Non Invasive Phisical Physical Regenerative Therapies: Laser therapy, Mechanism of Action and Results

/0 Comments/in /by

Review Article | Volume 1 | Issue 1 | JRS December 2021 | Page 21-25 | W. Leonardo Guiloff , Ondrej Prouza , Dragana Žarković. DOI: 10.13107/jrs.2021.v01.i01.013

Author: W. Leonardo Guiloff [1], Ondrej Prouza [2], Dragana Žarković [2]

[1] Department of Orthopedic Surgery of Davila Clinic, Santiago Chile, Past President Onlat-Achitoc, Santiago, Chile.

[2] Department of Anatomy and Biomechanics, Faculty of Physical Education and Sports, Charles
University, Prague, Czech Republic.

Address of Correspondence
Dr. W. Leonardo Guiloff, MD
Department of Orthopedic Surgery of Davila Clinic, Santiago Chile, Past President Onlat-Achitoc, Santiago, Chile.
E-mail: lguiloff@davila.cl

Abstract

Low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) have emerged as a therapeutic alternative suitable for a wide range of medical conditions. The main advantage of high-intensity laser over LLLT is its ability to deliver a much higher dose in a shorter time while achieving deeper penetration into the affected tissue and producing a thermal effect. Although HILT, provides very satisfactory clinical results, more clinical research is require to justify its massive use.
Keywords: Low-level laser therapy, High-level laser therapy, Biostimulation, Phototherapy.

References:

1. Huang C, Holfeld J, Schaden W, Orgill D, Ogawa R. Mechanotherapy: Revisiting physical therapy and recruiting mechanobiology for a new era in medicine. Trends Mol Med 2013;19:555-64.
2. 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.
3. Brañes J, Contreras HR, Cabello P, Antonic V, Guiloff LJ, Brañes M. Shoulder rotator cuff responses to extracorporeal shockwave therapy: Morphological and immunohistochemical analysis. Shoulder Elbow 2012;4:163-8.
4. Taylor N. Laser: The Inventor, the Nobel Laureate, and the Thirty Year Patent war. New York: Nick Taylor Simon Schuster; 2000.
5. Myers R, Dixon R. Who invented the laser: An analysis of the early patents. In: Historical Studies in the Physical and Biological Sciences. Vol. 34. California: University of California Press; 2003. p. 115-49.
6. Mester E. Risultati clinici di stimolazione laser e studi sperimentali circa il meccanismo di azione [Clinical results of laser stimulation and experimental studies on its mechanism of action]. Minerv Med. 1981;72:2195-9.
7. Huang YY, Chen AC, Carroll JD, Hamblin MR. Biphasic dose response in low level light therapy. Dose Response 2009;7:358-83.
8. Wickenheisser VA, Zywot EM, Rabjohns EM, Lee HH, Lawrence DS, Tarrant TK. Laser light therapy in inflammatory, musculoskeletal, and autoimmune disease. Curr Allergy Asthma Rep 2019;19:37.
9. Cotler HB, Chow RT, Hamblin MR, Carroll J. The use of low level laser therapy (LLLT) for musculoskeletal pain. MOJ Orthop Rheumatol 2015;2:00068.
10. Clijsen R, Brunner A, Barbero M, Clarys P, Taeymans J. Effects of low-level laser therapy on pain in patients with musculoskeletal disorders: A systematic review and meta-analysis. Eur J Phys Rehabil Med 2017;53:603-10.

