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Substantial Biomechanical Improvement by Extracorporeal Shockwave Therapy After Surgical Repair of Rodent Chronic Rotator Cuff Tears.

Abstract

BACKGROUND

Characteristics of chronic rotator cuff tears include continuous loss of tendon structure as well as tendon elasticity, followed by a high failure rate after surgical reconstruction. Several studies have already shown the beneficial effect of extracorporeal shockwave therapy (ESWT) on tissue regeneration in tendon pathologies.

HYPOTHESIS

ESWT improves biomechanical tendon properties as well as functional shoulder outcomes in chronic rotator cuff reconstruction in rodents.

STUDY DESIGN

Controlled laboratory study.

METHODS

After tendon detachment and 3 weeks of degeneration, a subsequent transosseous reattachment of the supraspinatus tendon was performed in 48 adult male Sprague-Dawley rats (n = 16 per group). Rodents were randomly assigned to 3 study groups: no ESWT/control group, intraoperative ESWT (IntraESWT), and intra- and postoperative ESWT (IntraPostESWT). Shoulder joint function, as determined by gait analysis, was assessed repeatedly during the observation period. Eight weeks after tendon reconstruction, the rats were euthanized, and biomechanical and gene expression analyses were performed.

RESULTS

Macroscopically, all repairs were intact at the time of euthanasia, with no ruptures detectable. Biomechanical analyses showed significantly improved load-to-failure testing results in both ESWT groups in comparison with the control group (control, 0.629; IntraESWT, 1.102; IntraPostESWT, 0.924; IntraESWT vs control, P≤ .001; IntraPostESWT vs control, P≤ .05). Furthermore, functional gait analyses showed a significant enhancement in intensity measurements for the IntraPostESWT group in comparison with the control group (P≤ .05). Gene expression analysis revealed no significant differences among the 3 groups.

CONCLUSION

Clearly improved biomechanical results were shown in the single-application and repetitive ESWT groups. Furthermore, functional evaluation showed significantly improved intensity measurements for the repetitive ESWT group.

CLINICAL RELEVANCE

This study underpins a new additional treatment possibility to prevent healing failure. Improved biomechanical stability and functionality may enable faster remobilization as well as an accelerated return to work and sports activities. Furthermore, as shockwave therapy is a noninvasive, easy-to-perform, cost-effective treatment tool with no undesired side effects, this study is of high clinical relevance in orthopaedic surgery. Based on these study results, a clinical study has already been initiated to clinically confirm the improved functionality by ESWT.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria. AUVA Trauma Center Vienna-Meidling, Vienna, Austria. Austrian Cluster for Tissue Regeneration, Vienna, Austria. Department of Orthopaedic Surgery II, Herz-Jesu Krankenhaus, Vienna, Austria.

    ,

    Austrian Cluster for Tissue Regeneration, Vienna, Austria. Department of Life Science Engineering, University of Applied Sciences Technikum Wien, Vienna, Austria.

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    Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria. Austrian Cluster for Tissue Regeneration, Vienna, Austria.

    ,

    Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria. Austrian Cluster for Tissue Regeneration, Vienna, Austria.

    ,

    Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria. AUVA Trauma Center Vienna-Meidling, Vienna, Austria. Austrian Cluster for Tissue Regeneration, Vienna, Austria.

    ,

    Austrian Cluster for Tissue Regeneration, Vienna, Austria. Department of Life Science Engineering, University of Applied Sciences Technikum Wien, Vienna, Austria.

    ,

    Metabolic Bone Diseases Unit, St Vincent Hospital, Vienna, Austria.

    ,

    Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria. Austrian Cluster for Tissue Regeneration, Vienna, Austria.

    ,

    AUVA Trauma Center Vienna-Meidling, Vienna, Austria. Center for the Musculoskeletal System, Medical Faculty, Sigmund Freud University, Vienna, Austria.

    Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria. AUVA Trauma Center Vienna-Meidling, Vienna, Austria. Austrian Cluster for Tissue Regeneration, Vienna, Austria.

