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Xu Z, Li S, Wan L, Hu J, Lu H, Zhang T. Role of low-intensity pulsed ultrasound in regulating macrophage polarization to accelerate tendon-bone interface repair. J Orthop Res 2022; 41:919-929. [PMID: 36203341 DOI: 10.1002/jor.25454] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/22/2022] [Accepted: 09/22/2022] [Indexed: 02/04/2023]
Abstract
Low-intensity pulsed ultrasound (LIPUS) has been proven to accelerate the healing of the tendon-bone interface (TBI), and macrophages are considered to play an important regulatory role. This study was designed to explore the polarization of macrophages during treatment of TBI injury with LIPUS. In a rat model of rotator cuff tear, LIPUS or mock sonication (controls) was administered from 1 week postoperatively. The supraspinatus-supraspinatus tendon-humerus complexes were harvested for further evaluation at different time points for measures such as new bone formation, TBI maturity, ultimate failure load and stiffness, and types of macrophages. In vitro, bone marrow-derived macrophages were cultured, and polarization was identified after stimulation with or without LIPUS (the LIPUS or control groups, respectively). Two weeks posttreatment, the LIPUS group showed higher bone volume/total volume ratios and better TBI maturity scores. Six weeks posttreatment, the failure load of the LIPUS group was significantly higher than that of the control group. LIPUS also accelerated initial inflammatory macrophage accumulation and facilitated anti-inflammatory macrophage polarization (M2) in the late period. In the in vitro macrophage polarization model, the LIPUS group showed a higher proportion of M2 macrophages and mRNA expression of anti-inflammatory genes than the control group, while there was no significant difference in the proinflammatory macrophages between the two groups. Our observations revealed that macrophage polarization may be a potential mechanism of LIPUS treatment for TBI repair.
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Affiliation(s)
- Zihan Xu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shengcan Li
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Liyang Wan
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jianzhong Hu
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Tao Zhang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Wang W, Qin S, He P, Mao W, Chen L, Hua X, Zhang J, Xiong X, Liu Z, Wang P, Meng Q, Dong F, Li A, Chen H, Xu J. Type II Collagen Sponges Facilitate Tendon Stem/Progenitor Cells to Adopt More Chondrogenic Phenotypes and Promote the Regeneration of Fibrocartilage-Like Tissues in a Rabbit Partial Patellectomy Model. Front Cell Dev Biol 2021; 9:682719. [PMID: 34336835 PMCID: PMC8322758 DOI: 10.3389/fcell.2021.682719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/15/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Fibrocartilage transition zone (FC) is difficult to regenerate after surgical re-attachment of tendon to bone. Here, we investigated whether type II collagen-sponges (CII-sponges) facilitated tendon stem/progenitor cells (TSPCs) to adopt chondrogenic phenotypes and further observed if this material could increase the FC areas in bone-tendon junction (BTJ) injury model. Methods CII-sponges were made as we previously described. The appearance and pore structure of CII-sponges were photographed by camera and microscopies. The viability, proliferation, and differentiation of TSPCs were examined by LIVE/DEAD assay, alamarBlue, and PKH67 in vitro tracking. Subsequently, TSPCs were seeded in CII-sponges, Matrigel or monolayer, and induced under chondrogenic medium for 7 or 14 days before being harvested for qPCR or being transplanted into nude mice to examine the chondrogenesis of TSPCs. Lastly, partial patellectomy (PP) was applied to establish the BTJ injury model. CII-sponges were interposed between the patellar fragment and tendon, and histological examination was used to assess the FC regeneration at BTJ after surgery at 8 weeks. Results CII-sponges were like sponges with interconnected pores. TSPCs could adhere, proliferate, and differentiate in this CII-sponge up to 14 days at least. Both qPCR and immunostaining data showed that compared with TSPCs cultured in monolayer or Matrigel, cells in CII-sponges group adopted more chondrogenic phenotypes with an overall increase of chondrocyte-related genes and proteins. Furthermore, in PP injured model, much more new formed cartilage-like tissues could be observed in CII-sponges group, evidenced by a large amount of positive proteoglycan expression and typical oval or round chondrocytes in this area. Conclusion Our study showed that CII-sponges facilitated the TSPCs to differentiate toward chondrocytes and increased the area of FCs, which suggests that CII-sponges are meaningful for the reconstruction of FC at bone tendon junction. However, the link between the two phenomena requires further research and validation.
