomia seguida de tenorrafia e aplicação precoce de ultra-som terapêutico com diferentes intensidades, em comparação com tendões submetidos somente à tenorrafia. MATERIAL E MÉTODOS: Quarenta e quatro coelhos foram divididos em quatro grupos experimentais de acordo com a aplicação do ultra-som. Todos foram submetidos a uma secção do tendão flexor profundo na zona 2 e imobilizados com uma órtese mantida durante todo o experimento. O grupo A recebeu tratamento ultra-sônico com uma intensidade de 1,4 W/cm², o grupo B com 0,6 W/cm², ambos no modo contínuo, o grupo C com 0,6 W/cm² SATA, no modo pulsado à 50% e o grupo D não recebeu tratamento ultra-sônico algum. A frequência ultra-sônica empregada foi de 1 MHz. Após a eutanásia os tendões foram dissecados e submetidos ao ensaio mecânico de tração e análise histológica qualitativa. As propriedades mecânicas avaliadas foram: força máxima, deformação na força máxima e rigidez. RESULTADO: Não houve diferença estatisticamente significante entre os grupos experimentais. CONCLUSÃO: O ultra-som terapêutico não melhorou as propriedades mecânicas dos tendões flexores após reparo.
Collapse
|
37
|
Silveira PCL, Victor EG, Schefer D, Silva LA, Streck EL, Paula MM, Pinho RA. Effects of therapeutic pulsed ultrasound and dimethylsulfoxide (DMSO) phonophoresis on parameters of oxidative stress in traumatized muscle. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:44-50. [PMID: 19900747 DOI: 10.1016/j.ultrasmedbio.2009.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 08/10/2009] [Accepted: 09/07/2009] [Indexed: 05/28/2023]
Abstract
Many studies have demonstrated an increase in reactive oxygen species (ROS) and oxidative damage markers after muscle damage. Phonophoresis aims to achieve therapeutically relevant concentrations of the transdermally introduced drug in the tissues subjected to the procedure by the use ultrasound waves. The aim of the study was to evaluate the effects on the therapeutic pulsed ultrasound (TPU) together with gel-dimethylsulfoxide (DMSO) in the parameters of muscular damage and oxidative stress. Male Wistar rats were divided randomly into six groups (n=6): sham (uninjured muscle); muscle injury without treatment; muscle injury and treatment with gel-saline (0.9%); muscle injury and treatment with gel-DMSO (15mg/kg); muscle injury and TPU plus gel-saline; and muscle injury and TPU plus gel-DMSO. Gastrocnemius injury was induced by a single impact blunt trauma. TPU (6min duration, frequency of 1.0MHz, intensity of 0.8W/cm(2)) was used 2, 12, 24, 48, 72, 96 and 120h after muscle trauma. The CK and acid phosphatase activity in serum was used as an indicator of skeletal muscle injury. Superoxide anion, TBARS, protein carbonyls, superoxide dismutase (SOD) and catalase (CAT) activity was used as indicators of stress oxidative. Results showed that TPU and gel-DMSO improved muscle healing. Moreover, superoxide anion production, TBARS level and protein carbonyls levels, superoxide dismutase (SOD) and catalase (CAT) activity were all decreased in the group TPU plus gel-DMSO. Our results show that DMSO is effective in the reduction of the muscular lesion and in the oxidative stress after mechanical trauma only when used with TPU. (E-mail: silveira_paulo2004@yahoo.com.br).
Collapse
Affiliation(s)
- Paulo C L Silveira
- Laboratório de Fisiologia e Bioquímica do Exercício/PPGCS/UNESC Criciúma, SC/Brazil.
| | | | | | | | | | | | | |
Collapse
|
38
|
Frasson NFV, Taciro C, Parizotto NA. Análise nanoestrutural da ação do ultra-som terapêutico sobre o processo de regeneração do tendão de ratos. FISIOTERAPIA E PESQUISA 2009. [DOI: 10.1590/s1809-29502009000300002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O ultra-som terapêutico pulsado (USTP) é uma das modalidades terapêuticas utilizadas para promover a aceleração do reparo tendíneo. Este estudo avaliou a microestrutura do tendão calcâneo sob o efeito do USTP em duas intensidades diferentes. Foram utilizados 24 ratos Wistar machos, divididos em quatro grupos, submetidos à tenotomia radical transversal do tendão calcâneo direito, sem posterior tenorrafia. Os animais do grupo controle (GC) não receberam tratamento; o grupo 1 (G1) foi submetido ao USTP de 1 MHz a 20%, com área de radiação efetiva de 1,0 cm² e intensidade média instantânea de 0,3 W/cm²; o grupo 2 (G2) recebeu USTP nos mesmos parãmetros, mas com intensidade de 1,5 W/cm²; no grupo 3 (G3), placebo, foi aplicado tratamento simulado (ultra-som desligado). Nos três grupos, o tratamento consistiu em uma sessão diária de 5 minutos, por 10 dias. No 11º dia pós-operatório os tendões foram removidos para análise qualitativa e quantitativa, por meio de microscopia de luz polarizada (MLP), de luz (ML) e de força atômica (MFA). As análises qualitativas de MLP e MFA foram coincidentes, mostrando melhor organização, agregação e orientação das fibras de colágeno no grupo G1. A análise quantitativa apresentou contagens médias de 400,7 fibroblastos e 2,22 capilares sangüíneos por campo de análise, não se encontrando diferença significativa entre os grupos (p>0,05). Conclui-se que o processo de regeneração tendínea em ratos pode ser beneficiado pelo tratamento com USTP em baixa intensidade.
