Radial extracorporeal shock wave therapy promotes osteochondral regeneration of knee joints in rabbits

Qi,Hui; Jin,Shaofeng; Yin,Chunyang; Chen,Lei; Sun,Lei; Liu,Yajun

doi:10.3892/etm.2018.6631

Radial extracorporeal shock wave therapy promotes osteochondral regeneration of knee joints in rabbits

Authors:
- Hui Qi
- Shaofeng Jin
- Chunyang Yin
- Lei Chen
- Lei Sun
- Yajun Liu
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Affiliations: Musculoskeletal Tissue Bank, Beijing Jishuitan Hospital, Beijing 100035, P.R. China, State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco‑Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, P.R. China, Orthopedic Shock Wave Treatment Center, Spine Surgery Department, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
Published online on: August 20, 2018 https://doi.org/10.3892/etm.2018.6631
Pages: 3478-3484
Copyright: © Qi et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY_NC 4.0].

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Abstract

Radial extracorporeal shock wave therapy (rESWT) has been proven to be effective for nonunion fractures. It was, thus, hypothesized that it may be used as a supplement therapy to promote osteochondral regeneration when combined with a scaffold previously prepared by our research group. In the present study, to verify this hypothesis, New Zealand white adult rabbits were anaesthetized and divided into three groups, as follows: Untreated control group, in which full‑thickness cylindrical osteochondral defects were created without repairing; scaffold group, in which rabbits were implanted with the scaffolds; scaffold plus rESWT group, in which rabbits were implanted with scaffolds and then treated with rESWT at 2 weeks post‑surgery. At 6 and 12 weeks after surgery, the animals were sacrificed. Nitric oxide (NO) levels in the synovial cavity of the knee joints were measured by the Griess method. In addition, macroscopic observation and the gross score according to the International Cartilage Repair Society (ICRS) histological scoring system were determined. Histological evaluation was also performed by hematoxylin‑eosin and Safranin O/fast green staining. The results demonstrated that both the scaffold and scaffold plus rESWT treatments significantly reduced NO levels in the synovial cavity at 6 weeks after surgery (P<0.05), whereas no significant difference was observed at 12 weeks after surgery. The ICRS scores of the scaffold and scaffold plus rESWT groups were significantly higher in comparison with those in the control group (P<0.05), and rESWT further increased these scores at 12 weeks after surgery (P<0.05). Histological results revealed that osteochondral regeneration was improved after treatment with scaffold or scaffold plus rESWT, with the latter displaying better results. These data suggested that rESWT improved the osteochondral regeneration when applied in combination with the scaffold, and that one of the underlying mechanisms may involve the reduction of NO in the synovial fluid. Therefore, rESWT may be a useful treatment for knee osteochondral regeneration.

