Exploratory Analysis of Pain and Function Improvement after Radial Pressure Wave Therapy in Plantar Fasciitis

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Original Article | Vol 5 | Issue 1 |  January-June 2025 | page: 08-13 | Armando Tonatiuh Ávila García, Ana Lilia Villagrana Rodríguez, Cinthia Citlalli Domínguez Navarrete, Karen Chacón Morales, Marco Antonio González López

DOI: https://doi.org/10.13107/jrs.2025.v05.i01.159

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 07 Mar 2025, Review Date: 30 Apr 2025, Accepted Date: 10 May 2025 & Published: 30 Jun 2025

Author: Armando Tonatiuh Ávila García [1], Ana Lilia Villagrana Rodríguez [1], Cinthia Citlalli Domínguez Navarrete [1], Karen Chacón Morales [1], Marco Antonio González López [1]

[1] Department of Physical Medicine and Rehabilitation, Hospital Civil de Guadalajara Fray Antonio Alcalde, Jalisco, México, 44280

Address of Correspondence
Dr. Armando Tonatiuh Ávila García,
Department of Physical Medicine and Rehabilitation, Hospital Civil de Guadalajara Fray Antonio Alcalde, Coronel Calderón 777, Guadalajara, Jalisco, México, 44280
E-mail: atavila@hcg.gob.mx

Abstract
Background: Plantar fasciitis (PF) is a common cause of heel pain, impairing functionality and quality of life. Radial pressure wave therapy (RPWT) is a well-known non-invasive option to treat PF, but evidence on factors influencing outcomes is limited.
Objectives: The objectives of the study are to explore associations between baseline patient characteristics and clinical outcomes and to evaluate the impact of RPWT on pain and functionality in PF patients.
Materials and Methods: This exploratory, pilot study included 19 PF patients treated with three RPWT sessions. Pain intensity (numerical pain rating scale [NPRS]) and functionality (World Health Organization Disability Assessment Schedule 2.0 [WHODAS 2.0]) were assessed pre- and post-treatment. Retrospective data on age, body mass index (BMI), and PF chronicity were analyzed. Statistical tests included Wilcoxon signed rank for outcome comparisons and Spearman’s correlation for associations.
Results: NPRS scores decreased significantly from 6.89 ± 1.88 to 4.42 ± 2.36 (P = 0.001), while WHODAS 2.0 scores improved from 47.60 ± 21.85 to 21.34 ± 20.30 (P = 0.001). Baseline NPRS scores showed a moderate, positive correlation with post-treatment NPRS scores (ρ = 0.561, P = 0.01). No significant correlations were found between post-treatment outcomes and BMI, age, or PF chronicity.
Conclusion: RPWT significantly reduced pain and improved functionality in PF patients, with baseline pain levels emerging as a factor associated with outcomes. These preliminary findings support RPWT as a promising treatment and highlight the need for larger, controlled studies to validate and expand these results.
Keywords: Pain intensity, Plantar fasciitis, Radial pressure wave therapy, Rehabilitation outcomes, Therapeutic effectiveness, Treatment predictors

References:

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How to Cite this article: Ávila García AT, Rodríguez ALV, Navarrete CCD, Morales KC, López MAG | Exploratory analysis of pain and function improvement after radial pressure wave therapy in plantar fasciitis. | Journal of Regenerative Science | Jan-Jun 2025; 5(1): 08-13.

 

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Autologous versus Non-autologous Exosomes: Immunological, Safety, and Regulatory Considerations in Regenerative Medicine

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Original Article | Vol 5 | Issue 1 |  January-June 2025 | page: 31-33 | Ivanny Marchant, Belén Rodríguez, Valentina Pozo, Leopoldo Parada, Carla Salvo, Pablo Olivero

DOI: https://doi.org/10.13107/jrs.2025.v05.i01.167

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 16 Mar 2025, Review Date: 20 May 2025, Accepted Date: May 2025 & Published: 30 Jun 2025

Author: Ivanny Marchant [1], Belén Rodríguez [1], Valentina Pozo [1], Leopoldo Parada [2], Carla Salvo [3], Pablo Olivero [1]

[1] Unidad de Estudios Clínicos, Escuela de Medicina, Universidad de Valparaíso, Chile,
[2] Centro de Medicina Regenerativa CITOMED, Viña del Mar, Chile,
[3] Centro de Sangre y Tejidos de Valparaíso, Chile.

