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. 2019 Mar;43(3):539-551.
doi: 10.1007/s00264-018-4274-3. Epub 2019 Jan 15.

Biophysical stimulation of bone and cartilage: state of the art and future perspectives

Leo Massari  1 , Franco Benazzo  2 , Francesco Falez  3 , Dario Perugia  4 , Luca Pietrogrande  5 , Stefania Setti  6 , Raffaella Osti  7 , Enrico Vaienti  8 , Carlo Ruosi  9 , Ruggero Cadossi  6
Affiliations

Biophysical stimulation of bone and cartilage: state of the art and future perspectives

Leo Massari et al. Int Orthop. 2019 Mar.

Abstract

Introduction: Biophysical stimulation is a non-invasive therapy used in orthopaedic practice to increase and enhance reparative and anabolic activities of tissue.

Methods: A sistematic web-based search for papers was conducted using the following titles: (1) pulsed electromagnetic field (PEMF), capacitively coupled electrical field (CCEF), low intensity pulsed ultrasound system (LIPUS) and biophysical stimulation; (2) bone cells, bone tissue, fracture, non-union, prosthesis and vertebral fracture; and (3) chondrocyte, synoviocytes, joint chondroprotection, arthroscopy and knee arthroplasty.

Results: Pre-clinical studies have shown that the site of interaction of biophysical stimuli is the cell membrane. Its effect on bone tissue is to increase proliferation, synthesis and release of growth factors. On articular cells, it creates a strong A2A and A3 adenosine-agonist effect inducing an anti-inflammatory and chondroprotective result. In treated animals, it has been shown that the mineralisation rate of newly formed bone is almost doubled, the progression of the osteoarthritic cartilage degeneration is inhibited and quality of cartilage is preserved. Biophysical stimulation has been used in the clinical setting to promote the healing of fractures and non-unions. It has been successfully used on joint pathologies for its beneficial effect on improving function in early OA and after knee surgery to limit the inflammation of periarticular tissues.

Discussion: The pooled result of the studies in this review revealed the efficacy of biophysical stimulation for bone healing and joint chondroprotection based on proven methodological quality.

Conclusion: The orthopaedic community has played a central role in the development and understanding of the importance of the physical stimuli. Biophysical stimulation requires care and precision in use if it is to ensure the success expected of it by physicians and patients.

Keywords: Biophysical stimulation; Bone tissue; CCEF; Cartilage; LIPUS; PEMF.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Schematic representation of the biophysical stimuli targets on the cell surface and corresponding metabolic pathways within the cell
Fig. 2
Fig. 2
Effect of PEMF exposure length on human osteosarcoma cell lines and human osteoblast cell (MG63) proliferation (Sollazzo et al. Electricity and Magnetism in Biology and Medicine 1997)
Fig. 3
Fig. 3
Effect of PEMF stimulation on mineral apposition rate in newly formed trabeculae measured by tetracycline labelling, in transcortical holes bored in the distal metaphysis and diaphysis of the third metacarpal bone in horses (Canè V et al. J Orthop Res 1993)
Fig. 4
Fig. 4
Effect of CCEF frequency on fibula osteotomy healing in rabbits (Brighton CT et al. J Orthop Res 1985)
Fig. 5
Fig. 5
Effect of PEMF (a, b) on femoral osteotomies at 40 and 90 days from surgery (Borsalino G et al. Clin Orthop Relat Res 1988), (c) on tibia osteotomies (Mammi GI et al. Clin Orthop Relat Res 1993) and (d) in patients undergoing allograft reconstruction following tumour resection (Capanna R et al. Clin Orthop Relat Res 1994)
Fig. 6
Fig. 6
Representation of spinal stimulation with PEMF device (a) and CCEF device (b)
See this image and copyright information in PMC

References

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