11. Konstantinovic LM, Kanjuh ZM, Milovanovic AN, Cutovic MR, Djurovic AG, Savic VG, et al. Acute low back pain with radiculopathy: A double-blind, randomized, placebo-controlled study. Photomed Laser Surg 2010;28:553-60.
12. Konstantinovic LM, Cutovic MR, Milovanovic AN, Jovic SJ, Dragin AS, Letic MD, et al. Low-level laser therapy for acute neck pain with radiculopathy: A double-blind placebo-controlled randomized study. Pain Med 2010;11:1169-78.
13. Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: A systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009;374:1897-908.
14. Djavid GE, Mehrdad R, Ghasemi M, Hasan-Zadeh H, Sotoodeh-Manesh A, Pouryaghoub G. In chronic low back pain, low level laser therapy combined with exercise is more beneficial than exercise alone in the long term: A randomised trial. Aust J Physiother 2007;53:155-60.
15. Momenzadeh S, Kiabi FH, Moradkhani M, Moghadam MH. Low level laser therapy (LLLT) combined with physical exercise, a more effective treatment in low back pain. J Laser Med Sci 2012;3:67-70.
16. Tumilty S, Munn J, McDonough S, Hurley DA, Basford JR, Baxter GD. Low level laser treatment of tendinopathy: A systematic review with meta-analysis. Photomed Laser Surg 2010;28:3-16.
17. Bjordal JM, Lopes-Martins RA, Iversen VV. A randomised, placebo controlled trial of low level laser therapy for activated Achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations. Br J Sports Med 2006;40:76-80; discussion 76-80.
18. Bjordal JM, Lopes-Martins RA, Joensen J, Couppe C, Ljunggren AE, Stergioulas A, et al. A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord 2008;9:75.
19. Bjordal JM, Couppé C, Chow RT, Tunér J, Ljunggren EA. A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. Aust J Physiother. 2003;49:107-16.
20. Tascioglu F, Armagan O, Tabak Y, Corapci I, Oner C. Low power laser treatment in patients with knee osteoarthritis. Swiss Med Wkly 2004;134:254-8.

21. Brosseau L, Welch V, Wells G, DeBie R, Gam A, Harman K, et al. Low level laser therapy (Classes I, II and III) for treating osteoarthritis. Cochrane Database Syst Rev 2004;3:CD002046.
22. Stasinopoulos DI, Johnson MI. Effectiveness of low-level laser therapy for lateral elbow tendinopathy. Photomed Laser Surg 2005;23:425-30.
23. Enwemeka CS, Parker JC, Dowdy DS, Harkness EE, Sanford LE, Woodruff LD. The efficacy of low-power lasers in tissue repair and pain control: A meta-analysis study. Photomed Laser Surg 2004;22:323-9.
24. Hopkins JT, McLoda TA, Seegmiller JG, Baxter GD. Low-level laser therapy facilitates superficial wound healing in humans: A triple-blind, sham-controlled study. J Athl Train 2004;39:223-9.
25. Fukuda VO, Fukuda TY, Guimarães M, Shiwa S, de Lima Bdel C, Martins RÁ, et al. Short-term Eefficacy of low-level laser therapy in patients with knee osteoarthritis: A randomized placebo-controlled, double-blind clinical trial. Rev Bras Ortop 2015;46:526-33.
26. Conti PC. Low level laser therapy in the treatment of temporomandibular disorders (TMD): A double-blind pilot study. Cranio 1997;15:144-9.
27. Brosseau L, Robinson V, Wells G, Debie R, Gam A, Harman K, et al. Low level laser therapy (Classes I, II and III) for treating rheumatoid arthritis. Cochrane Database Syst Rev 2005;4:CD002049.
28. Stiglić-Rogoznica N, Stamenković D, Frlan-Vrgoc L, Avancini-Dobrović V, Vrbanić TS. Analgesic effect of high intensity laser therapy in knee osteoarthritis. Coll Antropol 2011;35 Suppl 2:183-5.
29. Prochazka M. “Class IV Laser in Noninvasive Laser Therapy.” Laser Partner; 2006. Available from: https://www.laserpartner.org/lasp/web/en/2003/0069html [Last access date 2006].
30. Bettencourt F. Effects of class IV laser in knee osteoarthritis: A randomized control trial. J Arthritis 2020;9:1-289.