Address of Correspondence
Dr. Pablo Olivero,
Unidad de Estudios Clínicos, Escuela de Medicina, Universidad de Valparaíso, Chile.
E-mail: pablo.olivero@uv.cl

Abstract

Small extracellular vesicles (sEVs), commonly referred to as exosomes, have emerged as novel therapeutic tools in regenerative and esthetic medicine. A critical decision in their clinical application is the choice between autologous and non-autologous products, as this distinction directly impacts safety, immunocompatibility, efficacy, and regulatory compliance. This review analyzes the immunological profile and biological risks associated with exosomes’ clinical use according to their cellular origin, addressing persistence, pathogen transmission, delivery routes, and regulatory classification. Furthermore, we highlight the strategic role of blood centers and biobanks in producing high-safety allogeneic sEVs, especially those derived from human platelets and mesenchymal stromal cells expanded in xenofree conditions. While autologous exosomes offer maximal immunological safety, standardized allogeneic strategies free from animal-derived components represent a scalable and regulatory-compatible alternative for modern regenerative therapies.
Keywords: Exosomes, Regenerative Medicine, Autologous Exosomes, Non-autologous Exosomes

References:

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How to Cite this article: Marchant I, Rodríguez B, Pozo V, Parada L, Salvo C, Olivero P | Autologous versus Non-autologous Exosomes: Immunological, Safety, and Regulatory Considerations in Regenerative Medicine | Journal of Regenerative Science | Jan-Jun 2025; 5(1): 31-33.

 

 

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Assessment of the Efficacy of Extracorporeal Shock Wave Therapy in Adhesive Capsulitis: Outcomes Analysis and Predictors of Recurrence

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Original Article | Vol 5 | Issue 1 |  January-June 2025 | page: 23-30 | Paul Teran, Anabel Lozada, Francisco Endara, Luis Guzman

DOI: https://doi.org/10.13107/jrs.2025.v05.i01.165

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 26 April 2025, Review Date: 15 May 2025, Accepted Date: May 2025 & Published: 30 Jun 2025

Author: Paul Teran [1, 2], Anabel Lozada [1], Francisco Endara [1], Luis Guzman [3]

[1] Orthopedic Surgeon, Orthopedic Specialties Center (CEO), Quito-Ecuador,
[2] Department of Traumatology and Orthopedics, Metropolitan Hospital, Quito – Ecuador,
[3] Physician, Orthopedic Specialties Center (CEO), Quito-Ecuador.

Address of Correspondence
Dr. Paul Germán Terán Vela,
Orthopaedic Surgeon, Orthopedic Specialties Center (CEO), Quito-Ecuador.
E-mail: paulteranmd@gmail.com

Abstract

Background: Adhesive capsulitis of the shoulder is a condition characterized by pain and progressive restriction of the range of motion. Its management remains a clinical challenge due to variability in therapeutic response. Extracorporeal shock wave therapy (ESWT) has emerged as a non-invasive alternative with potential antifibrotic and analgesic effects. However, evidence regarding its efficacy and the factors associated with recurrence is limited.
Objectives: To assess the effectiveness of ESWT in functional improvement and pain reduction in patients with adhesive capsulitis and to analyze clinical factors associated with recurrence.
Study Design: A retrospective observational study conducted in a cohort of patients with adhesive capsulitis treated with ESWT. The study adhered to strengthening the reporting of observational studies in epidemiology guidelines for observational research.
Materials and Methods: Nineteen patients with a clinical and image-based diagnosis of adhesive capsulitis in the inflammatory or adhesive stage, treated with ESWT at a specialized center, were included. Patients with prior shoulder surgery, inflammatory arthritis, joint infection, or full-thickness rotator cuff tear were excluded. Demographic, clinical, and therapeutic variables were analyzed.
Measured Outcomes:
• Functionality: Disabilities of the arm, shoulder, and hand (DASH) score, pre- and post-treatment
• Pain: Visual analog scale (VAS)
• Recurrence: Reappearance of symptoms requiring additional intervention within a 1-year period.
Multivariable logistic regression with Lasso regularization was used to identify predictors of recurrence.
Outcomes: Following ESWT treatment, there was a significant reduction in DASH scores (62.4 ± 11.2 pre-treatment vs. 35.6 ± 9.8 post-treatment, P < 0.001) and in VAS scores (mean reduction of 3.8 points, P < 0.001). The 1-year recurrence rate was 26.3%. The following clinical factors were associated with an increased risk of recurrence:
• Advanced age (Odds ratio [OR] = 1.08, confidence interval [IC] 95%: 1.01–1.15, P = 0.02)
• Longer duration from symptom onset to the initiation of ESWT (OR = 1.23, IC 95%: 1.06–1.41, P = 0.004)
• Treatment cost as a mild protective factor (OR = 0.92, IC 95%: 0.85–0.99, P = 0.048).
No significant association was found between the number of ESWT sessions and functional improvement (r = 0.12, P = 0.34).
Conclusion: ESWT has demonstrated significant efficacy in improving functional outcomes and reducing pain in patients with adhesive capsulitis. Nevertheless, advanced age and delayed initiation of therapy have been identified as factors associated with an increased risk of recurrence. Early intervention is therefore recommended to optimize therapeutic outcomes. Further prospective studies with larger sample sizes and appropriate control groups are warranted to validate these findings.
Keywords: Adhesive capsulitis, Frozen shoulder, Extracorporeal shock waves, Extracorporeal shock wave therapy, Capsular fibrosis, Rehabilitation, Recurrence factors

