Analysis of Related Factors Influencing the Efficacy of Extracorporeal Shockwave in the Treatment of Fracture Nonunion: A Prospective Study in Shanghai, China

Abstract Background: Extracorporeal shockwave is recommended as the first choice for the treatment of fracture nonunion, However, some patients with fracture nonunion have poor response to extracorporeal shockwave therapy. The present study aimed to investigate related factors which may affect the clinical efficacy of extracorporeal shockwave on fracture nonunion. Methods: Ultrasound examination was applied to observe nonunion gap, local blood supply, hardness of callus and hematoma formation before and after extracorporeal shockwave therapy. The patient's condition was followed up for 12 months after extracorporeal shockwave therapy. Four correlations and regression analysis methods were applied to analyze the factors which were correlated the clinical efficacy of extracorporeal shockwave. Receiver-operating characteristic analysis revealed that the cut-off of the fracture nonunion gap was 4.200 mm and the cut-off of the hardness of callus/impulse energy was 2.555. Single factor linear correlation analysis, multi-factor linear regression analysis, single-factor logistic regression analysis were applied. Results: The four ultrasound signs were significantly correlated with extracorporeal shockwave therapy: nonunion gap (r = -0.723; OR = 3.074), local blood supply (r = 0.611; OR = 0.191), hardness of callus/impulse energy (r = -0.510; OR = 19.942), and hematoma formation (r = 0.722; OR = 0.015). Conclusions: Nonunion gap larger than 4.200 mm and hardness of callus/impulse energy larger than 2.555 are risk factors of extracorporeal shockwave therapy outcome, and good local blood supply and effective hematoma formation induced by extracorporeal shockwave therapy are protective factors. By analyzing the related factors of extracorporeal shockwave therapy on fracture nonunion, clinicians may screen out the patients with fracture nonunion who are not suitable for extracorporeal shockwave therapy, and reduce the risk of fracture nonunion.

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Comments on the article comparing radial extracorporeal shockwave therapy with ultrasound therapy in patients with lateral epicondylitis

Journal of Medical Ultrasonics ◽

10.1007/s10396-021-01087-1 ◽

2021 ◽

Author(s):

Dimitrios Stasinopoulos

Keyword(s):

Lateral Epicondylitis ◽

Ultrasound Therapy ◽

Extracorporeal Shockwave Therapy ◽

Extracorporeal Shockwave ◽

Shockwave Therapy

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Focused Extracorporeal Shockwave Therapy in Physical Medicine and Rehabilitation

Current Physical Medicine and Rehabilitation Reports ◽

10.1007/s40141-020-00306-z ◽

2020 ◽

Author(s):

Richard Crevenna ◽

Michael Mickel ◽

Othmar Schuhfried ◽

Christina Gesslbauer ◽

Andrej Zdravkovic ◽

...

Keyword(s):

Pain Syndrome ◽

Surrounding Tissue ◽

Patellar Tendinopathy ◽

Physical Medicine ◽

Physical Treatment ◽

Extracorporeal Shockwave Therapy ◽

Non Union ◽

Extracorporeal Shockwave ◽

Shockwave Therapy ◽

Physical Medicine And Rehabilitation

Abstract Purpose of Review Focused extracorporeal shockwave therapy (fESWT) is a physical treatment modality developed over the last 25 years for musculoskeletal indications. It has many indications in the field of physical medicine and rehabilitation (PM&R) and is effective, time-efficient, and cost-efficient. This review focuses on basics and on clinical indications as well as on significant trends in fESWT. Recent Findings In PM&R, stimulation of healing processes in tendons, surrounding tissue, and bones via mechanotransduction seems to be a relevant biological effect. The International Society for Medical Shockwave Treatment (ISMST) describes different types of indications (such as approved standard indications—in accordance with most scientific evidence—like calcifying tendinopathy of the shoulder, plantar fasciitis lateral epicondylopathy of the elbow, greater trochanter pain syndrome, patellar tendinopathy, Achilles tendinopathy and bone non-union, common empirically tested clinical uses, exceptional or expert indications, and experimental indications). Summary fESWT is a relevant treatment option in PM&R and regenerative medicine. In recent years, historical paradigms (for example, application in cancer patients) have changed and new indications (such as nerve regeneration, myofascial trapezius syndrome, low back pain, dermatosclerosis, and lymphedema) are supported. Future translational research should focus on establishing actual exceptional indications and experimental indications for clinical routine.