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Affiliation(s)
- Wen Wang
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.,Department of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Shengnan Qin
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Peiliang He
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.,Department of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Wei Mao
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.,Department of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Liang Chen
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.,Department of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Xing Hua
- Department of Pathology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Jinli Zhang
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Xifeng Xiong
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Zhihe Liu
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Pengzhen Wang
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Qingqi Meng
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Fei Dong
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Aiguo Li
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.,Department of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Honghui Chen
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Jiake Xu
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
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Histopathological changes in patellar tendon enthesis of rabbit induced by electrical stimulation intensity. J Orthop Sci 2020; 25:344-348. [PMID: 31101414 DOI: 10.1016/j.jos.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 04/06/2019] [Accepted: 04/09/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Enthesis injury is a common problem in athletes and workers, which is considered closely related to overuse. However, the early pathophysiologic changes of osteotendinous junction are not well understood, and moreover, few studies investigated the relationship between intensity and pathological changes. The purpose of this study was to evaluate microstructural changes induced by different loading intensities and to find out the threshold intensity. METHODS Forty-eight New Zealand White rabbits were randomly divided into six groups. One control group, the others were electrically stimulated to contract repetitively for 2 h per day, three days a week. 30% of peak tetanic force (7.06 N) was adopted to stimulate the rabbits in the 100% cyclic loading group. Other groups were stimulated with 20%, 40%, 60% and 80% of this force. After four weeks, prepared samples were stained with hematoxylin and eosin. RESULTS After 4 weeks of cyclic loading, the shape and the distribution of tendon cells in patellar enthesis changed, the arrangement of collagen fibers became disordered and the tidemark had become irregular or even disappeared. Different stimulus intensity caused a significant change of cell density in different groups (F = 10.19, P < 0.001). The cell densities of tendon were 34.3 ± 7.9 cells/100 μm2 (L60), 38.2 ± 5.9 cells/100 μm2 (L80), 43.8 ± 10.3 cells/100 μm2 (L100) respectively, which had significant difference with CON group 22.5 ± 3.5 cells/100 μm2. The thickness of fibrocartilage zone had no significant difference among the groups. CONCLUSIONS The changes of histomorphology with the increasing exercise intensity elucidated that the degree of enthesis microdamage was directly related to the intensity of exercises. The findings demonstrated that 18% (used in L60 group) of peak tetanic force was the threshold intensity which could induce pathological changes in enthesis in four weeks.
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Qiu S, Sun Y, Xu J, Wen G, Yu Y, Wu T, Chai Y. Ferulic acid improves self-renewal and differentiation of human tendon-derived stem cells by upregulating early growth response 1 through hypoxia. Genesis 2019; 57:e23291. [PMID: 31140714 DOI: 10.1002/dvg.23291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 12/12/2022]
Abstract
We aimed to investigate the potential beneficial effect of ferulic acid (FA) on stemness of human tendon-derived stem cells (hTSCs) in vitro and to elucidate the underlying molecular mechanism. The self-renewal ability of hTSCs was evaluated by colony formation and cell proliferation was determined by CCK-8 kit. Adipogenesis, osteogenesis, and chondrogenesis were determined by Oil Red O, Alizarin Red, and Alcian Blue stainings, respectively. Relative mRNA levels of PPARγ, Col2A1, Acan, Runx2, HIF1α, and EGR1 were measured with real-time PCR. Protein levels of HIF1α and EGR1 were detected by western blot. Direct binding of HIF1α with EGR1 promoter was analyzed by ChIP assay. Hypoxia-induced expression of EGR1 was interrogated by luciferase reporter assay. We demonstrated that FA treatment improved both self-renewal ability and multi-differentiation potential of hTSCs. FA induced hypoxia which in turn upregulated EGR1 expression via direct association with its hypoxia response element consensus sequence. Furthermore, we showed that both HIF1α and EGR1 were required for the enhancing effects of FA on hTSC self-renewal and differentiation. We hereby characterize the beneficial effect of FA on the stemness of hTSCs and highlight the critical role of HIF1α-EGR1 axis in this process.
