Influence of extracorporeal shock-wave application on normal bone in an animal model <i>in vivo</i>

Maier, Markus; Milz, Stefan; Tischer, Thomas; Münzing, Wolfgang; Manthey, N.; Stäbler, Axel; Holzknecht, N.; Weiler, Christoph; Nerlich, Andreas; Refior, H J; Schmitz, Christoph

doi:10.1302/0301-620x.84b4.0840592

Cited by 20 publications

(15 citation statements)

References 17 publications

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“…In contrast to previous studies demonstrating highenergy ESW (0.5 and 0.9 mJ/mm2 EFD) damaged bone tissue in rabbits [8,26], we showed that ESW treatment (0.16 mJ/mm2 EFD) did not induce side effects in rats. We speculate the discrepancy that influence of ESW on bone tissue depends on EFD and experimental animals.…”

Section: Discussioncontrasting

confidence: 99%

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Recruitment of mesenchymal stem cells and expression of TGF-$beta;1 and VEGF in the early stage of shock wave-promoted bone regeneration of segmental defect in rats

CHEN¹

2004

Journal of Orthopaedic Research

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Extracorporeal shock wave (ESW) treatment has recently been established as a method to enhance bone repair. Here, we reported that ESW-promoted healing of segmental defect via stimulation of mesenchymal stem cell recruitment and differentiation into bone forming cells. Rats with a segmental femoral defect were exposed to a single ESW treatment (0.16 mJ/mm?, 1 Hz, 500 impulses). Cell morphology and histological changes in the defect region were assessed 3, 7, 14, and 28 days post-treatment. Presence of mesenchymal stem cell was assayed by immuno-staing for RPS9, a recently discovered marker, and also production of TGF-PI and VEGF was monitored. ESW treatment increased total cell density and the proportion of RP59 positive cells in the defect region. High numbers of round-and cuboidal-shaped cells strongly expressing RPS9 were initially found. Later, the predominant cell type was spindle-shaped fibroblastic cells, subsequently, aggregates of osteogenic and chondrogenic cells were observed. Histological observation suggested that bone marrow stem cells were progressively differentiated into osteoblasts and chondrocytes. RP59 staining was initially intense and decreased with the appearance of expression depended on the differentiation states of osteogenic and chondrogenic cells during the regeneration phase. Mature chondrocytes and osteoblasts exhibited only slight RP59 immunoreactivity. Expression of TGF-PI and VEGF-A mRNA in the defect tissues was also significantly increased ( P < 0.05) after ESW treatment as determined by RT-PCR. Intensive TGF-PI immuno-reactivity was induced immediately, whereas a lag period was observed for VEGF-A. Chondrocytes and osteoblasts at the junction of ossified cartilage clearly exhibited VEGF-A expression. Our findings suggest that recruitment of meseoblasts at the junction of ossified cartilage clearly exhibited mesenchymal stem cells is a critical step in bone reparation that is enhanced by ESW treatment. TGF-P1 and VEGF-A are proposed to play a chemotactic and mitogenic role in recruitment and differentiation of mesenchymal stem cells.

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Section: Discussioncontrasting

confidence: 99%

“…In normal bone model, ESW potentially causes detachment of periosteum from bone and hematoma, as well as altered blood flow and bone metabolism in rabbits [8,26]. These effects may enhance recruitment and proliferation of marrow-, muscle-and periosteumderived osteogenic progenitor cells to the segmental defect.…”

Section: Discussionmentioning

confidence: 99%

Recruitment of mesenchymal stem cells and expression of TGF-$beta;1 and VEGF in the early stage of shock wave-promoted bone regeneration of segmental defect in rats

CHEN¹

2004

Journal of Orthopaedic Research

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“…ESW has been found t o be an effective non-invasive treatment for resolving calcifying tendinitis of shoulder, painful heel syndrome, lateral epicondylitis of the elbow and bony healing of nonunion [18,. ESW treatment has been found by scintography and sonography to affect local blood flow and metabolism of rabbit bone and Achilles tendon [20,26]. However, the cellular and biochemical mechanisms by which ESW enhance tendon repair remains to be determined.…”