    Source

    The American journal of sports medicine 47:9 2019 Jul pg 2158-2166

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31206305

    Citation

    Feichtinger, Xaver, et al. "Substantial Biomechanical Improvement By Extracorporeal Shockwave Therapy After Surgical Repair of Rodent Chronic Rotator Cuff Tears." The American Journal of Sports Medicine, vol. 47, no. 9, 2019, pp. 2158-2166.
    Feichtinger X, Monforte X, Keibl C, et al. Substantial Biomechanical Improvement by Extracorporeal Shockwave Therapy After Surgical Repair of Rodent Chronic Rotator Cuff Tears. Am J Sports Med. 2019;47(9):2158-2166.
    Feichtinger, X., Monforte, X., Keibl, C., Hercher, D., Schanda, J., Teuschl, A. H., ... Mittermayr, R. (2019). Substantial Biomechanical Improvement by Extracorporeal Shockwave Therapy After Surgical Repair of Rodent Chronic Rotator Cuff Tears. The American Journal of Sports Medicine, 47(9), pp. 2158-2166. doi:10.1177/0363546519854760.
    Feichtinger X, et al. Substantial Biomechanical Improvement By Extracorporeal Shockwave Therapy After Surgical Repair of Rodent Chronic Rotator Cuff Tears. Am J Sports Med. 2019;47(9):2158-2166. PubMed PMID: 31206305.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Substantial Biomechanical Improvement by Extracorporeal Shockwave Therapy After Surgical Repair of Rodent Chronic Rotator Cuff Tears. AU - Feichtinger,Xaver, AU - Monforte,Xavier, AU - Keibl,Claudia, AU - Hercher,David, AU - Schanda,Jakob, AU - Teuschl,Andreas H, AU - Muschitz,Christian, AU - Redl,Heinz, AU - Fialka,Christian, AU - Mittermayr,Rainer, Y1 - 2019/06/17/ PY - 2019/6/18/pubmed PY - 2019/6/18/medline PY - 2019/6/18/entrez KW - ESWT KW - biomechanical analysis KW - chronic rotator cuff tear KW - shockwave SP - 2158 EP - 2166 JF - The American journal of sports medicine JO - Am J Sports Med VL - 47 IS - 9 N2 - BACKGROUND: Characteristics of chronic rotator cuff tears include continuous loss of tendon structure as well as tendon elasticity, followed by a high failure rate after surgical reconstruction. Several studies have already shown the beneficial effect of extracorporeal shockwave therapy (ESWT) on tissue regeneration in tendon pathologies. HYPOTHESIS: ESWT improves biomechanical tendon properties as well as functional shoulder outcomes in chronic rotator cuff reconstruction in rodents. STUDY DESIGN: Controlled laboratory study. METHODS: After tendon detachment and 3 weeks of degeneration, a subsequent transosseous reattachment of the supraspinatus tendon was performed in 48 adult male Sprague-Dawley rats (n = 16 per group). Rodents were randomly assigned to 3 study groups: no ESWT/control group, intraoperative ESWT (IntraESWT), and intra- and postoperative ESWT (IntraPostESWT). Shoulder joint function, as determined by gait analysis, was assessed repeatedly during the observation period. Eight weeks after tendon reconstruction, the rats were euthanized, and biomechanical and gene expression analyses were performed. RESULTS: Macroscopically, all repairs were intact at the time of euthanasia, with no ruptures detectable. Biomechanical analyses showed significantly improved load-to-failure testing results in both ESWT groups in comparison with the control group (control, 0.629; IntraESWT, 1.102; IntraPostESWT, 0.924; IntraESWT vs control, P≤ .001; IntraPostESWT vs control, P≤ .05). Furthermore, functional gait analyses showed a significant enhancement in intensity measurements for the IntraPostESWT group in comparison with the control group (P≤ .05). Gene expression analysis revealed no significant differences among the 3 groups. CONCLUSION: Clearly improved biomechanical results were shown in the single-application and repetitive ESWT groups. Furthermore, functional evaluation showed significantly improved intensity measurements for the repetitive ESWT group. CLINICAL RELEVANCE: This study underpins a new additional treatment possibility to prevent healing failure. Improved biomechanical stability and functionality may enable faster remobilization as well as an accelerated return to work and sports activities. Furthermore, as shockwave therapy is a noninvasive, easy-to-perform, cost-effective treatment tool with no undesired side effects, this study is of high clinical relevance in orthopaedic surgery. Based on these study results, a clinical study has already been initiated to clinically confirm the improved functionality by ESWT. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/31206305/Substantial_Biomechanical_Improvement_by_Extracorporeal_Shockwave_Therapy_After_Surgical_Repair_of_Rodent_Chronic_Rotator_Cuff_Tears L2 - http://journals.sagepub.com/doi/full/10.1177/0363546519854760?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -