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Wuerfel T, Schmitz C, Jokinen LLJ. The Effects of the Exposure of Musculoskeletal Tissue to Extracorporeal Shock Waves. Biomedicines 2022; 10:biomedicines10051084. [PMID: 35625821 PMCID: PMC9138291 DOI: 10.3390/biomedicines10051084] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 12/14/2022] Open
Abstract
Extracorporeal shock wave therapy (ESWT) is a safe and effective treatment option for various pathologies of the musculoskeletal system. Many studies address the molecular and cellular mechanisms of action of ESWT. However, to date, no uniform concept could be established on this matter. In the present study, we perform a systematic review of the effects of exposure of musculoskeletal tissue to extracorporeal shock waves (ESWs) reported in the literature. The key results are as follows: (i) compared to the effects of many other forms of therapy, the clinical benefit of ESWT does not appear to be based on a single mechanism; (ii) different tissues respond to the same mechanical stimulus in different ways; (iii) just because a mechanism of action of ESWT is described in a study does not automatically mean that this mechanism is relevant to the observed clinical effect; (iv) focused ESWs and radial ESWs seem to act in a similar way; and (v) even the most sophisticated research into the effects of exposure of musculoskeletal tissue to ESWs cannot substitute clinical research in order to determine the optimum intensity, treatment frequency and localization of ESWT.
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Peters K, Wiesmann N, Heimes D, Schwab R, Kämmerer PW, Al-Nawas B, Unger RE, Hasenburg A, Brenner W. Extracorporeal Shock Wave Therapy Improves In Vitro Formation of Multilayered Epithelium of Oral Mucosa Equivalents. Biomedicines 2022; 10:biomedicines10030700. [PMID: 35327502 PMCID: PMC8945876 DOI: 10.3390/biomedicines10030700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Oral mucosa is used in various surgical fields as a graft for the reconstruction of tissue defects. Tissue engineering of oral mucosa equivalents using autologous cells represents a suitable less burdensome alternative. The survival of the multilayered epithelium is essential for the functionality of the tissues in vivo. To ensure its functionality after transplantation, mucosa equivalents in vitro were subjected to extracorporeal shock wave therapy (ESWT) to determine whether this treatment stimulated the formation and differentiation of the epithelium. Mucosa equivalents treated with ESWT were examined for cellular metabolic activity using AlamarBlueTM assay. The formation of vascular structures, basement membrane, and multilayered epithelium were examined using confocal fluorescence microscopy and immunohistochemistry. The potential ingrowth in vivo was simulated using the chorioallantoic membrane model (CAM assay) in ovo. ESWT on culture day 19 of oral mucosa equivalents resulted in slightly increased cellular metabolic activity. The in vitro development of basement membrane and multilayer epithelium was stimulated by ESWT. Additionally, in the CAM assay, ESWT led to a more pronounced multilayered epithelium. Thus, ESWT stimulated the formation of a more distinct and differentiated multilayered epithelium of oral mucosa equivalents in vitro and might increase the chance of efficient ingrowth, survival, and functionality of tissue equivalents in vivo.
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Affiliation(s)
- Katharina Peters
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.P.); (R.S.); (A.H.)
| | - Nadine Wiesmann
- Department of Oral and Maxillofacial and Plastic Surgery, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (N.W.); (D.H.); (P.W.K.); (B.A.-N.)
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Diana Heimes
- Department of Oral and Maxillofacial and Plastic Surgery, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (N.W.); (D.H.); (P.W.K.); (B.A.-N.)
| | - Roxana Schwab
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.P.); (R.S.); (A.H.)
| | - Peer W. Kämmerer
- Department of Oral and Maxillofacial and Plastic Surgery, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (N.W.); (D.H.); (P.W.K.); (B.A.-N.)
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial and Plastic Surgery, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (N.W.); (D.H.); (P.W.K.); (B.A.-N.)
| | - Ronald E. Unger
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany;
| | - Annette Hasenburg
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.P.); (R.S.); (A.H.)
| | - Walburgis Brenner
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.P.); (R.S.); (A.H.)
- Correspondence: ; Tel.: +49-6131-17-2740
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Kuwabara A, Dyrek P, Olson EM, Kraus E. Evidence-Based Management of Medial Tibial Stress Syndrome in Runners. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mittermayr R, Haffner N, Feichtinger X, Schaden W. The role of shockwaves in the enhancement of bone repair - from basic principles to clinical application. Injury 2021; 52 Suppl 2:S84-S90. [PMID: 33714550 DOI: 10.1016/j.injury.2021.02.081] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
Extracorporeal shockwave therapy is a treatment modality, originally introduced into the clinic as lithotripsie, which has also been successfully used in the last two decades in the non-invasive treatment of delayed or non-healing fractures. Initially, the mechanism of action was attributed to microfracture-induced repair, but intensive basic research has now shown that the shockwave generates its effect in tissue via mechanotransduction. Numerous signal transduction pathways have already been demonstrated, which in their entirety trigger an endogenous regeneration process via cell proliferation, migration and differentiation. Clinically, these shockwave-conveyed biological signals support healing of acute, delayed and non-union fractures. The attainable outcome is comparable to surgery but avoiding an open approach with associated potential complications. These advantageous properties with a clearly positive cost-benefit ratio make shockwave therapy a first line treatment in delayed and non-union fractures.
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Affiliation(s)
- Rainer Mittermayr
- Ludwig Boltzmann Institute for experimental and clinical traumatology, Vienna, Austria; AUVA Trauma Center Meidling, Vienna, Austria; AUVA trauma research center, Vienna, Austria; Austrian Cluster for Tissue Engineering, Vienna, Austria.
