Shoulder Rotator Cuff Responses to Extracorporeal Shockwave Therapy: Morphological and Immunohistochemical Analysis

Brañes, Julián; Contreras, Héctor R.; Cabello, Pablo; Antonic, Vlado; Guiloff, Leonardo; Brañes, Manuel

doi:10.1111/j.1758-5740.2012.00178.x

Cited by 18 publications

(12 citation statements)

References 41 publications

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“…An interesting clinical study by Brañes et al . reported positive effects of ESWT on the angiogenesis but also evaluated effects of shock wave therapy on lymph vessel formation.…”

Section: Potential Mechanism Of Shock Wave Therapymentioning

confidence: 99%

Extracorporeal shock wave therapy (ESWT) for wound healing: Technology, mechanisms, and clinical efficacy

Mittermayr

Antonic

Hartinger

et al. 2012

Wound Repair Regeneration

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179

138

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For almost 30 years, extracorporeal shock wave therapy has been clinically implemented as an effective treatment to disintegrate urinary stones. This technology has also emerged as an effective noninvasive treatment modality for several orthopedic and traumatic indications including problematic soft tissue wounds. Delayed/nonhealing or chronic wounds constitute a burden for each patient affected, significantly impairing quality of life. Intensive wound care is required, and this places an enormous burden on society in terms of lost productivity and healthcare costs. Therefore, cost-effective, noninvasive, and efficacious treatments are imperative to achieve both (accelerated and complete) healing of problematic wounds and reduce treatment-related costs. Several experimental and clinical studies show efficacy for extracorporeal shock wave therapy as means to accelerate tissue repair and regeneration in various wounds. However, the biomolecular mechanism by which this treatment modality exerts its therapeutic effects remains unclear. Potential mechanisms, which are discussed herein, include initial neovascularization with ensuing durable and functional angiogenesis. Furthermore, recruitment of mesenchymal stem cells, stimulated cell proliferation and differentiation, and anti-inflammatory and antimicrobial effects as well as suppression of nociception are considered important facets of the biological responses to therapeutic shock waves. This review aims to provide an overview of shock wave therapy, its history and development as well as its current place in clinical practice. Recent research advances are discussed emphasizing the role of extracorporeal shock wave therapy in soft tissue wound healing.

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“…An interesting clinical study by Brañes et al . reported positive effects of ESWT on the angiogenesis but also evaluated effects of shock wave therapy on lymph vessel formation.…”

Section: Potential Mechanism Of Shock Wave Therapymentioning

confidence: 99%

Extracorporeal shock wave therapy (ESWT) for wound healing: Technology, mechanisms, and clinical efficacy

Mittermayr

Antonic

Hartinger

et al. 2012

Wound Repair Regeneration

Self Cite

179

138

View full text Add to dashboard Cite

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“…However, due to physical attributes, radial pressure waves are differing significantly from shockwaves and do not meet the benefits of focused ESWT [ 11 ]. Brañes et al presented improved neovascularization and neolymphangiogenesis after rotator cuff repair in ESWT treated patients [ 38 ]. Recently, clear biomechanical and functional improvements in ESWT treated male Sprague-Dawley rats after repair of chronic rotator cuff tears have been shown [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Improved biomechanics in experimental chronic rotator cuff repair after shockwaves is not reflected by bone microarchitecture