31. Vescovi P, Merigo E, Manfredi M, Meleti M, Fornaini C, Bonanini M, et al. Nd: YAG laser biostimulation in the treatment of bisphosphonate-associated osteonecrosis of the jaw: Clinical experience in 28 cases. Photomed Laser Surg 2008;26:37-46.
32. Santamato A, Solfrizzi V, Panza F, Tondi G, Frisardi V, Leggin BG, et al. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of people with subacromial impingement syndrome: A randomized clinical trial. Phys Ther 2009;89:643-52.
33. Wyszyńska J, Bal-Bocheńska M. Efficacy of high-intensity laser therapy in treating knee osteoarthritis: A first systematic review. Photomed Laser Surg 2018;36:343-53.
34. Graudenz K, Raulin C. Von einsteins quantentheorie zur modernen lasertherapie: Historie des lasers in der dermatologie und ästhetischen medizin. Hautarzt 2003;7:575-82.
35. Kojevnikov A. Nikolay Gennadiyevich Basov. Encyclopedia Britannica; 2021. Available from: https://www.britannica.com/biography/Nikolay-Basov [Last accessed on 2021 Aug 2].
36. Charles H. Townes Biographical. NobelPrize.org. Nobel Prize Outreach AB 2021. Sun. 31 Oct; 2021. Available from: https://www.nobelprize.org/prizes/physics/1964/townes/biographical [Last accessed on 2021 Aug 2].
37. Schawlow AL. Schawlow Biographical. NobelPrize.org. Nobel Prize Outreach AB 2021. Sun. 31 Oct; 2021. Available from: https://www.nobelprize.org/prizes/physics/1981/schawlow/biographical [Last accessed on 2021 Aug 2].
38. Maiman TH. Stimulated optical radiation in ruby. Nature 1960;187:493-4.
39. Sommer AP, Pinheiro AL, Mester AR, Franke RP, Whelan HT. Biostimulatory windows in low-intensity laser activation: Lasers, scanners, and NASA’s light-emitting diode array system. J Clin Laser Med Surg 2001;19:29-33.
40. Nouri K, Ballard CJ. Laser therapy for acne. Clin Dermatol 2006;24:26-32.

41. Evans DH, Abrahamse H. Efficacy of three different laser wavelengths for in vitro wound healing. Photodermatol Photoimmunol Photomed 2008;24:199-210.
42. Whelan HT, Smits RL Jr., Buchman EV, Whelan NT, Turner SG, Margolis DA, et al. Effect of NASA light-emitting diode irradiation on wound healing. J Clin Laser Med Surg 2001;19:305-14.
43. Peplow PV, Chung TY, Baxter GD. Laser photobiomodulation of wound healing: A review of experimental studies in mouse and rat animal models. Photomed Laser Surg 2010;28:291-325.
44. Conlan MJ, Rapley JW, Cobb CM. Biostimulation of wound healing by low-energy laser irradiation. A review. J Clin Periodontol 1996;23:492-6.
45. Woodruff LD, Bounkeo JM, Brannon WM, Dawes KS, Barham CD, Waddell DL, et al. The efficacy of laser therapy in wound repair: A meta-analysis of the literature. Photomed Laser Surg 2004;22:241-7.
46. Dundar U, Turkmen U, Toktas H, Solak O, Ulasli AM. Effect of high-intensity laser therapy in the management of myofascial pain syndrome of the trapezius: A double-blind, placebo-controlled study. Lasers Med Sci 2015;30:325-32.
47. Kneebone WJ, Crna DC, DIHom CN. Practical applications of low level laser therapy. Pract Pain Manag 2006;6:34-40.
48. Marshall RP, Vlková K. Spectral dependence of laser light on light-tissue interactions and its influence on laser therapy: An experimental study. Insights Biomed 2020;5:1.
49. Baack HO. Comparison of energy spread homogeneity in automated and manual class 4 laser therapy. Res Rev 2020;9:1-9.
50. Khalkhal E, Razzaghi M, Rostami-Nejad M, Rezaei-Tavirani M, Heidari Beigvand H, Tavirani MR. Evaluation of laser effects on the human body after laser therapy. J Lasers Med Sci 2020;11:91-7.