| | - Nicolas Haffner
- Ludwig Boltzmann Institute for experimental and clinical traumatology, Vienna, Austria; Clinic Floridsdorf, Orthopedic and Traumatology Department, Vienna, Austria
| | | | - Wolfgang Schaden
- Ludwig Boltzmann Institute for experimental and clinical traumatology, Vienna, Austria; AUVA trauma research center, Vienna, Austria; Austrian Cluster for Tissue Engineering, Vienna, Austria; AUVA Medical Board, Vienna, Austria
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Song W, Ma X, Sun Y, Zhang L, Yao Y, Hao X, Zeng J. Extracorporeal shock wave therapy (ESWT) may be helpful in the osseointegration of dental implants: A hypothesis. Med Hypotheses 2020; 145:110294. [DOI: 10.1016/j.mehy.2020.110294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 12/26/2022]
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Heimes D, Wiesmann N, Eckrich J, Brieger J, Mattyasovszky S, Proff P, Weber M, Deschner J, Al-Nawas B, Kämmerer PW. In Vivo Modulation of Angiogenesis and Immune Response on a Collagen Matrix via Extracorporeal Shockwaves. Int J Mol Sci 2020; 21:ijms21207574. [PMID: 33066403 PMCID: PMC7589066 DOI: 10.3390/ijms21207574] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/02/2020] [Accepted: 10/11/2020] [Indexed: 12/12/2022] Open
Abstract
The effective management of tissue integration and immunological responses to transplants decisively co-determines the success of soft and hard tissue reconstruction. The aim of this in vivo study was to evaluate the eligibility of extracorporeal shock wave therapy (ESWT) with respect to its ability to modulate angiogenesis and immune response to a collagen matrix (CM) for tissue engineering in the chorioallantoic membrane (CAM) assay, which is performed with fertilized chicken eggs. CM were placed on the CAM on embryonic development day (EDD) 7; at EDD-10, ESWT was conducted at 0.12 mJ/mm2 with 500 impulses each. One and four days later, angiogenesis represented by vascularized area, vessel density, and vessel junctions as well as HIF-1α and VEGF gene expression were evaluated. Furthermore, immune response (iNOS2, MMP-9, and MMP-13 via qPCR) was assessed and compared between ESWT- and non-ESWT-groups. At EDD-14, the vascularized area (+115% vs. +26%) and the increase in vessel junctions (+751% vs. +363%) were significantly higher in the ESWT-group. ESWT significantly increased MMP-9 gene expression at EDD-11 and significantly decreased MMP-13 gene expression at EDD-14 as compared to the controls. Using the CAM assay, an enhanced angiogenesis and neovascularization in CM after ESWT were observed. Furthermore, ESWT could reduce the inflammatory activity after a latency of four days.
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Affiliation(s)
- Diana Heimes
- Department of Oral- and Maxillofacial and Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (N.W.); (B.A.-N.); (P.W.K.)
- Correspondence: ; Tel.: +49-6131-17-5086
| | - Nadine Wiesmann
- Department of Oral- and Maxillofacial and Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (N.W.); (B.A.-N.); (P.W.K.)
- Molecular Tumor Biology, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany; (J.E.); (J.B.)
| | - Jonas Eckrich
- Molecular Tumor Biology, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany; (J.E.); (J.B.)
| | - Juergen Brieger
- Molecular Tumor Biology, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany; (J.E.); (J.B.)
| | - Stefan Mattyasovszky
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University of Mainz, Langenbeckstraße 1, 55131 Mainz, Germany;
| | - Peter Proff
- Department of Orthodontics, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany;
| | - Manuel Weber
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - James Deschner
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University, Augustusplatz 2, 55131 Mainz, Germany;
| | - Bilal Al-Nawas
- Department of Oral- and Maxillofacial and Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (N.W.); (B.A.-N.); (P.W.K.)
| | - Peer W. Kämmerer
- Department of Oral- and Maxillofacial and Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (N.W.); (B.A.-N.); (P.W.K.)
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Kobayashi M, Chijimatsu R, Yoshikawa H, Yoshida K. Extracorporeal shock wave therapy accelerates endochondral ossification and fracture healing in a rat femur delayed-union model. Biochem Biophys Res Commun 2020; 530:632-637. [PMID: 32762942 DOI: 10.1016/j.bbrc.2020.07.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/12/2020] [Indexed: 11/30/2022]
Abstract
Extracorporeal shock wave therapy (ESWT) has been demonstrated to accelerate bone healing; however, the mechanism underlying ESWT-induced bone regeneration has not been fully elucidated. This study aimed to examine the effects of ESWT and the process of fracture healing. A rat model of femur delayed-union was established by cauterizing the periosteum. ESWT treatment at the fracture site was performed 2 weeks after the operation and the site was radiographically and histologically evaluated at weeks 4, 6, and 8. The bone union rate and radiographic score of the ESWT group were significantly higher than those of the control group at 8 weeks. Histological evaluation revealed enhanced endochondral ossification at the fracture site. The effects of ESWT on ATDC5 cells were examined in vitro. ESWT promoted chondrogenic differentiation without inhibiting the proliferation of ATDC5 cells. ESWT may induce significant bone healing by promoting endochondral ossification at the fracture site.
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Affiliation(s)
- Masato Kobayashi
- Osaka University, Graduate School of Medicine, Department of Orthopaedic Surgery, 2-2, Yamadaoka, Suita, Osaka, Japan
| | - Ryota Chijimatsu
- The University of Tokyo, Bone and Cartilage Regenerative Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hideki Yoshikawa
- Osaka University, Graduate School of Medicine, Department of Orthopaedic Surgery, 2-2, Yamadaoka, Suita, Osaka, Japan
| | - Kiyoshi Yoshida
- Osaka University, Graduate School of Medicine, Department of Orthopaedic Surgery, 2-2, Yamadaoka, Suita, Osaka, Japan.
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Kim DH, Han SH, Suh HS, Choi YS. Benefits of extracorporeal shock waves for keloid treatment: A pilot study. Dermatol Ther 2020; 33:e13653. [DOI: 10.1111/dth.13653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Dong Hee Kim
- Department of Dermatology Ulsan University Hospital, University of Ulsan College of Medicine Ulsan South Korea
| | - Seok Hyun Han
- Department of Dermatology Ulsan University Hospital, University of Ulsan College of Medicine Ulsan South Korea
| | - Ho Seok Suh
- Department of Dermatology Ulsan University Hospital, University of Ulsan College of Medicine Ulsan South Korea
| | - Yu Sung Choi
- Department of Dermatology Ulsan University Hospital, University of Ulsan College of Medicine Ulsan South Korea
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Buarque de Gusmão CV, Batista NA, Vidotto Lemes VT, Maia Neto WL, de Faria LD, Alves JM, Belangero WD. Effect of Low-Intensity Pulsed Ultrasound Stimulation, Extracorporeal Shockwaves and Radial Pressure Waves on Akt, BMP-2, ERK-2, FAK and TGF-β1 During Bone Healing in Rat Tibial Defects. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2140-2161. [PMID: 31101448 DOI: 10.1016/j.ultrasmedbio.2019.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 03/24/2019] [Accepted: 04/07/2019] [Indexed: 06/09/2023]
Abstract
An experimental study was conducted to determine whether low-intensity pulsed ultrasound stimulation (LIPUS), extracorporeal shockwave treatment (ESWT) and radial pressure wave treatment (RPWT) modulate Akt, bone morphogenetic protein-2 (BMP-2), extracellular signal-regulated kinase-2 (ERK-2), focal adhesion kinase (FAK) and transforming growth factor-β1 (TGF-β1) during bone healing in rat tibial defects. Rat tibial defects were exposed to 500 shots of ESWT delivered at 0.12 mJ/mm2, 500 impulses of RPWT operated at 2.0 bar or to daily 20-min 30 mW/cm2 LIPUS. Following 1, 3 and 6 wk, bones were harvested to determine the expression and activity of Akt, BMP-2, ERK-2, FAK and TGF-β1. Animals exposed to ultrasound were followed up to 3 wk. Protein expression and activity were unchanged following LIPUS treatment. ESWT increased Akt activity 2.11-fold (p = 0.043) and TGF-β1 expression 9.11-fold (p = 0.016) at 1 wk and increased FAK activity 2.16-fold (p = 0.047) at 3 wk. RPWT increased FAK activity 2.6-fold (p = 0.028) at 3 wk and decreased Akt expression 0.52-fold (p = 0.05) at 6 wk. In conclusion, the protocols employed for ESWT and RPWT modulated distinct signaling pathways during fracture healing, while LIPUS standard protocol did not change the usual signaling pathways of the proteins investigated. Future studies are required to monitor osteogenesis so that the biologic meaning of our results can be clarified.