Collapse
|
39
|
|
40
|
Papatheodorou LK, Malizos KN, Poultsides LA, Hantes ME, Grafanaki K, Giannouli S, Ioannou MG, Koukoulis GK, Protopappas VC, Fotiadis DI, Stathopoulos C. Effect of transosseous application of low-intensity ultrasound at the tendon graft-bone interface healing: gene expression and histological analysis in rabbits. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:576-584. [PMID: 19185973 DOI: 10.1016/j.ultrasmedbio.2008.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 04/23/2008] [Accepted: 07/15/2008] [Indexed: 05/27/2023]
Abstract
The present study investigates the effect of transosseous low-intensity pulsed ultrasound (LiUS) on the healing at tendon graft-bone interface, in molecular and histological level. The anterior cruciate ligament (ACL) in both knees of 52 New Zealand White rabbits was excised and replaced with the long digital extensor. A custom-made ultrasound transducer was implanted onto the medial tibial condyle, adjacent to the surface of the bone tunnel at both knees of the rabbits. The LiUS-treated right knees received 200-mus bursts of 1 MHz sine waves at a pulse repetition rate of 1 kHz and with 30 mW/cm(2) spatial-average temporal-average intensity for 20 min daily (study group), while the left knee received no LiUS (control group). Thirty-six rabbits were used to perform semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) analysis from both study and control groups for transforming growth factor-beta1 (TGF-beta1), biglycan and collagen I. RT-PCR products showed statistically significant upregulation of biglycan and collagen I gene expression in the study group, while TGF-beta1 gene expression exhibited a bimodal profile. Histological examination performed in 16 rabbits from both groups supported the findings of the molecular analysis, indicating a faster healing rate and a more efficient ligamentization process after ultrasound treatment. These findings suggest that transosseous application of LiUS enhances the healing rate of the tendon graft-bone interface, possibly by affecting the expression levels of genes significant for the tendon to bone healing process.
Collapse
Affiliation(s)
- Loukia K Papatheodorou
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences, University of Thessaly, 22 Papakiriazi st., Larissa, Greece
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Fu SC, Shum WT, Hung LK, Wong MWN, Qin L, Chan KM. Low-intensity pulsed ultrasound on tendon healing: a study of the effect of treatment duration and treatment initiation. Am J Sports Med 2008; 36:1742-9. [PMID: 18645043 DOI: 10.1177/0363546508318193] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Low-intensity pulsed ultrasound has been reported to be effective in promoting tendon healing. However, its optimal time and duration has not yet been determined. HYPOTHESIS Tendons at different stages of healing may respond differently to low-intensity pulsed ultrasound. In the present study, the timing effects of low-intensity pulsed ultrasound on tendon healing were investigated in a rat model with a patellar tendon graft harvest lesion. STUDY DESIGN Controlled laboratory study. METHODS Sixty Sprague-Dawley rats underwent central third patellar tendon donor site harvest. Low-intensity pulsed ultrasound sonication was then delivered to the injured knees at day 1, 14, or 28 after harvest for 2, 4, or 6 weeks. Tendon samples were harvested at day 14, 28, and 42 after lesion for histological examination and mechanical testing. RESULTS A 2-week session of low-intensity pulsed ultrasound applied from day 1 postlesion (D1-2W) significantly improved the ultimate mechanical strength of the healing tendons from 23.1 +/- 8.5 MPa to 36.6 +/- 9.0 MPa. Low-intensity pulsed ultrasound did not improve healing when it was given at later stages in D15-2W and D29-2W. When low-intensity pulsed ultrasound treatment was extended from 2 weeks (D1-2W) to 4 weeks (D1-4W) or 6 weeks (D1-6W), the beneficial effects on tendon healing became insignificant. Histological examination showed that low-intensity pulsed ultrasound sonication at late healing stages may disturb remodeling with a poor collagen fiber alignment. CONCLUSION Low-intensity pulsed ultrasound promoted restoration of mechanical strength and collagen alignment in healing tendons only when applied at early healing stages. CLINICAL RELEVANCE The present findings indicate that low-intensity pulsed ultrasound may be an effective treatment to reduce tendon donor site morbidity.