51. Tseng SH, Bargo P, Durkin A, Kollias N. Chromophore concentrations, absorption and scattering properties of human skin in-vivo. Opt Express 2009;17:14599-617.
52. Chen CH, Tsai JL, Wang YH, Lee CL, Chen JK, Huang MH. Low-level laser irradiation promotes cell proliferation and mRNA expression of Type I collagen and decorin in porcine Achilles tendon fibroblasts in vitro. J Orthop Res 2009;27:646-50.
53. Karu TI, Hode L. Ten Lectures on Basic Science of Laser Phototherapy. Grängesberg: Prima Books; 2007.
54. Mester A, Mester A. The history of photobiomodulation: Endre mester (1903-1984). Photomed Laser Surg 2017;35:393-4.
55. Peplow PV, Chung TY, Baxter GD. Laser photobiomodulation of proliferation of cells in culture: A review of human and animal studies. Photomed Laser Surg 2010;28 Suppl 1:S3-40.
56. Karu T. Mitochondrial mechanisms of photobiomodulation in context of new data about multiple roles of ATP. Photomed Laser Surg 2010;28:159-60.
57. Holden PK, Li C, Da Costa V, Sun CH, Bryant SV, Gardiner DM, et al. The effects of laser irradiation of cartilage on chondrocyte gene expression and the collagen matrix. Lasers Surg Med 2009;41:487-91.
58. Chen CH, Hung HS, Hsu SH. Low-energy laser irradiation increases endothelial cell proliferation, migration, and eNOS gene expression possibly via PI3K signal pathway. Lasers Surg Med 2008;40:46-54.
59. Zati A, Desando G, Cavallo C, Buda R, Giannini S, Fortuna D, et al. Treatment of human cartilage defects by means of Nd: YAG laser therapy. J Biol Regul Homeost Agents 2012;26:701-11.
60. Peat FJ, Colbath AC, Bentsen LM, Goodrich LR, King MR. In vitro effects of high-intensity laser photobiomodulation on equine bone marrow-derived mesenchymal stem cell viability and cytokine expression. Photomed Laser Surg 2018;36:83-91.

61. Bjordal JM, Lopes-Martins RA, Joensen J, Iversen VV. The anti-inflammatory mechanism of low level laser therapy and its relevance for clinical use in physiotherapy. Phys Ther Rev 2010;15:286-293.
62. Walker J. Relief from chronic pain by low power laser irradiation. Neurosci Lett 1983;43:339-44.
63. Fiore P, Panza F, Cassatella G, Russo A, Frisardi V, Solfrizzi V, et al. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of low back pain: A randomized controlled trial. Eur J Phys Rehabil Med 2011;47:367-73.
64. Bálint G, Barabás K, Zeitler Z, Bakos J, Kékesi KA, Pethes A, et al. Ex vivo soft-laser treatment inhibits the synovial expression of vimentin and α-enolase, potential autoantigens in rheumatoid arthritis. Phys Ther 2011;91:665-74.
65. Paradiz SG, Guiloff L, Aroca MB. HILT (High Intensity Laser Therapy) HILT and RSWT (Radial Schockwave Treatment): Pain and Pacient Satisfaction Evaluation of 100 Patients. Available from: https://www.shockwavetherapy.org/fileadmin/user_upload/dokumente/PDFs/Abstracts/abstracts-ismst-congress-18-mendoza-2015.pdf [Last accessed on 2021 Aug 2].
66. Coombes BK, Bisset L, Vicenzino B. A new integrative model of lateral epicondylalgia. Br J Sports Med 2009;43:252-8.
67. Armagan O, Tascioglu F, Ekim A, Oner C. Long-term efficacy of low level laser therapy in women with fibromyalgia: A placebo-controlled study. J Back Musculoskelet Rehabil 2006;19:135-40.
68. Jovicić M, Konstantinović L, Lazović M, Jovicić V. Clinical and functional evaluation of patients with acute low back pain and radiculopathy treated with different energy doses of low level laser therapy. Vojnosanit Pregl 2012;69:656-62.
69. Rochkind S, Geuna S, Shainberg A. Chapter 25: Phototherapy in peripheral nerve injury: Effects on muscle preservation and nerve regeneration. Int Rev Neurobiol 2009;87:445-64.
70. Kawecki M, Bernad-Wiśniewska T, Sakiel S, Nowak M, Andriessen A. Laser in the treatment of hypertrophic burn scars. Int Wound J 2008;5:87-97.

