Osteogenesis induced by extracorporeal shockwave in treatment of delayed osteotendinous junction healing.
Healing at the osteotendinous junction (OTJ) is challenging in orthopedic surgery. The present study aimed to test extracorporeal shockwave (ESW) in treatment of a delayed OTJ healing. Twenty-eight rabbits were used for establishing a delayed healing (DH) model at patella-patellar-tendon (PPT) complex after partial patellectomy for 4 weeks and then were divided into DH and ESW groups. In the ESW group, a single ESW treatment was given at postoperative week 6 to the PPT healing complex. The samples were harvested at week 8 and 12 for radiographic and histological evaluations with seven samples for each group at each time point. Micro-CT results showed that new bone volume was 1.18 +/- 0.61 mm(3) in the ESW group with no measurable new bone in the DH group at postoperative week 8. Scar tissue formed at the OTJ healing interface of the DH group, whereas ESW triggered high expression of VEGF in hypertrophic chondrocytes at week 8 and regeneration of the fibrocartilage zone at week 12 postoperatively. The accelerated osteogenesis could be explained by acceleration of endochondral ossification. In conclusion, ESW was able to induce osteogenesis at OTJ with delayed healing with enhanced endochondral ossification process and regeneration of fibrocartilage zone. These findings formed a scientific basis to potential clinical application of ESW for treatment of delayed OTJ healing.
Qin
Ling
L
Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, N.T. Hong Kong SAR, China. lingqin@cuhk.edu.hk
Wang
Lin
L
Wong
Margaret Wan-nar
MW
Wen
Chunyi
C
Wang
Gang
G
Zhang
Ge
G
Chan
Kai-ming
KM
Cheung
Wing-hoi
WH
Leung
Kwok-sui
KS
D000818:Animals; D019902:Chondrocytes / Q000473:pathology; D020219:Chondrogenesis; D004195:Disease Models, Animal; D005260:Female; D051445:Fibrocartilage / Q000473:pathology; D050723:Fractures, Bone / Q000503:physiopathology / Q000628:therapy*; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D018919:Neovascularization, Physiologic; D010012:Osteogenesis; D010329:Patella / Q000098:blood supply / Q000293:injuries / Q000473:pathology; D017847:Patellar Ligament / Q000098:blood supply / Q000293:injuries / Q000473:pathology; D011817:Rabbits; D013708:Tendon Injuries / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014945:Wound Healing