Experimental studies on the biological effects of extracorporeal shock wave therapy on tendon models. A review of the literature

Abstract

SummaryEncouraging results using extracorporeal shock wave therapy (ESWT) for treating chronic tendinopathies were recently obtained, although the specific mechanisms by which it induces therapeutic effects remain largely unknown. In order to provide possible explications of such clinical efficacy, several reports have investigated the effects of ESWT on animal models and different kind of cultured cells. Our contribute in establishing the potential outcome of ESWT on human primary cultured tenocytes, derived from healthy compared to ruptured tendons, have supported the growing evidence that shock waves may supply faster post-injury recovery. The purpose of this review was to summarize and evaluate the available basic scientific evidences for using ESWT in tendon pathologies, suggesting possible shock waves-induced mechanisms of tissue repair.

Radial extracorporeal shockwave therapy for the treatment of finger tenosynovitis (trigger digit)

“…Evidence from a recent study of human tendons suggested that the mechanical stimulus of ESWT aids tendon remodeling by promoting inflammatory and catabolic processes that are associated with the removal of damaged matrix constituents 42. In vitro studies have further suggested that ESWT increases tendon healing through the stimulation of cell proliferation and motility, neovascularization, and expression of critical differentiation genes 43. However, these in vitro findings cannot be automatically generalized to the in vivo conditions in human tendinopathies.…”

Conservative treatment for Insertional Achilles Tendinopathy: platelet-rich plasma and focused shock waves. A retrospective study

“…Both are regenerative treatments but their mechanism of action in vivo is still unclear. The rational of applying in vivo ESWT on tendons is supported by the results obtained with shockwaves on models in vitro, such as enhancing cell proliferation, migration and secretory activity of human primary cultured tenocytes 44 . Basic science studies about PRP mechanism action show that growth factors in PRP significantly enhance the healing of tendon injuries such as tendinopathy 45 .…”

Clinical and Radiological Outcomes of Extracorporeal Shock Wave Therapy in Early-Stage Femoral Head Osteonecrosis

“…Experimental animal studies demonstrated a significant increase in the ingrowth of neovascularization associated with increased expressions of angiogenic growth indicators in tendon, bone, and tendon-bone interface, which might play a role in the improvement of blood supply and healing, which in turn can improve subchondral bone remodeling and prevent femoral head collapse [21–23]. A close relationship between the decrease of substance P release and consecutive pain reduction after shock wave treatment has also been reported [24–26].…”