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Affiliation(s)
- Shuo Qiu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yunchu Sun
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jia Xu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Gen Wen
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yaling Yu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tianyi Wu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yimin Chai
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Zhou Y, Hu J, Zhou J, Zeng Z, Cao Y, Wang Z, Chen C, Zheng C, Chen H, Lu H. Three-dimensional characterization of the microstructure in rabbit patella-patellar tendon interface using propagation phase-contrast synchrotron radiation microtomography. JOURNAL OF SYNCHROTRON RADIATION 2018; 25:1833-1840. [PMID: 30407196 DOI: 10.1107/s160057751801353x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 09/22/2018] [Indexed: 06/08/2023]
Abstract
Understanding the three-dimensional ultrastructure morphology of tendon-to-bone interface may allow the development of effective therapeutic interventions for enhanced interface healing. This study aims to assess the feasibility of propagation phase-contrast synchrotron radiation microtomography (PPC-SRµCT) for three-dimensional characterization of the microstructure in rabbit patella-patellar tendon interface (PPTI). Based on phase retrieval for PPC-SRµCT imaging, this technique is capable of visualizing the three-dimensional internal architecture of PPTI at a cellular high spatial resolution including bone and tendon, especially the chondrocytes lacuna at the fibrocartilage layer. The features on the PPC-SRµCT image of the PPTI are similar to those of a histological section using Safranin-O staining/fast green staining. The three-dimensional microstructure in the rabbit patella-patellar tendon interface and the spatial distributions of the chondrocytes lacuna and their quantification volumetric data are displayed. Furthermore, a color-coding map differentiating cell lacuna in terms of connecting beads is presented after the chondrocytes cell lacuna was extracted. This provides a more in-depth insight into the microstructure of the PPTI on a new scale, particularly the cell lacuna arrangement at the fibrocartilage layer. PPC-SRµCT techniques provide important complementary information to the conventional histological method for characterizing the microstructure of the PPTI, and may facilitate in investigations of the repair mechanism of the PPTI after injury and in evaluating the efficacy of a different therapy.
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Affiliation(s)
- Yongchun Zhou
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Jianzhong Hu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Jingyong Zhou
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Ziteng Zeng
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Yong Cao
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Zhanwen Wang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Can Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Cheng Zheng
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Huabin Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
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Wu T, Liu S, Wen G, Xu J, Yu Y, Chai Y. Celastrol improves self-renewal and differentiation of human tendon-derived stem cells by suppressing Smad7 through hypoxia. Stem Cell Res Ther 2017; 8:274. [PMID: 29202812 PMCID: PMC5715986 DOI: 10.1186/s13287-017-0724-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/29/2017] [Accepted: 11/10/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We aimed to evaluate the potential enhancing effect of celastrol on the stemness of human tendon-derived stem cells (hTSCs) in vitro and the underlying molecular mechanisms. METHODS The capability of hTSC self-renewal was assessed by cell proliferation and colony formation as determined with the CCK-8 kit. Adipogenesis, chondrogenesis, and osteogenesis were determined by Oil Red O, Alcian Blue, and Alizarin Red staining, respectively. The relative mRNA levels of Sox9, PPARγ, Runx2, Smad7, and HIF1α were determined by real-time polymerase chain reaction (PCR). The levels of Smad7 and HIF1α protein were measured by immunoblotting. The chromatin immunoprecipitation (ChIP) assay was used to assess the direct binding of HIF1α to the Smad7 promoter. Suppression of Smad7 induced by hypoxia was examined using the luciferase reporter assay. RESULTS We found that treatment with celastrol resulted in improvement in both the multi-differentiation potential and self-renewal capability of hTSCs. Celastrol elicited hypoxia and subsequently suppressed the expression of Smad7 through direct association with the hypoxia response element consensus sequence. Further, we demonstrated that both Smad7 and HIF1α were involved in the beneficial effects of celastrol on the differentiation and self-renewal of hTSCs. CONCLUSIONS We demonstrated the positive effect of celastrol on the stemness of hTSCs and elucidated the essential role of the HIF1α-Smad7 pathway in this process.