Collapse
Affiliation(s)
- Sai-Chuen Fu
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | | | | | | | | | | |
Collapse
|
42
|
Watson T. Ultrasound in contemporary physiotherapy practice. ULTRASONICS 2008; 48:321-329. [PMID: 18466945 DOI: 10.1016/j.ultras.2008.02.004] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 02/29/2008] [Accepted: 02/29/2008] [Indexed: 05/26/2023]
Abstract
The use of therapeutic ultrasound as an element of physiotherapy practice is well established, but the nature of that practice has changed significantly over the last 20 years. This paper aims to review the rationale and range of applications for which this modality is employed in current practice. Whereas in the past, its primary use was as a thermal modality, it is argued that currently, it is the 'non-thermal' aspects of the intervention that are most commonly employed. The predominant use of therapeutic ultrasound is in relation to tissue repair and soft tissue lesion management, where the evidence would support its application in the inflammatory, proliferative and remodelling phases. The clinical outcomes appear to be dose dependent, and whilst this paper does not detail dose related clinical decision making, the broad issues are considered. The future possibilities for the use of the modality are reviewed, and although outside the immediate remit of this paper, the use of therapeutic ultrasound in fracture management is briefly considered.
Collapse
Affiliation(s)
- Tim Watson
- University of Hertfordshire, School of Health and Emergency Professions, College Lane, Hatfield AL109AB, United Kingdom.
| |
Collapse
|
43
|
|
44
|
Ng GYF, Fung DTC. The effect of therapeutic ultrasound intensity on the ultrastructural morphology of tendon repair. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:1750-4. [PMID: 17630094 DOI: 10.1016/j.ultrasmedbio.2007.05.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 03/19/2007] [Accepted: 05/20/2007] [Indexed: 05/16/2023]
Abstract
This study evaluated the effects of ultrasound intensity on the ultrastructural morphology of Achilles tendon healing. Twenty Sprague-Dawley rats with surgically hemi-transected Achilles tendons were randomly assigned into four groups of 0, 0.5, 1.2 and 2 W/cm(2) for ultrasound treatment, with five rats in each group. The treatments were administered with 1 MHz continuous ultrasound daily starting from day 5 after injury. On day 30, ultrathin slides of the Achilles tendons were prepared and examined with transmission electron microscopy. Results showed that the mean collagen fibril size of all treatment groups was higher than the control (p < 0.05). There was no significant difference in the collagen fibril size among the treatment groups. These findings suggest that therapeutic ultrasound can enhance the maturation of collagen fibrils of repairing tendons, and this was not dependent on the intensity of ultrasound applied.
Collapse
Affiliation(s)
- Gabriel Y F Ng
- Orthopaedic and Microscopy Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | | |
Collapse
|
45
|
Bolt P, Clerk AN, Luu HH, Kang Q, Kummer JL, Deng ZL, Olson K, Primus F, Montag AG, He TC, Haydon RC, Toolan BC. BMP-14 Gene Therapy Increases Tendon Tensile Strength in a Rat Model of Achilles Tendon Injury. J Bone Joint Surg Am 2007. [DOI: 10.2106/00004623-200706000-00021] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
|
46
|
Bolt P, Clerk AN, Luu HH, Kang Q, Kummer JL, Deng ZL, Olson K, Primus F, Montag AG, He TC, Haydon RC, Toolan BC. BMP-14 gene therapy increases tendon tensile strength in a rat model of Achilles tendon injury. J Bone Joint Surg Am 2007; 89:1315-20. [PMID: 17545436 DOI: 10.2106/jbjs.f.00257] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Molecular and cellular-based enhancements of healing combined with conventional methods may yield better outcomes after the surgical management of tendon injury. We examined the histological and biomechanical effects of adenovirus-mediated transgene expression of bone morphogenetic protein-14 (BMP-14) on healing in a rat Achilles tendon laceration model. Specifically, we hypothesized that this delivery system for gene therapy would hasten the restoration of the normal histological appearance and tensile strength of a surgically repaired tendon. METHODS The right Achilles tendon of ninety male Sprague-Dawley rats was transected, repaired, and immediately infected with adenovirus expressing either the gene for green fluorescent protein (AdGFP) or the gene for human BMP-14 and green fluorescent protein (AdBMP-14). A sham control group received no viral-mediated infection after repair. Animals from each of the three groups were killed at one, two, and three weeks after surgery. The retrieved tendons were inspected, examined under light and fluorescent microscopy, and tested to determine their tensile strength. RESULTS Tendons transduced with BMP-14 exhibited less visible gapping, a greater number of neotenocytes at the site of healing, and 70% greater tensile strength than did either those transduced with GFP or the sham controls at two weeks after repair. Histological examination revealed no inflammatory response to the adenovirus in tendons transduced with BMP-14 or GFP. No ectopic bone or cartilage formed in the tendons transduced with BMP-14. CONCLUSIONS Adenovirus-mediated gene therapy with BMP-14 expedites tendon-healing in this animal model. No adverse immunological response to the adenoviral vector was detected in the host tissue, and the local production of BMP-14 did not induce unwelcome bone or cartilage formation within the healing tendon. CLINICAL RELEVANCE The results of this animal study suggest that gene therapy with BMPs may improve the capacity of injured musculoskeletal tissue to heal.
Collapse
Affiliation(s)
- Patrick Bolt
- Section of Orthopaedic Surgery and Rehabilitation Medicine, Department of Surgery, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 3079, Chicago, IL 60637, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|