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How to Cite this article: Terán P, Lozada A, Endara F, Guzmán L | Assessment of the efficacy of extracorporeal shock wave therapy in adhesive capsulitis: Outcomes analysis and predictors of recurrence. | Journal of Regenerative Science | Jan-Jun 2025; 5(1): 23-30.

 

 

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Proposal of a standardized positioning for rotator cuff treatment with shock waves and radial pressure waves: An anatomo-imaging correlation

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Original Article | Vol 5 | Issue 1 |  January-June 2025 | page: 19-22 | María Laura Tutté, Marcela Cedrés, Gabriela Stadler, Daniel Moya

DOI: https://doi.org/10.13107/jrs.2025.v05.i01.163

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 2025, Review Date: 2025, Accepted Date: 2025 & Published: 30 Jun 2025

Author: María Laura Tutté [1], Marcela Cedrés [2], Gabriela Stadler [1], Daniel Moya [3]

[1] Department of Rehabilitation and Physical Medicine, State Insurance Bank Hospital Montevideo, Uruguay,
[2] Department of Imagenology, State Insurance Bank Hospital, Montevideo, Uruguay,
[3] Department of Orthopaedic Surgery, Buenos Aires British Hospital, Argentina.

Address of Correspondence
Dr. María Laura Tutté,
Department of Rehabilitation and Physical Medicine, State Insurance Bank Hospital Montevideo, Uruguay.
E-mail: dra.tutte@gmail.com

Abstract
One of the keys to successful treatment with radial pressure waves and focused shock waves is being able to deliver the energy to the right area. The shoulder region is characterized by a complex architecture with overlapping structures, which can make it difficult to locate the area to be treated.
The aim of this study is to describe the best upper limb positions and standardized approaches to treat rotator cuff pathology, based on the correlation of radiological and ultrasound images obtained during a joint examination by an imaging expert and a shock wave specialist.
Keywords: Extracorporeal shock wave therapy, Radial pressure waves, Arm positioning, Shoulder ultrasound

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1. Moya D, Ramón S, Schaden W, Wang CJ, Guiloff L, Cheng JH. The role of extracorporeal shockwave treatment in musculoskeletal disorders. J Bone Joint Surg Am 2018;100:251-63.
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3. Moya D, Rashid M, Rowinski S, Al-Qahtani S, Bernáldez Domínguez P, Gómez D, et al. Therapeutic options in rotator cuff calcific tendinopathy. SICOT J 2025;11:9.
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6. Tornese D, Mattei E, Bandi M, Zerbi A, Quaglia A, Melegati G. Arm position during extracorporeal shock wave therapy for calcifying tendinitis of the shoulder: A randomised study. Clin Rehabil 2011;25:731-9.
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11. Brañes J, Contreras H, Cabello P, Antonic V, Guiloff L, Brañes M. Shoulder rotator cuff responses to extracorporeal shockwave therapy: Morphological and immunohistochemical analysis. Shoulder Elbow 2012;4:163-8.
12. Pan PJ, Chou CL, Chiou HJ, Ma HL, Lee HC, Chan RC. Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulder: A functional and sonographic study. Arch Phys Med Rehabil 2003;84:988-93.
13. Cosentino R, De Stefano R, Selvi E, Frati E, Manca S, Frediani B, et al. Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulder: Single blind study. Ann Rheum Dis 2003;62:248-50.
14. Rebuzzi E, Coletti N, Schiavetti S, Giusto F. Arthroscopy surgery versus shock wave therapy for chronic calcifying tendinitis of the shoulder. J Orthop Traumatol 2008;9:179-85.
15. Sabeti-Aschraf M, Dorotka R, Gol Al, Trieb K. Extracorporeal shock wave therapy in the treatment of calcific tendinitis of the rotator cuff. Am J Sports 2005;33:1365-8.
16. Li Q, Chen R, Yu Y, Wang X, Feng X, Jiang L, et al. Extracorporeal shockwave therapy combined with multiple drilling and intramedullary drug injection for treating early-stage Femur Head Necrosis: Protocol for a randomized controlled trial. Medicine (Baltimore) 2020;99:e22598.
17. Moya D, Gómez D, Velóz Serrano D, Bernáldez Domínguez P, Dallo Lazzarini I, Gómez G. Treatment protocol for rotator cuff calcific tendinitis using a single-crystal piezoelectric focused shock wave source. J Vis Exp 2022;190:1-14