71. Marotti J, Sperandio FF, Fregnani ER, Aranha AC, de Freitas PM, de Eduardo CP. High-intensity laser and photodynamic therapy as a treatment for recurrent herpes labialis. Photomed Laser Surg 2010;28:439-44.
72. Kozarev J, Vizintin Z. Novel laser therapy in treatment of onychomycosis. J Laser Health Acad 2010;1:1-8..
73. Hochman LG. Laser treatment of onychomycosis using a novel 0.65-millisecond pulsed Nd: YAG 1064-nm laser. J Cosmet Laser Ther 2011;13:2-5.

How to Cite this article: Guiloff WL, Prouza O, Žarković D | Non-Invasive Physical Regenerative Therapies: Laser therapy, Mechanism of Action and Results. | Journal of Regenerative Science | Dec 2021; 1(1): 21-25.

[Full Text HTML] [Full Text PDF] [XML]

The Sports, Ultrasound, Biologics, and Arthroscopy Protocol in the New Era of Orthopaedic Sports Injuries Treatments

/0 Comments/in /by

Review Article | Volume 1 | Issue 1 | JRS December 2021 | Page 16-20 | Bernáldez Domínguez Pedro, Dallo Lazzarini Ignacio. DOI: 10.13107/jrs.2021.v01.i01.011

Author: Bernáldez Domínguez Pedro [1], Dallo Lazzarini Ignacio [1]

[1] Department of Orthopaedic Surgery and Sports Medicine, SportMe Medical Center, Unit of Biological Therapies and Ultrasounds, Seville, Spain.

Address of Correspondence
Dr. Bernáldez Domínguez Pedro, MD. PhD
Tabladilla, 2, 41013, Seville, Spain.
E-mail: pedrobernaldez@gmail.com

Abstract

In the new era of sports traumatology, the union of anatomical, biomechanical, and functional knowledge, together with an adequate clinical examination and complemented with ultrasound studies, arthroscopic surgery, and conventional surgery, makes us understand the pathology, in a new and modern way, of the locomotor system, such as the muscle, tendon, ligament, menisci, capsule, synovial membrane, as well as bone and cartilage pathologies. Biological therapies have shown a good result for soft tissue in chronic pathology that can be applied in an ultrasound guided manner to treat tendinopathy of the Achilles, patellar, and quadriceps tendons, also at the elbow and shoulder level. It is striking to highlight the good results of this biological therapy with platelet-rich plasma for degenerative joint diseases in patients with moderate osteoarthritis. In cases in which conservative or biological therapies have not had their effect, we will generally indicate surgery, in most cases arthroscopically if it is joint pathology. This indication will be mandatory, especially in joint instability cases where we will require stabilizing surgery. We emphasize the importance of multidisciplinary teams where there must be a sports doctor, a sports traumatologist, a physiotherapist, a functional trainer, a podiatrist, biomechanics specialist, and other professionals that surround the athlete, such as the nutritionist, the psychologist so that the athlete has comprehensive assistance and is always well cared for. Together, these concepts make a personalized approach named the Sports, Ultrasound, Biologics, and Arthroscopy protocol to improve clinical results, shorten recovery times, and considerably reduce healthcare costs.
Keywords: Sports, Ultrasound, Biologics, Arthroscopy protocol, Sports medicine, Ultrasound-guided therapies, Biological therapies, Arthroscopy.