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Extracorporeal shockwave therapy versus musculoskeletal mesotherapy for Achilles tendinopathy in athlete

Egyptian Rheumatology and Rehabilitation ◽

10.1186/s43166-020-00033-2 ◽

2020 ◽

Vol 47 (1) ◽

Author(s):

Reem EL-Mallah ◽

Enas A. Elattar

Keyword(s):

Treatment Options ◽

Visual Analogue Score ◽

Achilles Tendinopathy ◽

Extracorporeal Shockwave Therapy ◽

Extracorporeal Shockwave ◽

Shockwave Therapy ◽

Tendon Thickness ◽

Vas Scores ◽

Tendon Pathology

Abstract Background Achilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes. Different conservative treatment options have been introduced but with short-term effects; however, extracorporeal shockwave therapy (ESWT) and mesotherapy (MT) injections were claimed to provide longer effects and could be used in cases failure of response to conservative treatments. The objective of our prospective 12-week study was to compare the effect of ESWT and MT on chronic Achilles tendinopathy in athletes by both clinical and ultrasonographical assessment. Results Forty patients with chronic AT diagnosed clinically and with high-resolution ultrasound (US) randomly allocated in two groups first received weekly ESWT session, and the other group underwent weekly MT sessions for 4 consecutive weeks. Both groups improved during the treatment and follow-up period. The mean visual analogue score (VAS) decreased in both the ESWT group and the MT group. Mean American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and VAS scores were not significantly different between ESWT and MT groups at the 4th and the 12th week of follow-up. However, US assessment significantly improved after 12 weeks in the ESWT group (as regards tendon thickness, calcifications, and Doppler signal), and for the mesotherapy group, there was the only improvement of tendon thickness. Conclusion ESWT showed improvement of pain and inflammation and calcifications of AT than MT injections, which was documented by US improved findings at week 12 follow up.

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Reply to the comments on our article comparison of radial extracorporeal shockwave therapy with ultrasound therapy in patients with lateral epicondylitis

Journal of Medical Ultrasonics ◽

10.1007/s10396-021-01092-4 ◽

2021 ◽

Author(s):

Vasileios Dedes ◽

Konstantinos Tzirogiannis ◽

Maria Polikandrioti ◽

Ariadni Maria Dede ◽

Athanasios Mitseas ◽

...

Keyword(s):

Lateral Epicondylitis ◽

Ultrasound Therapy ◽

Extracorporeal Shockwave Therapy ◽

Extracorporeal Shockwave ◽

Shockwave Therapy

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Extracorporeal shockwave therapy in spinal cord injury, early to advance to clinical trials? A systematic review and meta-analysis on animal studies

The Neuroradiology Journal ◽

10.1177/19714009211026899 ◽

2021 ◽

pp. 197140092110268

Author(s):

Seyedeh Niloufar Rafiei Alavi ◽

Arian Madani Neishaboori ◽

Mahmoud Yousefifard

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Clinical Trials ◽

Animal Models ◽

Meta Analysis ◽

Mean Difference ◽

Extracorporeal Shockwave Therapy ◽

Extracorporeal Shockwave ◽

Shockwave Therapy ◽

Cord Injury

Background As there is no consensus over the efficacy of extracorporeal shockwave therapy in the management of spinal cord injury complications, the current meta-analysis aims to investigate preclinical evidence on the matter. Methods The search strategy was developed based on keywords related to ‘spinal cord injury’ and ‘extracorporeal shockwave therapy’. A primary search was conducted in Medline, Embase, Scopus and Web of Science until the end of 2020. Studies which administered extracorporeal shockwave therapy on spinal cord injury animal models and evaluated motor function and/or histological findings were included. The standardised mean difference with a 95% confidence interval (CI) were calculated. Results Seven articles were included. Locomotion was significantly improved in the extracorporeal shockwave therapy treated group (standardised mean difference 1.68, 95% CI 1.05–2.31, P=0.032). It seems that the efficacy of extracorporeal shockwave therapy with an energy flux density of 0.1 mJ/mm2 is higher than 0.04 mJ/mm2 ( P=0.044). Shockwave therapy was found to increase axonal sprouting (standardised mean difference 1.31, 95% CI 0.65, 1.96), vascular endothelial growth factor tissue levels (standardised mean difference 1.36, 95% CI 0.54, 2.18) and cell survival (standardised mean difference 2.49, 95% CI 0.93, 4.04). It also significantly prevents axonal degeneration (standardised mean difference 2.25, 95% CI 1.47, 3.02). Conclusion Extracorporeal shockwave therapy significantly improves locomotor recovery in spinal cord injury animal models through neural tissue regeneration. Nonetheless, in spite of the promising results and clinical application of extracorporeal shockwave therapy in various conditions, current evidence implies that designing clinical trials on extracorporeal shockwave therapy in the management of spinal cord injury may not be soon. Hence, further preclinical studies with the effort to reach the safest and the most efficient treatment protocol are needed.

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