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1	Huey DJ, Hu JC and Athanasiou KA: Unlike bone, cartilage regeneration remains elusive. Science. 338:917–921. 2012. View Article : Google Scholar : PubMed/NCBI
2	Marcacci M, Filardo G and Kon E: Treatment of cartilage lesions: What works and why? Injury. 44 Suppl 1:S11–S15. 2013. View Article : Google Scholar : PubMed/NCBI
3	Filardo G, Andriolo L, Balboni F, Marcacci M and Kon E: Cartilage failures. Systematic literature review, critical survey analysis, and definition. Knee Surg Sports Traumatol Arthrosc. 23:3660–3669. 2015. View Article : Google Scholar : PubMed/NCBI
4	Okano T, Mera H, Itokazu M, Okabe T, Koike T, Nakamura H and Wakitani S: Systemic administration of granulocyte colony-stimulating factor for osteochondral defect repair in a rat experimental model. Cartilage. 5:107–113. 2014. View Article : Google Scholar : PubMed/NCBI
5	Khorshidi S and Karkhaneh A: A review on gradient hydrogel/fiber scaffolds for osteochondral regeneration. J Tissue Eng Regen Med. 12:e1974–e1990. 2018. View Article : Google Scholar : PubMed/NCBI
6	Kon E, Roffi A, Filardo G, Tesei G and Marcacci M: Scaffold-based cartilage treatments: With or without cells? A systematic review of preclinical and clinical evidence. Arthroscopy. 31:767–775. 2015. View Article : Google Scholar : PubMed/NCBI
7	Qi H, Jie YS, Chen L, Li QH, Gao XS and Sun L: Repair of articular defects in the knee with a cell-free scaffold. Orthopaedic Journal of China (Chinese). 23:1303–1309. 2015.
8	Qi H, Jie YS, Chen L, Jiang J, Gao XS and Sun L: Preparation of acellular dermal matrix as a kind of scaffold for cartilage tissue engineering and its biocompatibility. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 28:768–772. 2014.(In Chinese). PubMed/NCBI
9	Qi H, Sun L, Chen L, Jie YS and Gao XS: Technics of hair removal-decellularization-reconstruction to build cartilage repair carrier. Orthopaedic J China (Chinese). 22:151–157. 2014.
10	Qi H, Jie YS, Chen L, Tao JF, Jiang J and Sun L: Comparison of scaffolds for chondrocyte implantation with two kinds of cross-linking agents. Chin Med Biotechnol (Chinese). 8:408–413. 2013.
11	Imamura M, Alamino S, Hsing WT, Alfieri FM, Schmitz C and Battistella LR: Radial extracorporeal shock wave therapy for disabling pain due to severe primary knee osteoarthritis. J Rehabil Med. 49:54–62. 2017. View Article : Google Scholar : PubMed/NCBI
12	Hochstrasser T, Frank HG and Schmitz C: Dose-dependent and cell type-specific cell death and proliferation following in vitro exposure to radial extracorporeal shock waves. Sci Rep. 6:306372016. View Article : Google Scholar : PubMed/NCBI
13	Schmitz C, Császár NB, Milz S, Schieker M, Maffulli N, Rompe JD and Furia JP: Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: A systematic review on studies listed in the PEDro database. Br Med Bull. 116:115–138. 2015.PubMed/NCBI
14	Mainil-Varlet P, Aigner T, Brittberg M, Bullough P, Hollander A, Hunziker E, Kandel R, Nehrer S, Pritzker K, Roberts S and Stauffer E: International Cartilage Repair Society. Histological assessment of cartilage repair: A report by the histology endpoint committee of the international cartilage repair society (ICRS). J Bone Joint Surg Am. 85-A (Suppl)2:S45–S57. 2003. View Article : Google Scholar
15	Li X, Ding J, Wang J, Zhuang X and Chen X: Biomimetic biphasic scaffolds for osteochondral defect repair. Regen Biomater. 2:221–228. 2015. View Article : Google Scholar : PubMed/NCBI
16	Dahlin RL, Kinard LA, Lam J, Needham CJ, Lu S, Kasper FK and Mikos AG: Articular chondrocytes and mesenchymal stem cells seeded on biodegradable scaffolds for the repair of cartilage in a rat osteochondral defect model. Biomaterials. 35:7460–7469. 2014. View Article : Google Scholar : PubMed/NCBI