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Affiliation(s)
- Carlos Vinícius Buarque de Gusmão
- Department of Orthopedics and Traumatology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
| | - Nilza Alzira Batista
- Department of Orthopedics and Traumatology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Valeria Trombini Vidotto Lemes
- Department of Orthopedics and Traumatology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Wilson Leite Maia Neto
- Department of Orthopedics and Traumatology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Lidia Dornelas de Faria
- Department of Orthopedics and Traumatology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - José Marcos Alves
- Electrical Engineering Department, College of Engineering of São Carlos, University of São Paulo (USP), São Carlos, São Paulo, Brazil
| | - William Dias Belangero
- Department of Orthopedics and Traumatology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Ginini JG, Emodi O, Sabo E, Maor G, Shilo D, Rachmiel A. Effects of Timing of Extracorporeal Shock Wave Therapy on Mandibular Distraction Osteogenesis: An Experimental Study in a Rat Model. J Oral Maxillofac Surg 2019; 77:629-638. [DOI: 10.1016/j.joms.2018.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 06/09/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
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Gadomski BC, McGilvray KC, Easley JT, Palmer RH, Jiao J, Li X, Qin YX, Puttlitz CM. An investigation of shock wave therapy and low-intensity pulsed ultrasound on fracture healing under reduced loading conditions in an ovine model. J Orthop Res 2018; 36:921-929. [PMID: 28762588 DOI: 10.1002/jor.23666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/21/2017] [Indexed: 02/04/2023]
Abstract
The use of shock wave therapy (SWT) and low-intensity pulsed ultrasound (LIPUS) as countermeasures to the inhibited fracture healing experienced during mechanical unloading was investigated by administering treatment to the fracture sites of mature, female, Rambouillet Columbian ewes exposed to partial mechanical unloading or full gravitational loading. The amount of fracture healing experienced by the treatment groups was compared to controls in which identical surgical and testing protocols were administered except for SWT or LIPUS treatment. All groups were euthanized after a 28-day healing period. In vivo mechanical measurements demonstrated no significant alteration in fixation plate strains between treatments within either partial unloading group. Similarly, DXA BMD and 4-point bending stiffness were not significantly altered following either treatment. μCT analyses demonstrated lower callus bone volume for treated animals (SWT and LIPUS, p < 0.01) in the full gravity group but not between reduced loading groups. Callus osteoblast numbers as well as mineralized surface and bone formation rate were significantly elevated to the level of the full gravity groups in the reduced loading groups following both SWT and LIPUS. Although no increase in 4-week mechanical strength was observed, it is possible that an increase in the overall rate of fracture healing (i.e., callus strength) may be experienced at longer time points under partial loading conditions given the increase in osteoblast numbers and bone formation parameters following SWT and LIPUS. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:921-929, 2018.
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Affiliation(s)
- Benjamin C Gadomski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Ft Collins, Colorado
| | - Kirk C McGilvray
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Ft Collins, Colorado
| | - Jeremiah T Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Ft Collins, Colorado
| | - Ross H Palmer
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Ft Collins, Colorado
| | - Jian Jiao
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Xiaofei Li
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Yi-Xian Qin
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Christian M Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Ft Collins, Colorado
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Liu Y, Chen X, Guo A, Liu S, Hu G. Quantitative Assessments of Mechanical Responses upon Radial Extracorporeal Shock Wave Therapy. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2018; 5:1700797. [PMID: 29593978 PMCID: PMC5867036 DOI: 10.1002/advs.201700797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Indexed: 05/03/2023]
Abstract
Although radial extracorporeal shock wave therapy (rESWT) has been widely used to treat orthopedic disorders with promising clinical results, rESWT largely relies on clinicians' personal experiences and arbitrary judgments, without knowing relationships between administration doses and effective doses at target sites. In fact, practitioners lack a general and reliable way to assess propagation and distribution of pressure waves inside biological tissues quantitatively. This study develops a methodology to combine experimental measurements and computational simulations to obtain pressure fields from rESWT through calibrating and validating computational models with experimental measurements. Wave pressures at the bottom of a petri dish and inside biological tissues are measured, respectively, by attaching and implanting flexible membrane sensors. Detailed wave dynamics are simulated through explicit finite element analyses. The data decipher that waves from rESWT radiate directionally and can be modeled as acoustic waves generated from a vibrating circular piston. Models are thus established to correlate pressure amplitudes at the bottom of petri dishes and in the axial direction of biological tissues. Additionally, a pilot simulation upon rESWT for human lumbar reveals a detailed and realistic pressure field mapping. This study will open a new avenue of personalized treatment planning and mechanism research for rESWT.
