Shoulder Rotator Cuff Responses to Extracorporeal Shockwave Therapy: Morphological and Immunohistochemical Analysis

Author:

BrañEs Julian1,Contreras Hector R.1,Cabello Pablo1,Antonic Vlado2,Guiloff Leonardo J.2,Brañes Manuel123

Affiliation:

1. Physiology and Biophysics Program, Institute of Biomedical Sciences, University of Chile, Santiago, Chile

2. BioSurgery Unit (Shockwave Center), MegaSalud-Arauco Clinic, Santiago, Chile

3. Faculty of Sciences, University of Chile, Santiago, Chile

Abstract

Background Application of extracorporeal shockwave therapy (ESWT) induces an improvement in tissue healing associated with augmented tissue perfusion. The present study aimed to investigate the responses of human rotator cuff tissue to the application of ESWT. Methods Thirty-one consecutive patients with symptomatic rotator cuff tendinopathy with complete tears were approached and enrolled in the present study. Before surgical resolution, a single treatment of focused ESWT was offered to all patients. Ten patients accepted such treatment and 21 refused ESWT. Tendon tissue biopsies were collected for evaluation using haematoxylin and eosin and characterized according to the Riley Classification. Vascular volume area (VVA) was determined semi-quantitatively and immunohistochemical (IHC) analysis included CD14, CD34, PCNA, Tenascin-C and D2-40 markers. Results Distribution of grade according to the Riley Classification with respect to study group was: Group A: Grade III ( n = 9), Grade IV ( n = 1); Group B: Grade III ( n = 13), Grade IV ( n = 8). Mean group-specific VVA analysis was 18.47% and 7.03% for Group A and Group B, respectively. IHC Grade III protein staining was significantly more prevalent in Group A compared to Group B for CD34, PCNA, Tenascin-C and D2-40 ( p < 0.05 for all comparisons). Conclusions ESWT is associated with increased neovascularization and neolymphangiogenesis in rotator cuff tendinopathy. IHC analysis suggests an improvement in healing response in the ESWT-treated tendon.

Publisher

SAGE Publications

Subject

Rehabilitation,Physical Therapy, Sports Therapy and Rehabilitation,Orthopedics and Sports Medicine,Surgery

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