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Extracorporeal Shock Wave Therapy in Treatment of Delayed Bone-Tendon Healing

Lin Wang, PhD^*,, Ling Qin, PhD^*,, Hong-bin Lu, PhD^*, Wing-hoi Cheung, PhD^*, Hu Yang, PhD, Wan-nar Wong, MBBS^*, Kai-ming Chan, FRCS^* and Kwok-sui Leung, MD, FRCS^*

From the ^* Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China, and College of Exercise Human Science, Beijing University of Physical Education, Beijing, PR China

Address correspondence to Qin Ling, PhD, Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Shatin, N.T., Hong Kong (e-mail: Lingqin{at}cuhk.edu.hk).

Background: Extracorporeal shock wave therapy is indicated for treatment of chronic injuries of soft tissues and delayed fracture healing and nonunion. No investigation has been conducted to study the effect of shock wave on delayed healing at the bone-tendon junction.

Hypothesis: Shock wave promotes osteogenesis, regeneration of fibrocartilage zone, and remodeling of healing tissue in delayed healing of bone-tendon junction surgical repair.

Study Design: Controlled laboratory study.

Methods: Twenty-eight mature rabbits were used for establishing a delayed healing model at the patella–patellar tendon complex after partial patellectomy and then divided into control and shock wave groups. In the shock wave group, a single shock wave treatment was given at week 6 postoperatively to the patella–patellar tendon healing complex. Seven samples were harvested at week 8 and 7 samples at week 12 for radiologic, densitometric, histologic, and mechanical evaluations.

Results: Radiographic measurements showed 293.4% and 185.8% more new bone formation at the patella–patellar tendon healing junction in the shock wave group at weeks 8 and 12, respectively. Significantly better bone mineral status was found in the week 12 shock wave group. Histologically, the shock wave group showed more advanced remodeling in terms of better alignment of collagen fibers and thicker and more mature regenerated fibrocartilage zone at both weeks 8 and 12. Mechanical testing showed 167.7% and 145.1% higher tensile load and strength in the shock wave group at week 8 and week 12, respectively, compared with controls.

Conclusion: Extracorporeal shock wave promotes osteogenesis, regeneration of fibrocartilage zone, and remodeling in the delayed bone-to-tendon healing junction in rabbits.

Clinical Relevance: These results provide a foundation for future clinical studies toward establishment of clinical indication for treatment of delayed bone-to-tendon junction healing.

Key Words: extracorporeal shock wave therapy (ESWT) • delayed healing • bone-tendon junction repair • tensile property • rabbits