 

How to Cite this article: Tutté ML, Cedrés M, Stadler G, Moya D | Proposal of a standardized positioning for rotator cuff treatment with shock waves and radial pressure waves: An anatomoimaging correlation. | Journal of Regenerative Science | Jan-Jun 2025; 5(1): 19-22.

 

 

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Prolactin: A New Actor in Musculoskeletal Physiology and its Implication in Orthopedic Pathologies

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Original Article | Vol 5 | Issue 1 |  January-June 2025 | page: 14-18 | Paul Germán Terán Vela, Estefanía Anabel Lozada Tobar, Luis Eduardo Guzmán Freire

DOI: https://doi.org/10.13107/jrs.2025.v05.i01.161

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 10 May 2025, Review Date: 20 May 2025, Accepted Date: May 2025 & Published: 30 Jun 2025

Author: Paul Germán Terán Vela [1], Estefanía Anabel Lozada Tobar [1], Luis Eduardo Guzmán Freire [2]

[1] Department of Traumatology and Orthopedics, Orthopedic Specialties Center, Quito- Ecuador,
[2] Orthopedic Specialties Center, Quito-Ecuador.

Address of Correspondence
Dr. Paul Germán Terán Vela,
Department of Traumatology and Orthopedics, Orthopedic Specialties Center, Quito-Ecuador.
E-mail: paulteranmd@gmail.com

Abstract
Prolactin (PRL), traditionally known for its role in lactation, has emerged as a pleiotropic hormone with actions that extend beyond reproduction. Growing evidence suggests its involvement in pain modulation, immune function and tissue homeostasis, with potential repercussions on musculoskeletal health. This review analyzes in depth the available scientific literature on PRL and its relationship with orthopedic pathologies, including chronic pain, tendinopathies, and conditions of the muscle, ligaments, and articular cartilage. The molecular and cellular mechanisms underlying the influence of PRL on musculoskeletal physiology are explored, as well as the clinical implications of its level disturbances, both hyperprolactinemia and hypoprolactinemia. Finally, future perspectives and lines of research are discussed to fully understand the role of PRL in the context of orthopedic pathologies are discussed.
Keywords: Prolactin, Hyperprolactinemia, Hypoprolactinemia, Chronic pain, Tendinopathies, Osteoarthritis, Skeletal muscle, Ligaments, Articular cartilage, Prolactin receptors

References:

