Effect of Extracorporeal Shock Wave Therapy on Osteoblastlike Cells

Abstract

Extracorporeal shock wave therapy has been used increasingly in musculoskeletal disorders although its biologic mechanisms are not understood completely. The current study evaluated the effects of extracorporeal shock wave therapy on human osteoblastlike cells by using an electrohydraulic shock wave generator and comparing three energy levels. (Group A, 14 kV and 0.15 mJ/mm2; Group B, 21 kV and 0.31 mJ/mm2; Group C, 28 kV and 0.40 mJ/mm2; Control Group, no energy) and two total impulses (500, 1000) for each level. At the end of treatment, a reduction by approximately 76% was observed in Group C cell number versus basal value when compared with the other groups. Viability, biochemical activity, and gene expression of cultured cells were evaluated 24 and 48 hours after treatment. The viability test showed a decrease in Group C viability of approximately 54% at both culture times as compared with the other groups. Significant increases in nitric oxide, osteocalcin, and transforming growth factor-beta1 production ranging from 10% to 35% were found in Group A. All treated groups had lower C-terminal procollagen Type I values than the Control Group, but important increases were observed between 24 and 48 hours in all groups except Group C. This particular finding reveals that osteoblast differentiation in Group A is enhanced strongly during the first 24 hours after exposure leading after another 24 hours to an increase in C-terminal procollagen Type I production and consequently in bone matrix deposition. The current study showed that one of the most important aspects to be considered is not the total number of impulses used, but the energy level of the shock waves, therefore confirming that extracorporeal shock wave therapy has a dose-dependent initial destructive effect on cells when the selected energy is higher than 21 kV.

Electrohydraulic High-Energy Shock-Wave Treatment for Chronic Plantar Fasciitis

“…Several musculoskeletal entities that have been treated include calcific tendinitis of the shoulder, lateral epicondylitis, delayed union and nonunion of fractures, chronic plantar fasciitis, Achilles and patellar tendinopathies, and osteonecrosis of the femoral head [1][2][3][4][5][6][7][8][9] . Basic-science studies increasingly are providing an understanding of the physiologic mechanisms of pain relief (often immediate) and the modification and repair of the target tissue, which usually requires weeks to months to occur [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] . Extracorporeal shock-wave treatments have been applied to patients with chronic plantar fasciitis who have failed to respond to multiple conservative pharmacologic and therapeutic interventions [29][30][31][32][33][34][35][36][37][38] .…”

Ortopedi ve travmatolojide şok dalga tedavisi

“…[27,35] Martini ve arkadaşları, osteoblast hücre kültürüne şok dalgası uygulandığında, osteoblastlarda nitrik oksit, osteokalsin ve TGF-B1 üretiminin arttığı ve osteoblastik farklılaşmanın hızlandığını bildirmişlerdir. [29] Maier ve arkadaşları, tavşanlarda yaptıkları deneysel çalışmada, normal femura ESWT uygulandığında, erken dönemde (10. günde) kanlanmada azalma ve ardından 28. günde kanlanmada artış tespit etmişlerdir. ESWT'nin etkisinin, kanlanması azalmış ya da avaskü-ler dokuların mikro-destrüksiyonu ile revaskülarizas-yon ivmelenmesi, lokal büyüme faktörlerinin salınımı arkadaşları, koyun tibialarında yaptıkları çalışmada, ESWT'nin kırık iyileşmesi üzerinde olumlu etkisinin olmadığını saptamışlar ve istatiksel olarak anlamlı olmasa da, dalga gücünün arttırılmasının kırık iyileş-mesinde olumsuz etki gösterdiğini bildirmişlerdir.…”

“…[29] Haake ve arkadaşları da, enerji miktarı arttıkça hücrelerin içerisinde defektler geliştiği ve hücrelerin kendini onarma kabiliyetinin de azaldığını belirtmişlerdir.…”

Effect of ultrasound on human umbilical cord peri-vascular cells

“…ALP is a biochemical marker for cell differentiation of osteogenic lineage [21,22,24,26,27] . Cells were washed with PBS and lysed with 2 mL of ALP buffer per well (0.5 M 2-amino-2-methyl-1-propanol and 0.1% Triton-X-100, pH 10.5).…”