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Affiliation(s)
- Yajun Liu
- Orthopedic Shock Wave Treatment CenterSpine Surgery DepartmentBeijing Jishuitan HospitalBeijing100035China
| | - Xiaodong Chen
- The State Key Laboratory of Nonlinear MechanicsBeijing Key Laboratory of Engineered Construction and MechanobiologyInstitute of MechanicsChinese Academy of SciencesBeijing100190China
- School of Engineering ScienceUniversity of Chinese Academy of SciencesBeijing100049China
| | - Anyi Guo
- Orthopedic Shock Wave Treatment CenterSpine Surgery DepartmentBeijing Jishuitan HospitalBeijing100035China
| | - Sijin Liu
- The State Key Laboratory of Environmental Chemistry and EcotoxicologyResearch Center for Eco‐Environmental SciencesChinese Academy of SciencesBeijing100085China
| | - Guoqing Hu
- The State Key Laboratory of Nonlinear MechanicsBeijing Key Laboratory of Engineered Construction and MechanobiologyInstitute of MechanicsChinese Academy of SciencesBeijing100190China
- School of Engineering ScienceUniversity of Chinese Academy of SciencesBeijing100049China
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Cirovic S, Gould DH, Park DH, Solan MC. Cadaveric experiments to evaluate pressure wave generated by radial shockwave treatment of plantar fasciitis. Foot Ankle Surg 2017; 23:285-289. [PMID: 29202989 DOI: 10.1016/j.fas.2016.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/28/2016] [Accepted: 08/18/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Shockwave treatment is increasingly used for plantar fasciitis and Achilles tendinopathy. To be effective it is believed that high pressure must be achieved in the tissues. We report on the first human cadaveric experiments to characterize pressure from radial shockwave therapy (rSWT) for plantar fasciitis. METHODS The pressure from rSWT was measured in two cadaveric feet using a needle hydrophone. Maximal pressure and energy flux were calculated from the measurements. RESULTS The pressure persisted longer than supposed, for up to 400μs. The peak negative pressure was up to two Mega Pascal. The predicted energy in the tissue strongly depended on the time interval used in calculations. CONCLUSIONS The measured pressure may be sufficiently high to cause cavitation in the tissue, which is one of the proposed healing mechanisms associated with rSWT. The results suggest that the energy is imparted to the tissues for much longer than previously thought.
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Affiliation(s)
- Srdjan Cirovic
- The Centre for Biomedical Engineering, Department of Mechanical Engineering Sciences, University of Surrey, Stag Hill, Guildford GU2 7XH, UK.
| | - David H Gould
- The Centre for Biomedical Engineering, Department of Mechanical Engineering Sciences, University of Surrey, Stag Hill, Guildford GU2 7XH, UK
| | - Derek H Park
- Trauma and Orthopaedic Surgery Department, Barnet Hospital, Wellhouse Lane, Barnet, London EN5 3DJ, UK
| | - Matthew C Solan
- The Centre for Biomedical Engineering, Department of Mechanical Engineering Sciences, University of Surrey, Stag Hill, Guildford GU2 7XH, UK; Department of Orthopeadic Surgery, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK
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Ma HZ, Zhou DS, Li D, Zhang W, Zeng BF. A histomorphometric study of necrotic femoral head in rabbits treated with extracorporeal shock waves. J Phys Ther Sci 2017; 29:24-28. [PMID: 28210032 PMCID: PMC5300798 DOI: 10.1589/jpts.29.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/20/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to determine the effectiveness and mechanisms of
extracorporeal shock wave therapy in the treatment of femoral head osteonecrosis.
[Subjects and Methods] Histomorphometric analysis of necrotic femoral head in rabbits
treated with shock waves was performed. Bilateral osteonecrosis of femoral heads was
induced with methylprednisolone and lipopolysaccharide in eight rabbits. The left limb
(study side) received shock waves to the femoral head. The right limb (control side)
received no shock waves. Biopsies of the femoral heads were performed at 12 weeks after
shock wave therapy. [Results] Necrotic femoral heads treated with shock waves, compared
with controls, had higher bone volume per tissue volume, trabecular thickness, trabecular
number, osteoblast surface/bone surface, osteoid surface/bone surface, osteoid thickness,
mineralizing surface/bone surface, mineralizing apposition rate, and bone formation rate.
However, trabecular separation was lower in shock wave-treated femoral heads than in
controls. Eroded surface/bone surface and osteoclast surface/bone surface did not differ
significantly between groups. [Conclusion] The bone mass of necrotic femoral heads treated
with shock waves increases. Extracorporeal shock wave may promote bone repair in necrotic
femoral heads through the proliferation and activation of osteoblasts.
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Affiliation(s)
- Huan-Zhi Ma
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University, China
| | - Dong-Sheng Zhou
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University, China
| | - Dong Li
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University, China
| | - Wei Zhang
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University, China
| | - Bing-Fang Zeng
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University, China
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Sansone V, Romeo P, Lavanga V. Extracorporeal Shock Wave Therapy Is Effective in the Treatment of Bone Marrow Edema of the Medial Compartment of the Knee: A Comparative Study. Med Princ Pract 2017; 26:23-29. [PMID: 27784022 PMCID: PMC5588340 DOI: 10.1159/000452836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 10/25/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To test the hypothesis that shock wave therapy can produce a statistically significant improvement in symptoms and imaging features of the knee bone marrow edema syndrome (BMES) within 6 months of treatment. SUBJECTS AND METHODS Eighty-six consecutive patients suffering from BMES of the medial compartment of the knee were prescribed a course of high-energy extracorporeal shock wave therapy (ESWT) and clinically followed up at 3 and 6 months and finally from 14 to approximately 18 months after treatment. Thirty-one patients were unable to undergo ESWT but returned for the 6-month and final follow-up; these were referred to as the conservative (control) group, while the other 55 patients constituted the ESWT group. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Visual Analog Scale (VAS) score of each patient were calculated at every follow-up. The BME area was assessed using magnetic resonance imaging before treatment and at the 6-month follow-up. RESULTS Statistically significant improvements were observed in clinical scores and in the BME area for both the ESWT and the control group (p < 0.05). The improvements in the ESWT group were statistically better in all parameters compared with the control group: the ESWT group had a reduction in the BME area of 86% versus 41% in the control group, the VAS pain score improved by 88% in the ESWT group versus 42% in the control group, and the WOMAC score improved by 65% in the ESWT group versus 22% in the control group. Clinical scores were significantly better for patients with medial tibial lesions in the ESWT group. CONCLUSION In this study, ESWT reduced pain and the BME area in the knee, with significant clinical improvement noticed 3 months after treatment.