1. Noel GL, Suh HK, Stone JG, Frantz AG. Human prolactin and growth hormone release during surgery and other conditions of stress. J Clin Endocrinol Metab 1972;35:840-51.
2. Sassin JF, Frantz AG, Weitzman ED, Kapen S. Human prolactin: 24-Hour pattern with increased release during sleep. Science 1972;177:1205-7.
3. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, et al. Diagnosis and treatment of hyperprolactinemia: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011;96:273-88.
4. Molitch ME. Drugs and prolactin. Pituitary 2008;11:209-18.
5. Bostwick JR, Guthrie SK, Ellingrod VL. Antipsychoticinduced hyperprolactinemia. Pharmacotherapy 2009;29:64-73.
6. Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Applegate G, Sutton ML. Hypopituitarism following external radiotherapy for pituitary tumours in adults. Q J Med 1989;70:145-60.
7. Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline comparative study group. N Engl J Med 1994;331:904-9.
8. Maciuba S, Bowden GD, Stratton HJ, Wisniewski K, Schteingart CD, Almagro JC, et al. Discovery and characterization of prolactin neutralizing monoclonal antibodies for the treatment of female-prevalent pain disorders. MAbs 2023;15:2254676.
9. Singh S, Kopruszinski CM, Watanabe M, Dodick DW,Navratilova E, Porreca F. Female-selective mechanisms promoting migraine. J Headache Pain 2024;25:63.
10. Clevenger CV, Furth PA, Hankinson SE, Schuler LA. The role of prolactin in mammary carcinoma. Endocr Rev 2003;24:1-27.
11. Ling C, Hellgren G, Gebre-Medhin M, Dillner K, Wennbo H, Carlsson B, et al. Prolactin (PRL) receptor gene expression in mouse adipose tissue: Increases during lactation and in PRLtransgenic mice. Endocrinology 2000;141:3564-72.
12. Guler HP, Zapf J, Froesch R. Short-term metabolic effects of recombinant human insulin-like growth factor I in healthy adults. N Engl J Med 1987;317:137-40.
13. Lubberts E, Joosten LA, Oppers B, Van Den Bersselaar L, Coenen-De Roo CJ, Kolls JK, et al. IL-1-independent role of IL-
17 in synovial inflammation and joint destruction duringcollagen-induced arthritis 1. J Immunol 2001;167:1004-13.
14. Schlechte JA, Shermanf BM, Chapler FK, Van Gilder J. Long term follow-up of women with surgically treated prolactinsecretingpituitary tumors. J Clin Endocrinol Metab1986;62:1296-301.
15. Klibanski A, Zervas NT. Diagnosis and management ofhormone-secreting pituitary adenomas. N Engl J Med 1991;324:822-31.
16. Yun SJ, Sang H, Park SY, Chin SO. Effect ofhyperprolactinemia on bone metabolism: Focusing onosteopenia/osteoporosis. Int J Mol Sci 2024;25:1474.
17. Buvat J, Lemaire A, Buvat-Herbaut M, Fourlinnie JC,Racadot A, Fossati P. Hyperprolactinemia and sexual functionin men. Horm Res 1985;22:196-203.
18. Szewczyk AK, Ulutas S, Aktürk T, Al-Hassany L, Börner C,Cernigliaro F, et al. Prolactin and oxytocin: Potential targets formigraine treatment. J Headache Pain 2023;24:31.

How to Cite this article: Terán Vela PG, Tobar EAL, Freire LEG | Prolactin: A New Actor in Musculoskeletal Physiology and its Implication in Orthopedic Pathologies| Journal of Regenerative Science | Jan-Jun 2025; 5(1): 14-18.

 

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Tibial delayed bone healing in a pediatric patient. Treatment with focused shock wave therapy

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Bibliographic Analysis | Vol 5 | Issue 1 |  January-June 2025 | page: 05-07 | Martín Turco, Fernando Dobkin, Purrello Silvia

DOI: https://doi.org/10.13107/jrs.2025.v05.i01.157

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 10 Feb 2025, Review Date: 12 Mar 2025, Accepted Date: May 2025 & Published: 30 Jun 2025

Author: Martín Turco [1], Fernando Dobkin [1], Purrello Silvia [2]

[1] Department of Orthopaedic Surgery, Sanatorio Parque Rosario, Rosario, Argentina,
[2] Department of Orthopaedic Surgery, Sanatorio de Niños Rosario, Rosario, Argentina.

Address of Correspondence
Dr. Martín Turco,
Department of Orthopaedic Surgery, Sanatorio Parque Rosario, Rosario, Argentina.
E-mail: martinturco@live.com.ar

Abstract
Surgery for leg fractures in children and adolescents can have complications such as delayed healing and non-unions. When this complication occurs in many cases, it is necessary to remove the previously placed implant, generate a new active focus (bone curettage), and place a new implant, with or without the addition of bone graft. In cases where the fracture site is stable, focused shock waves can play a therapeutic role with a low complication rate. We present the long-term results in a case of tibial shaft fracture with delayed healing treated with shock waves in an 11- year-old patient.
Keywords: Tibial delayed healing, Non-union; Leg fracture; Shock Waves, Pediatric Fracture

References:

