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Dose-dependent new bone formation by extracorporeal shock wave application on the intact femur of rabbits

By T. Tischer, S. Milz, C. Weiler, C. Pautke, J. Hausdorf, C. Schmitz and M. Maier


Background: Whereas various molecular working mechanisms of shock waves have been demonstrated, no study has assessed in detail the influence of varying energy flux densities (EFD) on new bone formation in vivo. Methods: Thirty Chinchilla bastard rabbits were randomly assigned to 5 groups (EFD 0.0, 0.35, 0.5, 0.9 and 1.2 mJ/mm(2)) and treated with extracorporeal shock waves at the distal femoral region (1,500 pulses; 1 Hz frequency). To investigate new bone formation, animals were injected with oxytetracycline at days 5-9 after shock wave application and sacrificed on day 10. Histological sections of all animals were examined using broad-band epifluorescent illumination, contact microradiography and Giemsa-Eosin staining. Results: Application of shock waves induced new bone formation beginning with 0.5 mJ/mm(2) EFD and increasing with 0.9 mJ/mm(2) and 1.2 mJ/mm(2). The latter EFD resulted in new bone formation also on the dorsal cortical bone; cortical fractures and periosteal detachment also occurred. Conclusion: Here, for the first time, a threshold level is presented for new bone formation after applying shock waves to intact bone in vivo. The findings of this study are of considerable significance for preventing unwanted side effects in new approaches in the clinical application of shock waves. Copyright (c) 2008 S. Karger AG, Basel.

Topics: Medizin, ddc:610
Publisher: Ludwig-Maximilians-Universität München
Year: 2008
DOI identifier: 10.1159/000128279
OAI identifier:
Provided by: Open Access LMU

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  1. (2004). al: Ras induction of superoxide activates ERK-dependent angiogenic transcription factor HIF-1alpha and VEG F - A exp r ess i o n in sh ock wa v e-stim u -lated osteoblasts.
  2. (2004). al: Recruitment of mesenchymal stem cells and expression of TGFbeta 1 and VEGF in the early stage of shock wave-promoted bone regeneration of segmental defect in rats.
  3. al: Temporal and spatial expression of bone morphogenetic proteins in extracorporeal shock wavepromoted healing of segmental defect.
  4. (1995). Biological effects of shock waves: in vivo effect of high energy pulses on rabbit bone. Ultrasound Med Biol
  5. (2006). CC: Humeral head osteonecrosis after extracorporeal shock-wave treatment for rotator cuff tendinopathy. A case report.
  6. (1998). Crum LA: In vivo pressure measurements of lithotripsy shock waves in pigs. Ultrasound Med Biol
  7. (2003). Detection of bone fragments in pulmonary vessels following extracorporeal shock wave application to the distal femur in an in-vivo animal model (in German). Z Orthop Ihre Grenzgeb
  8. (2006). Early effects of extracorporeal shock wave treatment on osteoblast-like cells: a comparative study between electromagnetic and electrohydraulic devices.
  9. et al: Acetabular augmentation induced by extracorporeal shock waves in rabbits.
  10. (2004). et al: Activation of extracellular signal-regulated kinase (ERK) and p38 kinase in shock wave-promoted bone formation of segmental defect in rats. Bone
  11. (2002). et al: Dose-related effects of extracorporeal shock waves on rabbit quadriceps tendon integrity. Arch Orthop Trauma Surg
  12. (2001). et al: Impaired tensile strength after shock-wave application in an animal model of tendon calcification. Ultrasound Med Biol
  13. (2002). et al: Influence of extracorporeal shock-wave application on normal bone in an animal model in vivo. Scintigraphy, MRI and histopathology.
  14. (2004). et al: New bone formation by extracorporeal shock waves. Dependence of induction on energy flux density (in German). Orthopade
  15. et al: Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits.
  16. (2003). Extracorporeal shock waves in the treatment of nonunions.
  17. (2002). Extracorporeal shock waves induce ventral-periosteal new bone formation out of the focus zone – results of an in-vivo animal trial (in German). Z Orthop Ihre Grenzgeb
  18. (2003). FS: Shock wave application enhances pertussis toxin protein-sensitive bone formation of segmental femoral defect in rats.
  19. (2004). Gene expression for extracellular matrix proteins in shockwave-induced osteogenesis in rats. Calcif Tissue Int
  20. (2004). HH: Shock wave treatment shows dose-dependent enhancement of bone mass and bone strength after fracture of the femur.
  21. (2001). High-energy extracorporeal shock wave treatment of nonunions. Clin Orthop Relat Res
  22. (2001). Hotzinger H: High-energy shock wave treatment of femoral head necrosis in adults. Clin Orthop Relat Res
  23. (2004). KF: Effect of shock-wave therapy on patellar tendinopathy in a rabbit model.
  24. (1998). Krischek O: Dose-related effects of shock waves on rabbit tendo Achillis. A sonographic and histological study.
  25. (1993). Kristelijn MJ: The effect of high energy shock waves focused on cortical bone: an in vitro study.
  26. (2006). Lischer CJ: Histomorphologic evaluation of extracorporeal shock wave therapy of the fourth metatarsal bone and the origin of the suspensory ligament in horses without lameness.
  27. (2003). M a i e r M , A v e r b e c k
  28. (1992). Matura E: Pressure distribution and energy flow in the focal region of two different electromagnetic shock wave sources. J Stone Dis
  29. (1991). Michailov P: High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop
  30. Sailler A: Extracorporeal shock wave therapy of nonunion or delayed osseous union. Clin Orthop Relat Res
  31. (1998). Saunders JE: Acoustic performance and clinical use of a fibreoptic hydrophone. Ultrasound Med Biol
  32. Shock wave therapy (Orthotripsy) in musculoskeletal disorders. Clin Orthop Relat Res
  33. (2002). SM: Extracorporeal shock wave promotes growth and differentiation of bone-marrow stromal cells towards osteoprogenitors associated with induction of TGF-beta1. J Bone Joint Surg Br
  34. (1995). Suger G: In vivo effect of shock-waves on the healing of fractured bone. Clin Biomech (Bristol,
  35. (1999). Takayama K: Application of extracorporeal shock wave on bone: preliminary report.
  36. (2005). Treatment for osteonecrosis of the femoral head: comparison of extracorporeal shock waves with core decompression and bone-grafting.
  37. (2001). Yang KD: Physical shock wave mediates membrane hyperpolarization and Ras activation for osteogenesis in human bone marrow stromal cells. Biochem Biophys Res Commun
  38. (2002). Yang KD: Superoxide mediates shock wave induction of ERK-dependent osteogenic transcription factor (CBFA1) and mesenchymal cell differentiation toward osteoprogenitors.
  39. (2001). Yang KD: Treatment of nonunions of long bone fractures with shock waves. Clin Orthop Relat Res
  40. (2005). Yang YJ: The effect of shock wave treatment at the tendon-bone interface – an histomorphological and biomechanical study in rabbits.

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