et al. 2022

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Purpose The aim of this study was to investigate the effect of extracorporeal shockwave therapy (ESWT) on bone microstructure as well as the bone-tendon-interface and the musculo-tendinous transition zone to explain the previously shown improved biomechanics in a degenerative rotator cuff tear animal model. This study hypothesized that biomechanical improvements related to ESWT are a result of improved bone microstructure and muscle tendon properties. Methods In this controlled laboratory study unilateral supraspinatus (SSP) tendon detachment was performed in 48 male Sprague-Dawley rats. After a degeneration period of three weeks, SSP tendon was reconstructed transosseously. Rats were randomly assigned into three groups (n = 16 per group): control (noSW); intraoperative shockwave treatment (IntraSW); intra- and postoperative shockwave treatment (IntraPostSW). Eight weeks after SSP repair, all rats were sacrificed and underwent bone microstructure analysis as well as histological and immunohistochemical analyses. Results With exception of cortical porosity at the tendon area, bone microstructure analyses revealed no significant differences between the three study groups regarding cortical and trabecular bone parameters. Cortical Porosity at the Tendon Area was lowest in the IntraPostSW (p≤0.05) group. Histological analyses showed well-regenerated muscle and tendon structures in all groups. Immunohistochemistry detected augmented angiogenesis at the musculo-tendinous transition zone in both shockwave groups indicated by CD31 positive stained blood vessels. Conclusion In conclusion, bone microarchitecture changes are not responsible for previously described improved biomechanical results after shockwave treatment in rotator cuff repair in rodents. Immunohistochemical analysis showed neovascularization at the musculo-tendinous transition zone within ESWT-treated animals. Further studies focusing on neovascularization at the musculo-tendinous transition zone are necessary to explain the enhanced biomechanical and functional properties observed previously. Clinical relevance In patients treated with a double-row SSP tendon repair, an improvement in healing through ESWT, especially in this area, could prevent a failure of the medial row, which is considered a constantly observed tear pattern.

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“…Indeed, it has been proved that the biological effects are related to the pressure wave from [ 30 ]. BrañEs et al [ 31 ] proved that F-SWT was associated with increased neovascularization in rotator cuff tendinopathies. Tei et al [ 32 ] showed that CD34+ mononuclear cells were able to incorporate into neoangiogenic foci and participated in ligament tissue repair.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Focused Shockwave Therapy versus Radial Shockwave Therapy for Noncalcific Rotator Cuff Tendinopathies: A Randomized Clinical Trial

Shi

et al. 2021

BioMed Research International

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Background. The superiority of focused shockwave therapy (F-SWT) versus radial shockwave therapy (R-SWT) for treating noncalcific rotator cuff tendinopathies remains controversial. This study is aimed at comparing the effectiveness of F-SWT versus R-SWT for the management of noncalcific rotator cuff tendinopathies. Methods. A total of 46 patients affected by noncalcific rotator cuff tendinopathies were randomly divided into 2 groups of 23 individuals. Patients in group A received 4 sessions of F-SWT, while patients in group B were treated by 4 sessions of R-SWT. In each session, mean energy flux density (EFD) for F-SW 3000 shots was 0.09 ± 0.018 mJ/mm2 with 5.1 ± 0.5 Hz, while average pressure for R-SW 3000 shots was 4.0 ± 0.35 bar with 3.2 ± 0.0 Hz. Pain level and shoulder function were assessed with the numerical rating scale (NRS) and Constant-Murley Scale (CMS). The primary endpoint was the change in the mean NRS pain score from baseline to 24 weeks after the intervention. Secondary endpoints were changes in the mean NRS pain scores at all other follow-up points, changes in the mean CMS scores, and radiographic findings. Results. There were no significant differences between the two groups regarding NRS pain score and CMS score within 24 weeks after intervention (all p > 0.05 ). However, F-SWT resulted in significantly lower NRS compared with R-SWT at 24 weeks and 48 weeks after treatment ( 2.7 ± 1.0 vs. 4.5 ± 1.2 and 1.4 ± 1.0 vs. 3.0 ± 0.8 , respectively, all p < 0.001 ). Similar results were found in CMS changes and radiographic findings. Conclusions. Both F-SWT and R-SWT are effective in patients with noncalcific rotator cuff tendinopathy. F-SWT proved to be significantly superior to R-SWT at long-term follow-up (more than 24 weeks). This trial is registered with ChiCTR1900022932.

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Shoulder Rotator Cuff Responses to Extracorporeal Shockwave Therapy: Morphological and Immunohistochemical Analysis

Cited by 18 publications

References 41 publications

Extracorporeal shock wave therapy (ESWT) for wound healing: Technology, mechanisms, and clinical efficacy

Extracorporeal shock wave therapy (ESWT) for wound healing: Technology, mechanisms, and clinical efficacy

Improved biomechanics in experimental chronic rotator cuff repair after shockwaves is not reflected by bone microarchitecture

Effectiveness of Focused Shockwave Therapy versus Radial Shockwave Therapy for Noncalcific Rotator Cuff Tendinopathies: A Randomized Clinical Trial

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