17	Jeon JE, Vaquette C, Theodoropoulos C, Klein TJ and Hutmacher DW: Multiphasic construct studied in an ectopic osteochondral defect model. J R Soc Interface. 11:201401842014. View Article : Google Scholar : PubMed/NCBI
18	Armiento AR, Stoddart MJ, Alini M and Eglin D: Biomaterials for articular cartilage tissue engineering: Learning from biology. Acta Biomater. 65:1–20. 2018. View Article : Google Scholar : PubMed/NCBI
19	Maia FR, Carvalho MR, Oliveira JM and Reis RL: Tissue engineering strategies for osteochondral repair. Adv Exp Med Biol. 1059:353–371. 2018. View Article : Google Scholar : PubMed/NCBI
20	Wang CJ: An overview of shock wave therapy in musculoskeletal disorders. Chang Gung Med J. 26:220–232. 2003.PubMed/NCBI
21	Wang CJ: Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res. 7:112012. View Article : Google Scholar : PubMed/NCBI
22	Lyon R, Liu XC, Kubin M and Schwab J: Does extracorporeal shock wave therapy enhance healing of osteochondritis dissecans of the rabbit knee? a pilot study. Clin Orthop Relat Res. 471:1159–1165. 2013. View Article : Google Scholar : PubMed/NCBI
23	Frisbie DD, Kawcak CE and McIlwraith CW: Evaluation of the effect of extracorporeal shock wave treatment on experimentally induced osteoarthritis in middle carpal joints of horses. Am J Vet Res. 70:449–454. 2009. View Article : Google Scholar : PubMed/NCBI
24	Kim JH, Kim JY, Choi CM, Lee JK, Kee HS, Jung KI and Yoon SR: The dose-related effects of extracorporeal shock wave therapy for knee osteoarthritis. Ann Rehabil Med. 39:616–623. 2015. View Article : Google Scholar : PubMed/NCBI
25	Ochiai N, Ohtori S, Sasho T, Nakagawa K, Takahashi K, Takahashi N, Murata R, Takahashi K, Moriya H, Wada Y and Saisu T: Extracorporeal shock wave therapy improves motor dysfunction and pain originating from knee osteoarthritis in rats. Osteoarthritis Cartilage. 15:1093–1096. 2007. View Article : Google Scholar : PubMed/NCBI
26	Evens DM and Ralston SH: Nitric oxide and bone. J Bone Miner Res. 11:300–305. 1996. View Article : Google Scholar : PubMed/NCBI
27	Wang CJ, Yang KD, Ko JY, Huang CC, Huang HY and Wang FS: The effects of shockwave on bone healing and systemic concentrations of nitric oxide (NO), TGF-beta1, VEGF and BMP-2 in long bone non-unions. Nitric Oxide. 20:298–303. 2009. View Article : Google Scholar : PubMed/NCBI
28	Abramson SB: Nitric oxide in inflammation and pain associated with osteoarthritis. Arthritis Res Ther. 10 Suppl 2:S22008. View Article : Google Scholar : PubMed/NCBI
29	Hancock CM and Riegger-Krugh C: Modulation of pain in osteoarthritis: The role of nitric oxide. Clin J Pain. 24:353–365. 2008. View Article : Google Scholar : PubMed/NCBI
30	Studer R, Jaffurs D, Stefanovic-Racic M, Robbins PD and Evans CH: Nitric oxide in osteoarthritis. Osteoarthritis Cartilage. 7:377–379. 1999. View Article : Google Scholar : PubMed/NCBI
31	Zhao Z, Ji H, Jing R, Liu C, Wang M, Zhai L, Bai X and Xing G: Extracorporeal shock-wave therapy reduces progression of knee osteoarthritis in rabbits by reducing nitric oxide level and chondrocyte apoptosis. Arch Orthop Trauma Surg. 132:1547–1553. 2012. View Article : Google Scholar : PubMed/NCBI
32	Du Q, Park KS, Guo Z, He P, Nagashima M, Shao L, Sahai R, Geller DA and Hussain SP: Regulation of human nitric oxide synthase 2 expression by Wnt beta-catenin signaling. Cancer Res. 66:7024–7031. 2006. View Article : Google Scholar : PubMed/NCBI
33	Nguyen LT, Sharma AR, Chakraborty C, Saibaba B, Ahn ME and Lee SS: Review of prospects of biological fluid biomarkers in osteoarthritis. Int J Mol Sci. 18:E6012017. View Article : Google Scholar : PubMed/NCBI
34	Li N, Rivéra-Bermúdez MA, Zhang M, Tejada J, Glasson SS, Collins-Racie LA, Lavallie ER, Wang Y, Chang KC, Nagpal S, et al: LXR modulation blocks prostaglandin E2 production and matrix degradation in cartilage and alleviates pain in a rat osteoarthritis model. Proc Natl Acad Sci USA. 107:pp. 3734–3739. 2010; View Article : Google Scholar : PubMed/NCBI