1. Wang Y, Doyle M, Smit K, Varshney T, Carsen S. The toddler‘s fracture. Pediatr Emerg Care 2022;38:36-9.
2. Rockwood CA, Wilkins KE, Beaty JH, Kasser JR. Rockwood and Wilkins‘ Fractures in Children. Philadelphia, PA: Lippincott Williams and Wilkins; 2001.
3. Gordon JE, Gregush RV, Schoenecker PL, Dobbs MB, Luhmann SJ. Complications after titanium elastic nailing of pediatric tibial fractures. J Pediatr Orthop 2007;27:442-6.
4. Valchanou VD, Michailov P. High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop 1991;15:181-4.
5. Moya D, Ramón S, Schaden W, Wang CJ, Guiloff L, Cheng JH. The role of extracorporeal shockwave treatment in musculoskeletal disorders. J Bone Joint Surg Am 2018;100:251-63.
6. Haupt G. Use of extracorporeal shock waves in the treatment of pseudarthrosis, tendinopathy and other orthopedic diseases. J Urol 1997;158:4-11.
7. Rompe JD, Rosendahl T, Schöllner C, Theis C. High-energy extracorporeal shock wave treatment of nonunions. Clin Orthop Relat Res 2001;387:102-11.
8. Wang CJ, Chen HS, Chen CE, Yang KD. Treatment of nonunions of long bone fractures with shock waves. Clin Orthop Relat Res 2001;387:95-101.
9. Schaden W, Fischer A, Sailler A. Extracorporeal shock wave therapy of nonunion or delayed osseous union. Clin Orthop Relat Res 2001;387:90-4.
10. Elster EA, Stojadinovic A, Forsberg J, Shawen S, AndersenRC, Schaden W. Extracorporeal shock wave therapy for nonunion of the tibia. J Orthop Trauma 2010;24:133-41.
11. Schaden W, Mittermayr R, Haffner N, Smolen D, Gerdesmeyer L, Wang CJ. Extracorporeal shockwave therapy (ESWT)–First choice treatment of fracture non-unions? Int J Surg 2015;24:179-83.
12. Moya D, Brañes M, Guiloff L, Ramón S, Olivieri H. Use of Focused Shockwaves Under 18 Years Old: Is it Justified to Cross the Limit? 22nd ISMST Congress, Beijing, China, 2019.
13. Senes S, Staudacher G, Iglesias S, Moya D, Goyeneche R. Treatment of a femoral shaft non-union in a pediatric patient with focused shockwaves. Regen Sci 2022;2:36-8.
14. Ruíz-Mejía O, Pimentel-Rangel J, Escudero-Rivera D, Valle-de Lascurain G, Oribio-Gallegos JA. Manejo de las fracturas diafisarias en pacientes pediátricos con clavos elásticos de titanio [Management of shaft fractures with elastic titanium nails in pediatric patients]. Acta Ortop Mex 2012;26:162-9.
15. Mendoza-Balta RJ, Bello-González A, Rosas-Cadena JL. Tratamiento de fracturas diafisiarias en niños con clavos elásticos de titanio [Treatment of shaft fractures in children with elastic titanium nails]. Acta Ortop Mex 2009;23:286-91.
16. Yao LF, Chen Q, Zhong ZP, Xu RM, Wang HR, Peng LR, et al. [Analysis on complications of elastic nail treating children’s long bone fractures]. Zhongguo Gu Shang 2009;22:98-100.
17. Lascombes P, Haumont T, Journeau P. Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop 2006;26:827-34.
19. Jhan SW, Wu KT, Chou WY, Chen JW, Siu KK, Huang WC, Wang CJ, Cheng JH. Does extracorporeal shockwave therapy treat leg length discrepancy? an experimental animal study. Arthritis Res Ther. 2025 Mar 4;27(1):47. doi: 10.1186/s13075- 025-03519-6. PMID: 40038756; PMCID: PMC11877862.

How to Cite this article: Turco M, Dobkin F, Silvia P | Tibial delayed bone healing in a pediatric patient. Treatment with focused shock wave therapy. | Journal of Regenerative Science | Jan-Jun 2025; 5(1): 05-07.

 

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A Commentary on “Extracorporeal Shock Wave Therapy with Imaging Examination for Early Osteonecrosis of the Femoral Head: A Systematic Review”

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Bibliographic Analysis | Vol 5 | Issue 1 |  January-June 2025 | page: 03-04 | Song Dehui, Sun Wei, Fuqiang Gao

DOI: https://doi.org/10.13107/jrs.2025.v05.i01.155

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 08 Apr 2025, Review Date: 24 May 2025, Accepted Date: May 2025 & Published: 30 Jun 2025

Author: Song Dehui [1], Sun Wei [2, 3], Fuqiang Gao [1]

[1] Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving and Reconstruction, China-Japan Friendship Hospital, Beijing, China,
[2] Department of Orthopedics, Beijing United Family Hospital, Chaoyang, Beijing, China,
[3] Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Address of Correspondence
Dr. Fuqiang Gao.
Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving and Reconstruction, China-Japan Friendship Hospital, Beijing, China.
E-mail: gaofuqiang@bjmu.edu.cn