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Affiliation(s)
- Tianyi Wu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200033, People's Republic of China
| | - Shenghe Liu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200033, People's Republic of China
| | - Gen Wen
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200033, People's Republic of China
| | - Jia Xu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200033, People's Republic of China
| | - Yaling Yu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200033, People's Republic of China
| | - Yimin Chai
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200033, People's Republic of China.
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Lu H, Liu F, Chen H, Chen C, Qu J, Xu D, Zhang T, Zhou J, Hu J. The effect of low-intensity pulsed ultrasound on bone-tendon junction healing: Initiating after inflammation stage. J Orthop Res 2016; 34:1697-1706. [PMID: 26833973 PMCID: PMC6084317 DOI: 10.1002/jor.23180] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/21/2016] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to explore the effect of low-intensity pulsed ultrasound (LIPUS) treatment initiating after inflammation stage on the process of bone-tendon junction (BTJ) healing in a rabbit model. Thirty-six rabbits undergoing partial patellectomy were randomly divided into two groups: control and LIPUS. The period of initial inflammatory stage is 2 weeks. So LIPUS treatment was initiated at postoperative week 2 and continued until the patella-patellar tendon (PPT) complexes were harvested at postoperative weeks 4, 8, and 16. At each time point, the PPT complexes were harvested for qRT-PCR, histology, radiographs, synchroton radiation micro computed tomography (SR-µCT), and biomechanical testing. The qRT-PCR results showed that LIPUS treatment beginning at postoperative week 2 played an anti-inflammatory role in BTJ healing. Histologically, the LIPUS group showed more advanced remodeling of the lamellar bone and marrow cavity than the control group. The area and length of the new bone in the LIPUS group were significantly greater than the control group at postoperative weeks 8 and 16. SR-µCT demonstrated that new bone formation and remodeling in the LIPUS group were more advanced than the control group. Biomechanical test results demonstrated that the failure load, ultimate strength and energy at failure were significantly higher than those of the control group. In conclusion, LIPUS treatment beginning at postoperative week 2 was able to accelerate bone formation during the bone-tendon junction healing process and significantly improved the healing quality of BTJ injury. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1697-1706, 2016.
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Affiliation(s)
- Hongbin Lu
- Department of Sports MedicineResearch Center of Sports MedicineXiangya HospitalCentral South UniversityChangsha410008China
| | - Feifei Liu
- Department of Sports MedicineResearch Center of Sports MedicineXiangya HospitalCentral South UniversityChangsha410008China
| | - Huabin Chen
- Department of Sports MedicineResearch Center of Sports MedicineXiangya HospitalCentral South UniversityChangsha410008China
| | - Can Chen
- Department of Sports MedicineResearch Center of Sports MedicineXiangya HospitalCentral South UniversityChangsha410008China
| | - Jin Qu
- Department of Sports MedicineResearch Center of Sports MedicineXiangya HospitalCentral South UniversityChangsha410008China
| | - Daqi Xu
- Department of Sports MedicineResearch Center of Sports MedicineXiangya HospitalCentral South UniversityChangsha410008China
| | - Tao Zhang