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Affiliation(s)
- Valerio Sansone
- Department of Orthopedics, Università degli Studi di Milano, Milan, Italy
- Istituto Ortopedico Galeazzi IRCCS, Milan, Italy
- *Valerio Sansone, MD, Istituto Ortopedico Galeazzi IRCCS, Via Riccardo Galeazzi 4, IT–20161 Milano (Italy), E-Mail
| | - Pietro Romeo
- Istituto Ortopedico Galeazzi IRCCS, Milan, Italy
| | - Vito Lavanga
- Department of Orthopedics, Università degli Studi di Milano, Milan, Italy
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Extracorporeal shockwave therapy (ESWT) ameliorates healing of tibial fracture non-union unresponsive to conventional therapy. Injury 2016; 47:1506-13. [PMID: 27158008 DOI: 10.1016/j.injury.2016.04.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/29/2016] [Accepted: 04/11/2016] [Indexed: 02/02/2023]
Abstract
Tibial non-unions are common cause of demanding revision surgeries and are associated with a significant impact on patients' quality of life and health care costs. Extracorporeal shockwave therapy (ESWT) has been shown to improve osseous healing in vitro and in vivo. The main objective of present study was to evaluate the efficacy of ESWT in healing of tibial non-unions unresponsive to previous surgical and non-surgical measures. A retrospective multivariant analysis of a prospective open, single-centre, clinical trial of tibia non-union was conducted. 56 patients with 58 eligible fractures who met the FDA criteria were included. All patients received 3000-4000 impulses of electrohydraulic shockwaves at an energy flux density of 0.4mJ/mm(2) (-6dB). On average patients underwent 1.9 times (±1.3SD) surgical interventions prior to ESWT displaying the rather negatively selected cohort and its limited therapy responsiveness. In 88.5% of patients receiving ESWT complete bone healing was observed after six months irrespective of underlying pathology. The multivariant analysis showed that time of application is important for therapy success. Patients achieving healing received ESWT earlier: mean number of days between last surgical intervention and ESWT (healed - 355.1 days±167.4SD vs. not healed - 836.7 days±383.0SD; p<0.0001). ESWT proved to be a safe, effective and non-invasive treatment modality in tibial non-unions recalcitrant to standard therapies. The procedure is well tolerated, time-saving, lacking side effects, with potential to significantly decrease health care costs. Thus, in our view, ESWT should be considered the treatment of first choice in established tibial non-unions.
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Rinella L, Marano F, Berta L, Bosco O, Fraccalvieri M, Fortunati N, Frairia R, Catalano MG. Extracorporeal shock waves modulate myofibroblast differentiation of adipose-derived stem cells. Wound Repair Regen 2016; 24:275-86. [DOI: 10.1111/wrr.12410] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 01/20/2016] [Indexed: 01/05/2023]
Affiliation(s)
| | | | | | - Ornella Bosco
- Department of Medical Sciences; University of Turin; Italy
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Dias Dos Santos PR, De Medeiros VP, Freire Martins de Moura JP, Eduardo da Silveira Franciozi C, Nader HB, Faloppa F. Effects of shock wave therapy on glycosaminoglycan expression during bone healing. Int J Surg 2015; 24:120-3. [DOI: 10.1016/j.ijsu.2015.09.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/27/2015] [Accepted: 09/22/2015] [Indexed: 11/16/2022]
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Shock wave as biological therapeutic tool: From mechanical stimulation to recovery and healing, through mechanotransduction. Int J Surg 2015; 24:147-53. [PMID: 26612525 DOI: 10.1016/j.ijsu.2015.11.030] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/28/2015] [Accepted: 11/09/2015] [Indexed: 02/07/2023]
Abstract
Extracorporeal Shock Wave Therapy (ESWT) is a form of "mechanotherapy", that, from its original applications as urological lithotripsy, gained the field of musculo-skeletal diseases as Orthotripsy (mainly tendinopaties and bone regenerative disorders) and Regenerative Medicine as well. The mechanisms of action of Shock Waves (SW), when applied in non-urological indications, are not related to the direct mechanical effect, but to the different pathways of biological reactions, that derive from that acoustic stimulations, through "mechano-transduction". So, the "mechanical model" of urological lithotripsy has been substituted by a "biological model", also supported by current knowledge in "mechanobiology", the emerging multidisciplinary field of science that investigates how physical forces and changes in cell/tissue mechanics can influence the tissue development, physiology and diseases. Although some details are still under study, it is known that SW are able to relief pain, as well to positively regulate inflammation (probably as immunomodulator), to induce neoangiogenesis and stem cells activities, thus improving tissue regeneration and healing. ESWT can be nowadays considered an effective, safe, versatile, repeatable, noninvasive therapy for the treatment of many musculo-skeletal diseases, and for some pathological conditions where regenerative effects are desirable, especially when some other noninvasive/conservative therapies have failed. Moreover, based on the current knowledge in SW mechanobiology, it seems possible to foresee new interesting and promising applications in the fields of Regenerative Medicine, tissue engineering and cell therapies.
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Alkhamaali ZK, Crocombe AD, Solan MC, Cirovic S. Finite element modelling of radial shock wave therapy for chronic plantar fasciitis. Comput Methods Biomech Biomed Engin 2015; 19:1069-78. [PMID: 26465270 DOI: 10.1080/10255842.2015.1096348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Therapeutic use of high-amplitude pressure waves, or shock wave therapy (SWT), is emerging as a popular method for treating musculoskeletal disorders. However, the mechanism(s) through which this technique promotes healing are unclear. Finite element models of a shock wave source and the foot were constructed to gain a better understanding of the mechanical stimuli that SWT produces in the context of plantar fasciitis treatment. The model of the shock wave source was based on the geometry of an actual radial shock wave device, in which pressure waves are generated through the collision of two metallic objects: a projectile and an applicator. The foot model was based on the geometry reconstructed from magnetic resonance images of a volunteer and it comprised bones, cartilage, soft tissue, plantar fascia, and Achilles tendon. Dynamic simulations were conducted of a single and of two successive shock wave pulses administered to the foot. The collision between the projectile and the applicator resulted in a stress wave in the applicator. This wave was transmitted into the soft tissue in the form of compression-rarefaction pressure waves with an amplitude of the order of several MPa. The negative pressure at the plantar fascia reached values of over 1.5 MPa, which could be sufficient to generate cavitation in the tissue. The results also show that multiple shock wave pulses may have a cumulative effect in terms of strain energy accumulation in the foot.