Dear Editor,
We have carefully read the systematic review article by Tan et al. [1] published in the International Journal of Surgery. By combining imaging and clinical findings as an important indicator, they studied the clinical effect and images of extracorporeal shock wave therapy (ESWT) in early stage osteonecrosis of the femoral head (ONFH), and suggested that ESWT can improve the symptom of bone marrow edema and was expected to be used as a promising treatment to enhance hip function and reduce pain in the early ONFH. However, we have a few considerations we would like to discuss regarding specific aspects of the study.
First, this systematic review included the randomized controlled trials (RCTs) and case series studies. RCT is widely considered the “gold standard” for evaluating the causal effect of the intervention, and case series, which provide some observational evidence for practical clinical applications, have a low level of evidence and a high risk of selection bias due to insufficient patient selection criteria. The combination of two types of studies for analysis may introduce bias and affect the efficacy of ESWT. In addition, we found that one of the studies involved fewer than 20 cases. It may result in insufficient statistical power, increasing the risk of false-positive or false-negative results due to random variability. Second, when comparing the three main indicators: Damage size (lesion size), change in Association Research Circulation Osseous stage, and marrow edema grade after ESWT, the results mainly relied on only one single-center RCT by Wang et al. [2] and significant differences existed in the cont ol group interventions across several included studies. Some studies used medical treatment as a control, whereas others conducted surgical intervention. This variability makes it challenging to isolate the potential contributions of other treatments, significantly limiting the precise assessment of the relative effect of ESWT.
Finally, throughout the study, the authors did not clearly differentiate between ONFH and bone marrow edema syndrome (BMES). Instead, they examined bone marrow edema as an early symptom of avascular necrosis (AVN), which may obscure the distinct nature of these conditions and misrepresent the effects of ESWT. ONFH is a common condition characterized by hypoxia and necrosis of bone tissue caused by disrupted local blood supply. This is a worsening and irreversible process, leading to irreparable bone damage and structural deformity. Surgical interventions, such as total hip replacement, are often required in severe cases. In contrast, BMES is a reversible condition characterized by elevated intraosseous pressure and a localized inflammatory response causing fluid accumulation in the bone marrow.
Its primary symptom is acute localized pain, but it often resolves spontaneously. Conservative treatments, including non-steroidal antiinflammatory drugs, physical therapy, and weight-bearing reduction, are typically effective. ESWT has demonstrated efficacy in promoting tissue regeneration, enhancing angiogenesis, and alleviating local pain, particularly in BMES.
However, the efficacy of ESWT in treating AVN of the femoral head is relatively limited. Thus, treating bone marrow edema as an early manifestation of femoral head necrosis may overestimate the overall efficacy of ESWT, potentially misrepresenting its therapeutic impact. Simple bone marrow edema typically presents as a diffuse high-signal response in the femoral head on magnetic resonance imaging (MRI). In contrast, bone marrow edema secondary to ONFH appears as a low or absent signal on MRI, reflecting necrotic and inactive bone tissue. In the discussion, the citation of Figs. 8 and 9 failed to clearly differentiate whether the imaging sources represented BMES alone or bone marrow edema secondary to AVN. When citing relevant imaging results, special attention should be paid to the differences in imaging between the two types of BMES. Such ambiguous referencing may mislead readers into assuming that ESWT has comparable therapeutic effects across all types of bone marrow edema. Nevertheless, we commend the authors for their contribution to the study, and we believe that with further differentiation between BMES and ONFH the related research will be more precise and in-depth.

References:

1. Tan H, Tang P, Chai H, Ma W, Cao Y, Lin B, et al. Extracorporeal shock wave therapy with imaging examination for early osteonecrosis of the femoral head: A systematic review. Int J Surg 2024;111:1144-53.
2. Wang CJ, Huang CC, Wang JW, Wong T, Yang YJ. Longterm results of extracorporeal shockwave therapy and core decompression in osteonecrosis of the femoral head with eightto nine-year follow-up. Biomed J 2012;35:481-5.

How to Cite this article: Dehui S, Wei S, Gao F | A Commentary on “Extracorporeal Shock Wave Therapy with Imaging Examination for Early Osteonecrosis of the Femoral Head: A Systematic Review”. | Journal of Regenerative Science | Jan-Jun 2025; 5(1): 03-04.

 

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Combined Regenerative Treatments for Musculoskeletal Disorders: Is this the Way Forward?

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Editorial | Vol 5 | Issue 1 |  January-June 2025 | page: 01-02 | Daniel Moya

DOI: https://doi.org/10.13107/jrs.2025.v05.i01.153

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 05 Feb 2025, Review Date: 15 May 2025, Accepted Date: 25 May 2025 & Published: 30 Jun 2025

Author: Daniel Moya [1]

[1] Department of Orthopaedics, Hospital Británico de Buenos Aires, Argentina.