- Department of Sports MedicineResearch Center of Sports MedicineXiangya HospitalCentral South UniversityChangsha410008China
| | - Jingyong Zhou
- Department of Sports MedicineResearch Center of Sports MedicineXiangya HospitalCentral South UniversityChangsha410008China
| | - Jianzhong Hu
- Department of Spine SurgeryResearch Center of Sports MedicineXiangya HospitalCentral South UniversityChangsha410008China
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Hu J, Zhang T, Xu D, Qu J, Qin L, Zhou J, Lu H. Combined magnetic fields accelerate bone‐tendon junction injury healing through osteogenesis. Scand J Med Sci Sports 2014; 25:398-405. [PMID: 24845774 DOI: 10.1111/sms.12251] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2014] [Indexed: 12/29/2022]
Affiliation(s)
- J. Hu
- Department of Sports Medicine, Research Center of Sports Medicine Xiangya Hospital Central South University Changsha Hunan China
- Department of Spine Surgery Xiangya Hospital Central South University Changsha Hunan China
| | - T. Zhang
- Department of Sports Medicine, Research Center of Sports Medicine Xiangya Hospital Central South University Changsha Hunan China
- Department of Spine Surgery Xiangya Hospital Central South University Changsha Hunan China
| | - D. Xu
- Department of Sports Medicine, Research Center of Sports Medicine Xiangya Hospital Central South University Changsha Hunan China
| | - J. Qu
- Department of Sports Medicine, Research Center of Sports Medicine Xiangya Hospital Central South University Changsha Hunan China
- Department of Spine Surgery Xiangya Hospital Central South University Changsha Hunan China
| | - L. Qin
- Department of Orthopaedics and Traumatology The Chinese University of Hong Kong Hong Kong SAR China
| | - J. Zhou
- Department of Sports Medicine, Research Center of Sports Medicine Xiangya Hospital Central South University Changsha Hunan China
| | - H. Lu
- Department of Sports Medicine, Research Center of Sports Medicine Xiangya Hospital Central South University Changsha Hunan China
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Chow DHK, Suen PK, Huang L, Cheung WH, Leung KS, Ng C, Shi SQ, Wong MWN, Qin L. Extracorporeal shockwave enhanced regeneration of fibrocartilage in a delayed tendon-bone insertion repair model. J Orthop Res 2014; 32:507-14. [PMID: 24375544 DOI: 10.1002/jor.22566] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 12/02/2013] [Indexed: 02/04/2023]
Abstract
Fibrous tissue is often formed in delayed healing of tendon bone insertion (TBI) instead of fibrocartilage. Extracorporeal shockwave (ESW) provides mechanical cues and upregulates expression of fibrocartilage-related makers and cytokines. We hypothesized that ESW would accelerate fibrocartilage regeneration at the healing interface in a delayed TBI healing model. Partial patellectomy with shielding at the TBI interface was performed on 32 female New Zealand White Rabbits for establishing this delayed TBI healing model. The rabbits were separated into the control and ESW group for evaluations at postoperative week 8 and 12. Shielding was removed at week 4 and a single ESW treatment was applied at week 6. Fibrocartilage regeneration was evaluated histomorphologically and immunohistochemically. Vickers hardness of the TBI matrix was measured by micro-indentation. ESW group showed higher fibrocartilage area, thickness, and proteoglycan deposition than the control in week 8 and 12. ESW increased expression of SOX9 and collagen II significantly in week 8 and 12, respectively. ESW group showed a gradual transition of hardness from bone to fibrocartilage to tendon, and had a higher Vickers hardness than the control group at week 12. In conclusion, ESW enhanced fibrocartilage regeneration at the healing interface in a delayed TBI healing model.
