Important improvements of diseases of the rotator cuff supraspinatus tendons are seen after shock wave (SW) treatment. Neo-angiogenesis stimulation and hypercellularization result from short periods of treatment. The present work is an attempt to provide a first approach to these bioprocesses, most likely associated with structural aspects resulting from biochemical changes brought about by the SW. Immunohistochemical data indicate that collagen areas in the tissues are influenced the most by the SW. Presence of additional collagens I and III by the SW treatment is inferred from an observed increase of the tissue’s tinctorial properties. The tools selected for our studies are Ramanspectroscopy and the ultrasensitive surface-enhanced Raman scattering (SERS). Here we extract information from 1016 SERS spectra of 52 biopsies of human tendon tissues on Ag nanoparticles before and after the SW treatment. The spectral information is analyzed on the basis of Raman and SERS data of collagen types I and III and their most abundant amino acid components. SERS spectra of tissues reveal the presence of characteristic modes related mainly to amino acids. It has been found that the main differences between both tissue samples could be correlated with the structural conformational aspects of collagen.This work was financially supported by project FONDECYT
1090074. JJC acknowledges support from Becas Chile 2010 and
a doctoral fellowship from CONICYT. AEA acknowledges support
from AT-24090050 CONICYT and Becas Chile 2010
Background
High energy diaphyseal fractures constitute a complicated matter for trauma units and urgent medical and surgical decisions to prompt stabilization of these patients, might leave some skeletal distortions that affect bone union. The objective is to evaluate the safety and efficacy of extracorporeal shockwave therapy (ESWT), as a treatment for patients with atrophic or pseudoatrophic nonunion.
Patients and Methods
Case series which included 50 patients with nonseptic and stable nonunion diaphyseal fracture of femur and tibia. They received a defined protocol of up to three high-energy ESWT (10.000 shocks per session). Each patient was evaluated with x-rays or CT between 4 and 6 weeks, to determine the necessity to continue the protocol and obtain data about initial periosteal-endosteal responses and its evolution. We analyzed, semi-quantitatively, the volume of the fracture zone from initial CT using a mathematical method to calculate the volume in cylinders, and confronting this data with Winquist Classification.
Results
17/25 (68%) tibia and 13/25 (52%) femur nonunion were treated successfully. There were no complications during or after treatment.
Conclusions
ESWT induced bone healing in an average 60% of cases, which is consistent with current reported literature. CT studies gave some clues to patients’ real condition of fracture anatomy before treatment, allowing a better decision in the orientation of ESWT application for each case. Volumetric Fracture Analysis for Winquist Classification shown that ESWT was able to induce significant bone regeneration in fractures with high volume. This kind of therapy was well accepted in reluctant patients to invasive methods.
Highlights
Background
Application of extracorporeal shockwave therapy (ESWT) induces an improvement in tissue healing associated with augmented tissue perfusion. The present study aimed to investigate the responses of human rotator cuff tissue to the application of ESWT.
Methods
Thirty‐one consecutive patients with symptomatic rotator cuff tendinopathy with complete tears were approached and enrolled in the present study. Before surgical resolution, a single treatment of focused ESWT was offered to all patients. Ten patients accepted such treatment and 21 refused ESWT. Tendon tissue biopsies were collected for evaluation using haematoxylin and eosin and characterized according to the Riley Classification. Vascular volume area (VVA) was determined semi‐quantitatively and immunohistochemical (IHC) analysis included CD14, CD34, PCNA, Tenascin‐C and D2‐40 markers.
Results
Distribution of grade according to the Riley Classification with respect to study group was: Group A: Grade III (n = 9), Grade IV (n = 1); Group B: Grade III (n = 13), Grade IV (n = 8). Mean group‐specific VVA analysis was 18.47% and 7.03% for Group A and Group B, respectively. IHC Grade III protein staining was significantly more prevalent in Group A compared to Group B for CD34, PCNA, Tenascin‐C and D2‐40 (p < 0.05 for all comparisons).
Conclusions
ESWT is associated with increased neovascularization and neolymphangiogenesis in rotator cuff tendinopathy. IHC analysis suggests an improvement in healing response in the ESWT‐treated tendon.
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