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Affiliation(s)
- Zaied K Alkhamaali
- a The Centre for Biomedical Engineering , University of Surrey , Guildford , UK.,b Department of Mechanical Engineering Sciences , University of Surrey , Guildford , UK
| | - Andrew D Crocombe
- a The Centre for Biomedical Engineering , University of Surrey , Guildford , UK
| | - Matthew C Solan
- c Department of Orthopaedic Surgery , Royal Surrey County Hospital, Guildford , UK
| | - Srdjan Cirovic
- a The Centre for Biomedical Engineering , University of Surrey , Guildford , UK.,b Department of Mechanical Engineering Sciences , University of Surrey , Guildford , UK
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Effect of shock waves on macrophages: A possible role in tissue regeneration and remodeling. Int J Surg 2015; 24:124-30. [PMID: 26291028 DOI: 10.1016/j.ijsu.2015.07.719] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 07/19/2015] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Extracorporeal Shock Wave Therapy (ESWT) is broadly used as a non-surgical therapy in various diseases for its pro-angiogenic and anti-inflammatory effects. However, the molecular mechanisms translating tissue exposure to shock waves (SW) in a biological response with potential therapeutic activity are largely unknown. As macrophages take part in both the onset and amplification of the inflammatory response, and well in its resolution, we investigated the effect of SW on their biology. METHODS Human monocyte-derived macrophages were polarized to classic (M1) pro-inflammatory macrophages or alternative (M2) anti-inflammatory macrophages and exposed to SW ad different intensities. Expression levels of marker genes of macrophage activation were measured by qPCR at different time points. RESULTS SW did not induce activation of resting macrophages at any energy level used. Conversely, when used at low energy SW caused a significant inhibition of some M1 marker genes (CD80, COX2, CCL5) in M1 macrophages and a significant synergistic effect for some M2 marker genes (ALOX15, MRC1, CCL18) in M2 macrophages. SW also affected cytokine and chemokine production, inducing in particular a significant increase in IL-10 and reduction in IL-1β production. CONCLUSIONS Macrophage exposure to low energy SW dampens the induction of the pro-inflammatory profile characterizing M1 macrophages and promotes the acquisition of an anti-inflammatory profile synergizing with macrophage alternative activation.
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Pemberton GD, Childs P, Reid S, Nikukar H, Tsimbouri PM, Gadegaard N, Curtis ASG, Dalby MJ. Nanoscale stimulation of osteoblastogenesis from mesenchymal stem cells: nanotopography and nanokicking. Nanomedicine (Lond) 2015; 10:547-60. [PMID: 25723089 DOI: 10.2217/nnm.14.134] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
AIM Mesenchymal stem cells (MSCs) have large regenerative potential to replace damaged cells from several tissues along the mesodermal lineage. The potency of these cells promises to change the longer term prognosis for many degenerative conditions currently suffered by our aging population. We have endeavored to demonstrate our ability to induce osteoblatogenesis in MSCs using high-frequency (1000-5000 Hz) piezo-driven nanodisplacements (16-30 nm displacements) in a vertical direction. MATERIALS & METHODS Osteoblastogenesis has been determined by the upregulation of osteoblasic genes such as osteonectin (ONN), RUNX2 and Osterix, assessed via quantitative real-time PCR; the increase of osteocalcin (OCN) and osteopontin (OPN) at the protein level and the deposition of calcium phosphate determined by histological staining. RESULTS Intriguingly, we have observed a relationship between nanotopography and piezo-stimulated mechanotransduction and possibly see evidence of two differing osteogenic mechanisms at work. These data provide confidence in nanomechanotransduction for stem cell differentiation without dependence on soluble factors and complex chemistries. CONCLUSION In the future it is envisaged that this technology may have beneficial therapeutic applications in the healthcare industry, for conditions whose overall phenotype maybe characterized by weak or damaged bones (e.g., osteoporosis and bone fractures), and which can benefit from having an increased number of osteoblastic cells in vivo.
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Affiliation(s)
- Gabriel D Pemberton
- Centre for cell Engineering, Institute for Molecular, Cell & Systems Biology, College of Medical, Veterinary & Life Sciencies, University of Glasgow, Glasgow, G12 8QQ, UK
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Hazan-Molina H, Aizenbud I, Kaufman H, Teich S, Aizenbud D. The Influence of Shockwave Therapy on Orthodontic Tooth Movement Induced in the Rat. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 878:57-65. [DOI: 10.1007/5584_2015_179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hazan-Molina H, Reznick AZ, Kaufman H, Aizenbud D. Periodontal cytokines profile under orthodontic force and extracorporeal shock wave stimuli in a rat model. J Periodontal Res 2014; 50:389-96. [PMID: 25073624 DOI: 10.1111/jre.12218] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Extracorporeal shock wave therapy has been used in various clinical conditions as a result of its ability to stimulate healing processes in acute and chronic inflammatory states. Orthodontic force application triggers an inflammatory reaction in the periodontal tissue surrounding the involved teeth, resulting in tooth movement. Preliminary work revealed that extracorporeal shock wave therapy increased the expression of the inflammatory cytokines involved. Our aim was to investigate the expression of inflammatory cytokines in the periodontal tissues following orthodontic force induction, with and without shock wave therapy, in experimental rats. MATERIAL AND METHODS An orthodontic appliance was fabricated and applied between the molars and the incisors of adult Wistar rats. In conjunction with orthodontic force commencement, the rats were treated with a single episode of 1000 shock waves. Every day, during the 3 d of the study, rats were killed and the immunolocalization of RANKL, interleukin (IL)-1β, IL-6 and tumor necrosis factor-alpha was evaluated. RESULTS The percentage of the area staining positively for all inflammatory cytokines during the first 2 d decreased statistically significantly more in the shock wave-treated group compared with the nontreated control group. On the first day, the percentage of the area staining positively for IL-1β and RANKL on the compression side peaked in both groups, with a sequential rise in the number of TRAP-positive cells. CONCLUSION The induction of shock wave therapy during orthodontic tooth movement influences the expression of different inflammatory cytokines in the tissue and might alter the expected periodontal remodeling rate.
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Affiliation(s)
- H Hazan-Molina
- Orthodontic and Craniofacial Department, Graduate School of Dentistry, Rambam Health Care Campus and the Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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25
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Effectiveness of extracorporeal shock wave therapy in bone marrow edema syndrome of the hip. Rheumatol Int 2014; 34:1513-8. [DOI: 10.1007/s00296-014-2991-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/12/2014] [Indexed: 11/25/2022]
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Romeo P, Lavanga V, Pagani D, Sansone V. Extracorporeal shock wave therapy in musculoskeletal disorders: a review. Med Princ Pract 2014; 23:7-13. [PMID: 24217134 PMCID: PMC5586835 DOI: 10.1159/000355472] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 09/05/2013] [Indexed: 01/03/2023] Open
Abstract
Regenerative therapy is one of the most challenging and intriguing branches of modern medicine. Basic research has demonstrated the effectiveness of extracorporeal shockwaves (ESWT) in stimulating biological activities that involve intra-cell and cell-matrix interactions. These interactions are at the basis of the current clinical applications, and open the horizons to new applications in tissue regeneration. It is also feasible that shock waves could be used to treat various orthopaedic pathologies, removing the need for surgery. However, suitable translational studies need to be performed before ESWT can become a valid alternative to surgery.
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Affiliation(s)
| | | | | | - Valerio Sansone
- *Valerio Sansone, MD, Istituto Ortopedico Galeazzi IRCCS, Via Riccardo Galeazzi 4, IT−20161 Milan (Italy), E-Mail
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Nikukar H, Reid S, Tsimbouri PM, Riehle MO, Curtis ASG, Dalby MJ. Osteogenesis of mesenchymal stem cells by nanoscale mechanotransduction. ACS NANO 2013; 7:2758-67. [PMID: 23442213 DOI: 10.1021/nn400202j] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
It is likely that mesenchymal stem cells will find use in many autologous regenerative therapies. However, our ability to control cell stem growth and differentiation is presently limited, and this is a major hurdle to the clinical use of these multipotent cells especially when considering the desire not to use soluble factors or complex media formulations in culture. Also, the large number of cells required to be clinically useful is currently a hurdle to using materials-based (stiffness, chemistry, nanotopography, etc.) culture substrates. Here we give a first demonstration of using nanoscale sinusoidal mechanotransductive protocols (10-14 nm displacements at 1 kHz frequency), "nanokicking", to promote osteoblastogenesis in human mesenchymal stem cell cultures. On the basis of application of the reverse piezo effect, we use interferometry to develop the optimal stem cell stimulation conditions, allowing delivery of nanoscale cues across the entire surface of the Petri dishes used. A combination of immunofluorescence, PCR, and microarray has then been used to demonstrate osteoblastogenesis, and the arrays implicate RhoA as central to osteoblastic differentiation in agreement with materials-based strategies. We validate this with pharmacological inhibition of RhoA kinase. It is easy to envisage such stimulation protocols being up-scaled to form large-scale osteoblast bioreactors as standard cell culture plates and incubators are used in the protocol.
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Affiliation(s)
- Habib Nikukar
- Centre for Cell Engineering, Institute for Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, United Kingdom
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Hazan-Molina H, Reznick AZ, Kaufman H, Aizenbud D. Assessment of IL-1β and VEGF concentration in a rat model during orthodontic tooth movement and extracorporeal shock wave therapy. Arch Oral Biol 2013; 58:142-50. [DOI: 10.1016/j.archoralbio.2012.09.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 07/21/2012] [Accepted: 09/20/2012] [Indexed: 01/03/2023]
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Saggini R, Coco V, Di Pancrazio L, Megna M, Iodice P, Bellomo R. Long-Term Results of Rehabilitative Management with Extracorporeal Shockwave Therapy in Rotator Cuff Disease with Partial Tears. EUR J INFLAMM 2012. [DOI: 10.1177/1721727x1201000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study is to evaluate the effects of rehabilitative approach using MJS and dynamic antigravity postural system (SPAD) with extracorporeal Shockwave therapy (ESWT) on rotator cuff syndrome associated tendon supraspinatus and infraspinatus medium tear (1–3 cm) of the tendons. In the last few years, ESWT has been proposed as an elective treatment in somatic diseases with encouraging short-term results. For this study the authors enrolled 108 patients who underwent 3 treatments with ESWT associated with 24 rehabilitation sessions over 3 weeks. Outcome measures were the VAS for pain and the Constant Murley Scale. The outcomes were measured pre-training, post-training and at 2, 4, 6 month follow-ups. Additional follow-up evaluation sessions were performed every year for 5 years by a telephone interview to evaluate changes in pain and function and the efficacy of treatment. Our study shows that the therapeutic efficacy of rehabilitative approach with ESWT in the rotator cuff syndrome with medium tears persists over time and significantly improves the patient's quality of life. The results obtained are certainly to be attributed to the biological mechanisms that ESWT are able to engage in tissues of the rotator cuff. The results seen at the conclusion of the treatment were maintained over the following years, thanks to the use of MJS and SPAD. In our opinion a conservative treatment with extracorporeal shock-wave (ESW), dynamic antigravity postural system (SPAD) and multi joint system (MJS) should be considered as an alternative and effective treatment for rotator cuff syndromes with medium tears.
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Affiliation(s)
- R. Saggini
- Department of Neuroscience and Imaging, “G. d'Annunzio” University, Chieti, Italy
| | - V. Coco
- Degree Course in Physiotherapy, University of Catania, Catania, Italy
| | - L. Di Pancrazio
- Department of Medicine and Science of Aging “G. d'Annunzio” University, Chieti, Italy
| | - M. Megna
- Department of Neurological and Psychiatric Sciences, University of Bari “Aldo Mow”, Bari, Italy
| | - P. Iodice
- Department of Neuroscience and Imaging, “G. d'Annunzio” University, Chieti, Italy
| | - R.G. Bellomo
- Department of Medicine and Science of Aging “G. d'Annunzio” University, Chieti, Italy
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The Use of Extracorporeal Shock Wave-Stimulated Periosteal Cells for Orthotopic Bone Generation. Tissue Eng Part A 2012; 18:1500-8. [DOI: 10.1089/ten.tea.2011.0573] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cinar BM, Circi E, Guven G, Tuncay IC, Hersekli MA, Derincek A. Extracorporeal shock waves in articular cartilage defects in the rats. Musculoskelet Surg 2012; 96:23-28. [PMID: 21671100 DOI: 10.1007/s12306-011-0145-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 05/27/2011] [Indexed: 05/30/2023]
Abstract
Thirty adult Sprague-Dawley rats were used to assess the nature of healing tissues in hyaline cartilage defects and to compare the healing in defects treated with shock waves, with those in defects without treatment. A 2 × 2 mm cartilage defect with exposed cancellous bone was created in a nonweight-bearing area of each medial femoral condyle. Each right knee defect was received extracorporeal shock waves (Swiss Dolorclast) of 500 impulses in 5 min at 2 bar (comparative to 0.09 mJ/mm(2)), and the left knee defects were assigned as controls. The rat groups were sacrificed at 6 and 12 weeks postsurgery. Sections from each knee were stained with hematoxylin-eosin to analyze synovial adhesion, synovial thickness, bone maturation, and chondroid metaplasia and with masson trichrome to analyze collagen fiber intensity. There was not a significant difference found between the study and control groups (P > 0.05). Extracorporeal shock waves did not effect healing of the chondral defects.
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Affiliation(s)
- Bekir Murat Cinar
- Department of Orthopaedics and Traumatology, Baskent University Medical Faculty, Adana, Turkey.
