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Review
. 2023 Mar 31:11:1150290.
doi: 10.3389/fbioe.2023.1150290. eCollection 2023.

External stimulation: A potential therapeutic strategy for tendon-bone healing

Shijie Fu  1   2   3 , Yujian Lan  2 , Guoyou Wang  2 , Dingsu Bao  2 , Bo Qin  2 , Qiu Zheng  2 , Huan Liu  2 , Vincent Kam Wai Wong  3
Affiliations
Review

External stimulation: A potential therapeutic strategy for tendon-bone healing

Shijie Fu et al. Front Bioeng Biotechnol. .

Abstract

Injuries at the tendon-bone interface are very common in the field of sports medicine, and healing at the tendon-bone interface is complex. Injuries to the tendon-bone interface can seriously affect a patient's quality of life, so it is essential to restore stability and promote healing of the tendon-bone interface. In addition to surgical treatment, the healing of tendons and bones can also be properly combined with extracorporeal stimulation therapy during the recovery process. In this review, we discuss the effects of extracorporeal shock waves (ESWs), low-intensity pulsed ultrasound (LIPUS), and mechanical stress on tendon-bone healing, focusing on the possible mechanisms of action of mechanical stress on tendon-bone healing in terms of transcription factors and biomolecules. The aim is to provide possible therapeutic approaches for subsequent clinical treatment.

Keywords: extracorporeal shock wave; low-intensity pulsed ultrasound; mechanical stress; mechanism of action; tendon-bone healing.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
(A) The schematic diagram of the external stimulation methods, (B) The four stages of the bone-tendon healing process.
FIGURE 2
FIGURE 2
The typical histological or photograph images before and after treatment of each method. (A) Before and after ESWT with improved pathology. Reproduced with permission (Yu et al., 2017); (B) Comparative histology before and after LIPUS treatment. New bone formation at the proximal patella was observed in both groups at postoperative weeks 8 and 16. The LIPUS group showed more trabecular and marrow cavities than the control group at postoperative week 16. The dotted line represents the surface of osteotomy (NB, newly formed bone; RP, remaining patella; TF, tendon fiber). Reproduced with permission (Lu et al., 2016); (C) Before and after comparison chart of mechanical loading treatment. Adipocyte were seen within the callus tissue in both groups at 1 week, but it was more common in the loaded tendons, at 4 weeks, there was less adipocytes in the callus in both groups. Reproduced with permission (Khayyeri et al., 2020); (D) Before and after comparison of electrical stimulation treatment. Both collagen 1 and 3 were more highly expressed in the group receiving electrical stimulation than in the control group. Reproduced with permission (Casagrande et al., 2021); (E) Before and after comparison chart of combined magnetic field treatment. NB, newly formed bone; RP, residual patella; TF, tendon fiber; the arrowhead, directed at the regenerated fibrocartilage). The CMF group showed more trabecular bone, more marrow cavities, and more advanced remodeling from woven bone to trabecular lamellar bone than the control group. Reproduced with permission (Hu et al., 2015); (F) Histological diagram before and after exercise. Mice were allowed for free cage activities after surgery (FC group); Mice received treadmill running initiated on postoperative day 7 (TR group); In comparision to FC group, TR group showed better fibrocartilage regeneration which was characterized by more cartilage-like cells and richer proteoglycans accumulation at repaired site at postoperative week 4 and 8. Reproduced with permission (Liu et al., 2022).
FIGURE 3
FIGURE 3
Mechanism of action of force stimulation of tendon bone healing.
See this image and copyright information in PMC

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