References:

1. Lind M, Seil R, Dejour D, Becker R, Menetrey J, Ross M. Creation of a specialist core curriculum for the European Society for Sports traumatology, Knee surgery and Arthroscopy (ESSKA). Knee Surg Sports Traumatol Arthrosc 2020;28:3066-79.
2. Centeno C. In: Aldridge K, editor. Orthopedics 2.0: How Regenerative Medicine and Interventional Orthopedics will Change Everything. RHIA; 2018.
3. Daniels EW, Cole D, Jacobs B, Phillips SF. Existing evidence on ultrasound-guided injections in sports medicine. Orthop J Sports Med 2018;6:2325967118756576.
4. Hoeber S, Aly AR, Ashworth N, Rajasekaran S. Ultrasound-guided hip joint injections are more accurate than landmark-guided injections: A systematic review and meta-analysis. Br J Sports Med 2016;50:392-6.
5. Peck E, Jelsing E, Onishi K. Advanced ultrasound-guided interventions for tendinopathy. Phys Med Rehabil Clin N Am 2016;27:733-48.
6. Domínguez B. Martos AT. El ecógrafo: El fonendo del Traumatólogo: Utilidad diagnostica y terapéutica. Rev S Traum Ort 2017;34:17-26.
7. Dallo I, Chahla J, Mitchell JJ, Pascual-Garrido C, Feagin JA, LaPrade RF. Biologic approaches for the treatment of partial tears of the anterior cruciate ligament: A current concepts review. Orthop J Sports Med 2017;5:2325967116681724.
8. Kon E, Di Matteo B, Delgado D, Cole BJ, Dorotei A, Dragoo JL, et al. Platelet-rich plasma for the treatment of knee osteoarthritis: An expert opinion and proposal for a novel classification and coding system. Expert Opin Biol Ther 2020;20:1447-60.
9. Le AD, Enweze L, DeBaun MR, Dragoo JL. Current clinical recommendations for use of platelet-rich plasma. Curr Rev Musculoskelet Med 2018;11:624-34.
10. Piuzzi NS, Khlopas A, Newman JM, Ng M, Roche M, Husni ME, et al. Bone marrow cellular therapies: Novel therapy for knee osteoarthritis. J Knee Surg 2018;31:22-6.

11. Gobbi A, Whyte GP. Long-term clinical outcomes of one-stage cartilage repair in the knee with hyaluronic acid-based scaffold embedded with mesenchymal stem cells sourced from bone marrow aspirate concentrate. Am J Sports Med 2019;47:1621-8.
12. Gobbi A, Karnatzikos G, Scotti C, Mahajan V, Mazzucco L, Grigolo B. One-Step cartilage repair with bone marrow aspirate concentrated cells and collagen matrix in full-thickness knee cartilage lesions: Results at 2-year follow-up. Cartilage 2011;2:286-99.

13. Dallo I, Morales M, Gobbi A. Platelets and Adipose Stroma Combined for the Treatment of the Arthritic Knee. Arthroscopy Techniques; November 2021.
14. Gobbi A, Dallo I, Rogers C, Striano RD, Mautner K, Bowers R, et al. Two-year clinical outcomes of autologous microfragmented adipose tissue in elderly patients with knee osteoarthritis: A multi-centric, international study. Int Orthop 2021;45:1179-88.
15. Jackson RW. A history of arthroscopy. Arthroscopy 2010;26:91-103.
16. Perets I, Rybalko D, Mu BH, Friedman A, Morgenstern DR, Domb BG. Hip Arthroscopy: Extra-articular Procedures. Hip Int 2019;29:346-54.
17. Chloros GD, Shen J, Mahirogullari M, Wiesler ER. Wrist arthroscopy. J Surg Orthop Adv 2007;16:49-61.
18. DiFelice GS, van der List JP. Clinical outcomes of arthroscopic primary repair of proximal anterior cruciate ligament tears are maintained at mid-term follow-up. Arthroscopy 2018;34:1085-93.
19. van der List JP, DiFelice GS. Primary repair of the anterior cruciate ligament: A paradigm shift. Surgeon 2017;15:161-8.

