Biophysical stimulation of bone and cartilage: state of the art and future perspectives

Abstract

Introduction Biophysical stimulation is a non-invasive therapy used in orthopaedic practice to increase and enhance reparative and anabolic activities of tissue. Methods A sistematic web-based search for papers was conducted using the following titles: (1) pulsed electromagnetic field (PEMF), capacitively coupled electrical field (CCEF), low intensity pulsed ultrasound system (LIPUS) and biophysical stimulation; (2) bone cells, bone tissue, fracture, non-union, prosthesis and vertebral fracture; and (3) chondrocyte, synoviocytes, joint chondroprotection, arthroscopy and knee arthroplasty. Results Pre-clinical studies have shown that the site of interaction of biophysical stimuli is the cell membrane. Its effect on bone tissue is to increase proliferation, synthesis and release of growth factors. On articular cells, it creates a strong A 2A and A 3 adenosine-agonist effect inducing an anti-inflammatory and chondroprotective result. In treated animals, it has been shown that the mineralisation rate of newly formed bone is almost doubled, the progression of the osteoarthritic cartilage degeneration is inhibited and quality of cartilage is preserved. Biophysical stimulation has been used in the clinical setting to promote the healing of fractures and non-unions. It has been successfully used on joint pathologies for its beneficial effect on improving function in early OA and after knee surgery to limit the inflammation of periarticular tissues. Discussion The pooled result of the studies in this review revealed the efficacy of biophysical stimulation for bone healing and joint chondroprotection based on proven methodological quality. Conclusion The orthopaedic community has played a central role in the development and understanding of the importance of the physical stimuli. Biophysical stimulation requires care and precision in use if it is to ensure the success expected of it by physicians and patients.

Bone Morphogenetic Protein-2 Signaling in the Osteogenic Differentiation of Human Bone Marrow Mesenchymal Stem Cells Induced by Pulsed Electromagnetic Fields

“…BMP2 treatment and exposure to PEMFs characterized by specific physical parameters are used in clinics to favor bone repair in critical conditions [2][3][4]8,19,21]. Among more than 20 identified BMPs, BMP2 is considered one of the most powerful inducing osteogenesis and since 2002 it has been approved for clinical use.…”

“…Generally bone fractures heal by standard clinical practices, although approximately 10% patients suffer from delayed unions or non-unions [1]. Electromagnetic field (EMF) exposure represents a safe and efficient non-surgical treatment in promoting bone ununited fracture healing in clinics [2][3][4]. The use of biophysical stimulation in clinical setting is supported by excellent results of in vivo and in vitro studies, which identified the EMF effects on the cells involved in bone repair processes, especially osteoblasts and mesenchymal stem cells (MSCs) [5][6][7][8].…”

Establishment of a Numerical Model to Design an Electro-Stimulating System for a Porcine Mandibular Critical Size Defect

“…Taking advantage of bone's bioelectric properties, electrical stimulation for bone regeneration was attempted as early as in the 1950s with Yasuda [22] as the "pioneer" in the field of bone bioelectricity and stimulation. Since then, accelerated bone regeneration due to electrical stimulation has been widely investigated in numerous in vitro, in vivo, in silico, and clinical studies [23,24].…”

Modern Physical Methods of Stimulating the Bone Tissue Healing Processes

“…Терапевтичний ефект низько-інтенсивних пульсуючих ультразвукових коливань полягає у мікромеханічному пошкодженні ділянки кісткового дефекту звуковою хвилею, що, у свою чергу, спричиняє низку змін на молекулярному та клітинному рівнях, які забезпечують процес загоєння [3,4]. Цей метод здебільшого застосовується при лікуванні переломів трубчастих кісток (зокрема у курців), а також показаний пацієнтам, яким було проведено остеотомію [5][6][7].…”