Address of Correspondence
Dr. Daniel Moya,
Department of Orthopaedics, Hospital Británico de Buenos Aires, Argentina.
E-mail: drdanielmoya@yahoo.com.ar

Editorial

If we had the opportunity to visit a European pharmacy during the 16th century, we would surely find crushed Egyptian mummies among the medicines for sale [1]. Its use was indicated for all types of ailments, from headaches or indigestion to treating the consequences of bubonic plague [2].
The practice of consuming parts of ancient Egyptian mummies began in the 11th century [3], and its widespread in Western Europe was in fact, due to a series of mistranslations and misunderstandings [1]. The Persians considered asphalt a miraculous substance, with healing effects in the treatment of wounds and fractures. They called this substance “mum” [3]. It was first described in detail in the Arabic medical pharmacy texts as “mumiya” [1-4]. Probably, translation errors and the fact that Egyptian mummies were covered in a layer of resin, led to the conclusion that eating mummies powder would have beneficial effects on health. The custom spreaded from Byzantium throughout Europe, remaining in some cases until the 19th century [1-4].
These stories, which are laughable today, reflect human nature and its eternal search for the source of eternal youth and health. While therapeutic attempts may change over the centuries, our nature remains the same. The explosion of interest in “regenerative medicine” in recent years has opened up new hope as a healing option that is often presented as miraculous. As if the constant emergence of new therapeutic options whose effectiveness is not fully proven was not enough, we also faced the capricious combination of these methods. It is not uncommon to see the indiscriminate dissemination of these techniques by colleagues on social media and congresess and its application in medical practice without solid scientific evidence. For example, the proposal to combine shock waves with platelet-rich plasma has become very popular at scientific conferences and presentations. However, there is no solid evidence to support it for most musculoskeletal indications.
A simple ankle sprain is treated with four different therapeutic methods simultaneously. After 2 weeks, the hematoma and edema miraculously resolved!!! The same thing that would happen only with ice and rest.
In the case of a professional athlete, where a positive result is needed as quickly as possible, it may make some sense to deviate from the usual norms, but it is not necessarily valid to apply this as a massive practice.
The principle of Ockham’s razor is a philosophical rule that recommends choosing the simplest explanation in situations where several explanations for the same phenomenon are presented [5]. It is very difficult to apply in cases of combined treatment. When many therapies are applied, we’ll never know which method really cured the patient, if any of them actually made a difference, but the professional and the promoted devices will undoubtedly increase their sales. Likewise, if the patient worsens, we will not know which treatment or combination of treatments was responsible for the poor outcome.
It is important to differentiate between “complementary treatments” and “combined treatments.” We could say that in the case of complementary treatments, we use techniques that have different objectives and mechanisms of action, for example immobilization, ice, and rest in the case of an acute traumatic injury. In the case of “combined” treatments, there is often an overlap of mechanisms of action.
In his unforgettable television series on the development of science and technology, Burke [6] stated, “If you follow the trail from the past to a modern procedure used by humanity, the story has many twists, turns, false leads, and conjectures.” New therapeutic alternatives can offer us the results we’ve always desired, but in some cases, they may be false leads. Scientifically based study of the combination of therapeutic methods before offering them commercially and undiscriminatingly will prevent our generation from becoming the mummy powder salesmen of the 21st century that will cause laughter in the future among those who follow us on the path of medicine.

References:

1. Dannenfeldt KH. Egyptian mumia: The sixteenth century experience and debate. Sixt Century J 1985;16:163-80.
2. Abel GM. Mummy Extract, the Multipurpose Remedy of the Middle Ages in Spanish. National Geographic; 2023. Available from: https://historia.nationalgeographic.com.es/a/extracto-momia-remedio-multiusos-edad-media-18121 [Last accessed on 2025 May ???].
3. Blakemore E. The Gory History of Europe’s Mummy-Eating Fad. National Geographic; 2023. Available from: https://www.nationalgeographic.com/history/article/mummy-eating-medical-cannibalism-gory-history [Last accessed on 2025 May].
4. Bouras-Vallianatos P, Käs F. Treating with minerals in the middle ages: The rare substance mūmiyā‘ (pitch-asphalt) and its medicinal uses in Byzantium. Med Hist 2024;68:223-36.
5. McFadden J. Razor sharp: The role of occam’s razor in science. Ann N Y Acad Sci 2023;1530:8-17.
6. Burke J. Connections. BBC; 1978. Available from: https://archive.org/details/connectionsbyjamesburke [Last accessed on 2025 May].

How to Cite this article: Moya D | Combined Regenerative Treatments for Musculoskeletal Disorders: Is this the Way Forward? | Journal of Regenerative Science | Jan-Jun 2025; 5(1): 01-02.

 

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