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Affiliation(s)
- Dick Ho Kiu Chow
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Chow DHK, Suen PK, Fu LH, Cheung WH, Leung KS, Wong MWN, Qin L. Extracorporeal shockwave therapy for treatment of delayed tendon-bone insertion healing in a rabbit model: a dose-response study. Am J Sports Med 2012; 40:2862-71. [PMID: 23075803 DOI: 10.1177/0363546512461596] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tendon-bone insertion (TBI) consists of both hard and soft tissues. TBI injury with delayed repair is not uncommon. High-dose extracorporeal shockwave (ESW) is effective for treating nonunion fracture, whereas low-dose ESW is used for tendinopathy therapy. The dosing effect of ESW on delayed TBI healing is lacking. HYPOTHESIS Low-dose ESW might have a healing enhancement effect comparable to that of high-dose ESW in treating delayed TBI healing. STUDY DESIGN Controlled laboratory study. METHODS Partial patellectomy was adopted to create a delayed TBI healing model by shielding the healing interface between tendon and bone. Ninety-six female New Zealand White rabbits with unilateral delayed TBI healing at the knee joint were divided into 3 groups: controls, low-dose ESW (LD-ESW; 0.06 mJ/mm(2), 4 Hz, 1500 impulses), and high-dose ESW (HD-ESW; 0.43 mJ/mm(2), 4 Hz, 1500 impulses). The TBI shielding was removed at week 4 after partial patellectomy, followed by treatment with control or ESW at week 6. The rabbits were euthanized at week 8 and week 12 for radiological, microarchitectural, histological, and mechanical assessments of healing tissues. RESULTS Radiologically, both the LD-ESW group and the HD-ESW group showed larger new bone area than the controls at week 8 and week 12. Microarchitectural measurements showed that the LD-ESW and HD-ESW groups had larger new bone volume than the controls at week 12. Histological assessments confirmed osteogenesis enhancement. Both the LD-ESW and HD-ESW groups showed significantly higher failure load at the TBI healing complex than the control group at week 12. No significant difference was detected between the 2 ESW treatment groups at week 8 or week 12. CONCLUSION Extracorporeal shockwave, a unique noninvasive physical modality, had similar effects between the low and high dose for treating delayed TBI healing. CLINICAL RELEVANCE Low-dose ESW for TBI delayed healing might be more desirable and have better compliance in clinical applications.
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Affiliation(s)
- Dick Ho Kiu Chow
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Zhao J, Zhang P, Qin L, Pan XH. Hypoxia is essential for bone-tendon junction healing: the molecular biological evidence. INTERNATIONAL ORTHOPAEDICS 2010; 35:925-8. [PMID: 21127862 DOI: 10.1007/s00264-010-1157-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 10/24/2010] [Accepted: 10/30/2010] [Indexed: 11/29/2022]
Abstract
Bone-tendon junction (BTJ) injury is difficult to cure due to its special anatomical structure. Most methods applied for BTJ injury treatment cannot lead to the perfect restoration of the fibrocartilage zone and perfect vascular regeneration, which are two important facets of BTJ reconstruction. Based on current research, hypoxia, which has been discovered to induce chondrogenesis and angiogenesis in vivo, plays an essential role in the tissue repair process. Consequently, it is reasonable to confirm that a hypoxic environment is the prerequisite condition to obtain physiological healing of BTJ injury. In this paper, the potential relationship between hypoxia and BTJ healing is discussed. Moreover, an operation model and possible drug application to obtain hypoxic conditions are delineated.
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Affiliation(s)
- Jian Zhao
- Orthopedic Department, Affiliated Hospital of Nantong University, Xisi Road 20, 226001 Nantong City, China
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Lui P, Zhang P, Chan K, Qin L. Biology and augmentation of tendon-bone insertion repair. J Orthop Surg Res 2010; 5:59. [PMID: 20727196 PMCID: PMC2931497 DOI: 10.1186/1749-799x-5-59] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 08/21/2010] [Indexed: 02/06/2023] Open
Abstract
Surgical reattachment of tendon and bone such as in rotator cuff repair, patellar-patella tendon repair and anterior cruciate ligament (ACL) reconstruction often fails due to the failure of regeneration of the specialized tissue ("enthesis") which connects tendon to bone. Tendon-to-bone healing taking place between inhomogenous tissues is a slow process compared to healing within homogenous tissue, such as tendon to tendon or bone to bone healing. Therefore special attention must be paid to augment tendon to bone insertion (TBI) healing. Apart from surgical fixation, biological and biophysical interventions have been studied aiming at regeneration of TBI healing complex, especially the regeneration of interpositioned fibrocartilage and new bone at the healing junction. This paper described the biology and the factors influencing TBI healing using patella-patellar tendon (PPT) healing and tendon graft to bone tunnel healing in ACL reconstruction as examples. Recent development in the improvement of TBI healing and directions for future studies were also reviewed and discussed.
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Affiliation(s)
- Ppy Lui
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
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