Section: -8456mentioning

confidence: 99%

Extracorporeal shock waves promote healing of collagenase‐induced Achilles tendinitis and increase TGF‐β1 and IGF‐I expression

Chen

Wang

Yang

et al. 2004

Journal Orthopaedic Research

249

174

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Extracorporeal shock waves (ESW) have recently been used in resolving tendinitis. However, mechanisms by which ESW promote tendon repair is not fully understood. In this study, we reported that an optimal ESW treatment promoted healing of Achilles tendintis by inducing TGF-PI and IGF-I. Rats with the collagenease-induced Achilles tendinitis were given a single ESW treatment (0.16 mJ/mm' energy flux density) with 0, 200, 500 and 1000 impulses. Achilles tendons were subjected to biomechanical (load to failure and stiffness), biochemical properties (DNA, glycosaminoglycan and hydroxyproline content) and histological assessment. ESW with 200 impulses restored biomechanical and biochemical characteristics of healing tendons 12 weeks after treatment. However, ESW treatments with 500 and 1000 impulses elicited inhibitory effects on tendinitis repair. Histological observation demonstrated that ESW treatment resolved edema, swelling, and inflammatory cell infiltration in injured tendons. Lesion site underwent intensive tenocyte proliferation, neovascularization and progressive tendon tissue regeneration. Tenocytes at the hypertrophied cellular tissue and newly developed tendon tissue expressed strong proliferating cell nuclear antigen (PCNA) after ESW treatment, suggesting that physical ESW could increase the mitogenic responses of tendons. Moreover, the proliferation of tenocytes adjunct to hypertrophied cell aggregate and newly formed tendon tissue coincided with intensive TGF-PI and IGF-I expression. Increasing TGF-Dl expression was noted in the early stage of tendon repair, and elevated IGF-I expression was persisted throughout the healing period. Together, low-energy shock wave effectively promoted tendon healing. TGF-PI and IGF-I played important roles in mediating ESW-stimulated cell proliferation and tissue regeneration of tendon.

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“…The data revealed that approximately half of the pressure of the shock wave is absorbed after covering a 10 mm distance in the femoral head. Therefore, we assume that biological shock wave responses in terms of induction of vascular growth Ma et al, 2007) and bone growth (Maier et al, 2002;Wang et al, 2003) can be due to the shock wave pressure, if the applied energy is high enough. The threshold to induce new bone growth is supposed to be between 0.16 mJ/mm 2 used in animal experiments Wang et al, 2003;Ma et al, 2007) and 0.62 mmJ/mm 2 in clinical studies (Rompe et al, 2001;Schaden et al, 2001).…”

Section: Discussionmentioning

confidence: 99%

“…Positive effects of ESW on bone and vascular endothelial growth factor (VEGF) were demonstrated in vitro Aicher et al, 2006) and in vivo (Delius et al, 1995;Maier et al, 2002;Chen et al, 2004). An upregulation of VEGF following ESW treatment in necrotic femoral heads was shown in rabbits and a clinical trial displayed promising results of ESW treatment (Wang et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Shock wave therapy for femoral head necrosis—Pressure measurements inside the femoral head

Hausdorf

Lutz

Mayer-Wagner

et al. 2010

Journal of Biomechanics

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Influence of extracorporeal shock-wave application on normal bone in an animal model in vivo

Cited by 20 publications

References 17 publications

Recruitment of mesenchymal stem cells and expression of TGF-$beta;1 and VEGF in the early stage of shock wave-promoted bone regeneration of segmental defect in rats

Recruitment of mesenchymal stem cells and expression of TGF-$beta;1 and VEGF in the early stage of shock wave-promoted bone regeneration of segmental defect in rats

Extracorporeal shock waves promote healing of collagenase‐induced Achilles tendinitis and increase TGF‐β1 and IGF‐I expression

Shock wave therapy for femoral head necrosis—Pressure measurements inside the femoral head

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