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Ito K, Fukumoto Y, Shimokawa H. Extracorporeal Shock Wave Therapy for Ischemic Cardiovascular Disorders. Am J Cardiovasc Drugs 2011; 11:295-302. [DOI: 10.2165/11592760-000000000-00000] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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D'Agostino C, Romeo P, Amelio E, Sansone V. Effectiveness of ESWT in the treatment of Kienböck's disease. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1452-1456. [PMID: 21767905 DOI: 10.1016/j.ultrasmedbio.2011.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 05/25/2011] [Accepted: 06/01/2011] [Indexed: 05/31/2023]
Abstract
Kienböck's disease is a rare, painful disorder of the wrist that can seriously restrict the quality of life of patients who have the disease. Although a century has passed since the pathology was identified, its etiology is still uncertain, with mechanical, traumatic, vascular, and systemic factors all being advocated. Likewise, there is no consensus regarding treatment, and no approach-either conservative or surgical-has been demonstrated to yield significantly better outcomes. Extracorporeal shock wave treatment (ESWT) has been effective in stimulating fracture healing, and it has been adopted as a therapy to restore vascular supply in those bone conditions characterized by vascular impairment. We report our experience in treating 22 patients with Kienböck's disease at various stages with high-energy shock waves. Our results indicate that ESWT has a positive effect on pain and functional impairment of the wrist, and may delay surgical treatment. Further studies are necessary to understand the full potential of this therapeutic tool.
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Notarnicola A, Tamma R, Moretti L, Panella A, Dell'endice S, Zallone A, Moretti B. Effect of shock wave treatment on platelet-rich plasma added to osteoblast cultures. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:160-168. [PMID: 21084153 DOI: 10.1016/j.ultrasmedbio.2010.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 10/07/2010] [Accepted: 10/14/2010] [Indexed: 05/30/2023]
Abstract
The aim of this study was to verify the effects on osteoblast cultures of adding a platelet-rich plasma (PRP) concentrate pretreated with 500 shock wave (SW) at an energy flow density of 0.17 mJ/mm(2), emitted by an electromagnetic generator Minilith SL1 (STORZ, Germany), reproducing the conditions of our previous study in which we apply SW directly on osteoblasts. Real-time PCR showed that in osteoblast cultures with added PRP pretreated with SW, there was an increased expression at 48 h of insulin-like growth factor binding protein 3 (IGFBP-3) and runt-related transcription factor 2 (RUNX2) and at 72 h, of collagen type I, osteocalcin, insulin-like growth factor 1 (IGF-1) as well as IGFBP-3. Western blotting confirmed the increased protein synthesis of IGFBP-3. This experience suggests that extracorporeal shock wave treatment (ESWT) should stimulate osteogenesis also by indirect platelets-mediated network. It therefore seems possible that combining the two methods, ESWT and bioengineering procedures to infiltrate PRP and growth factors, could be a successful approach.
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Affiliation(s)
- Angela Notarnicola
- Department of Clinical Methodology and Surgical Techniques, Orthopedics Section, Faculty of Medicine and Surgery of University of Bari, General Hospital, Bari, Italy.
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Notarnicola A, Moretti L, Tafuri S, Gigliotti S, Russo S, Musci L, Moretti B. Extracorporeal shockwaves versus surgery in the treatment of pseudoarthrosis of the carpal scaphoid. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:1306-13. [PMID: 20691920 DOI: 10.1016/j.ultrasmedbio.2010.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Revised: 05/03/2010] [Accepted: 05/05/2010] [Indexed: 05/08/2023]
Abstract
The peculiar anatomical characteristics and precarious vascularization of the carpal scaphoid are responsible for a difficult healing of fractures and a fairly frequent subsequent evolution to pseudoarthrosis. Recently, extracorporeal shockwaves therapy (ESWT) has yielded encouraging results in the treatment of pseudoarthrosis of various bone segments. We report a retrospective study comparing the results of application of three sessions of shockwaves therapy (SW) with energy flux density (EFD) impulses of 0.09 (SD = 0.02) mJ/mm(2) ESWT emitted by an electromagnetic generator in 58 patients (group I) affected by pseudoarthrosis of the carpal scaphoid, with the results of surgical treatment consisting of stabilization and bone graft according to the Matti-Russe technique, performed in 60 subjects (controls, group II). There were no statistically significant differences in the mean duration of the pseudoarthrosis (p = 0.46), sex distribution (p = 0.41) and mean age at recruitment (p = 0.95) between the two patient groups. Posttreatment clinical-functional assessment, based on the Mayo Wrist Score, showed a significantly improved score, rising from 28-74.6 in group I already after 2 mo (p < 0.001), with 86.3% of the results judged as satisfactory or excellent; in group II the mean score rose from 27.5-74.2 after 2 mo, with 83.4% of the results judged as satisfactory or excellent (p < 0.001). At the same two-months follow-up (FU), radiographic consolidation was shown in 75.9% of patients in group I and 76.7% in group II. These improvements persisted at the subsequent controls at six and 12 mo in both groups. The Mayo Wrist Score and X-rays did not show statistically significant differences at the various FU visits in the two groups (p > 0.05). On the basis of our data, we can conclude that the results of ESWT are comparable with those of surgical stabilization and bone graft in the treatment of scaphoid pseudoarthrosis. In view of their minimal invasiveness, shockwaves should therefore be considered the treatment of choice of this disorder.
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Affiliation(s)
- A Notarnicola
- Department of Clinical Methodology and Surgical Techniques, Orthopedics Section, Faculty of Medicine and Surgery of University of Bari, General Hospital, Bari, Italy.
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Notarnicola A, Moretti L, Tafuri S, Panella A, Filipponi M, Casalino A, Panella M, Moretti B. Shockwave therapy in the management of complex regional pain syndrome in medial femoral condyle of the knee. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:874-879. [PMID: 20447749 DOI: 10.1016/j.ultrasmedbio.2010.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/20/2010] [Accepted: 03/15/2010] [Indexed: 05/29/2023]
Abstract
The aim of this prospective study was to assess the efficacy of shockwave (SW) therapy in the management of complex regional pain syndrome (CRPS). In this study, 30 patients (pts) who were affected by CRPS of the medial femoral condyle and unresponsive to previous standard physiotherapeutic and pharmacological treatment underwent 3 SW sessions at 72-h intervals, each consisting of 4000 shocks emitted by a MiniLith SL1 Storz electromagnetic generator. An energy flux density (EFD) of 0.035 or 0.09 mJ/mm(2) was used, depending on how well the patient endured the pain during the treatment. Satisfactory results were observed in 76.7% of the cases (23 pts) at the 2-month follow-up (FU) visit, and in 80% (24 pts) at the 6-month FU visit. The therapeutic effects of SW were caused by decreasing pain. The significant improvements we obtained bear witness to the potential value of SW therapy in the management of CRPS.
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Affiliation(s)
- Angela Notarnicola
- Department of Clinical Methodology and Surgical Techniques, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, General Hospital, Italy.
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