 

How to Cite this article: Pedro BD, Ignacio DL | The Sports, Ultrasound, Biologics, and Arthroscopy Protocol in the New Era of Orthopaedic Sports Injuries Treatments. | Journal of Regenerative Science | Dec 2021; 1(1): 16-20.

[Full Text HTML] [Full Text PDF] [XML]

Shockwave Therapy and Anesthesia: What Evidence is there?

/0 Comments/in /by

Review Article | Volume 1 | Issue 1 | JRS December 2021 | Page 13-15 | Paulo Roberto Dias Santos, Bruno Schiefer Dos Santos, Nacime Salomao Barbachan Mansur DOI: 10.13107/jrs.2021.v01.i01.009

Author: Paulo Roberto Dias Santos [1], Bruno Schiefer Dos Santos [1], Nacime Salomao Barbachan Mansur [1,2]

[1] Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.

[2] Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, Iowa.

 

Address of Correspondence:
Dr. Nacime Salomao Barbachan Mansur, MD, PhD.
Departamento de Ortopedia e Traumatologia, Disciplina de Ortopedia e Traumatologia, Escola Paulista de Medicina – Universidade Federal de São Paulo, Brazil.
E-mail: nacime@uol.com.br

Abstract

Introduction: The use of anesthetics on extracorporeal shockwave therapy (ESWT) for musculoskeletal disorders is a matter of debate. Although widely performed, especially on focal procedures, its scientific background is sparse. This study aims to review the current evidence
on the use of anesthetics in ESWT.
Methods: A literature review of the PubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases was performed. Studies assessing or comparing the use of any type of anesthetic in any form of shockwave therapy were collected.

Results: After inclusion and exclusion criteria assessment, a total of seven studies were found to directly address the subject and only four were original articles.
Conclusion: The produced evidence is small and lacks methodological quality. These facts support the necessity for new studies using the present technology to determine the real effect of anesthetics on ESWT.

Level of Evidence: Level V. Literature Review

Keywords: Shock waves, Radial pressure waves, Quality standards

Reference:

  1. Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res 2012;7:11.
  2. Moya D, Ramon 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.
  3. Schmitz C, Csaszar NB, Milz S, Schieker M, Maffulli N, Rompe JD, et al. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: A systematic review on studies listed in the PEDro database. Br Med Bull 2015;116:115-38.
  4. Korakakis V, Whiteley R, Tzavara A, Malliaropoulos N. The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: A systematic review including quantification of patient-rated pain reduction. Br J Sports Med 2018;52:387-407..
  5. Schaden W, Thiele R, Kolpl C, Pusch M, Nissan A, Attinger CE, et al. Shock wave therapy for acute and chronic soft tissue wounds: A feasibility study. J Surg Res 2007;143:112.
  6. Barbachan Mansur NS, Matsunaga FT, Carrazzone OL, Dias dos Santos P, Schiefer Dos Santos B, Nunes CG, et al. Shockwave therapy plus eccentric exercises versus isolated eccentric exercises for achilles insertional tendinopathy: A double-blinded randomized clinical trial. J Bone Joint Surg Am 2021;103:1295-302.
  7. 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.
  8. Valchanou VD, Michailov P. High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop 1991;15:181-4.
  9. Treatment ISFMS. ISMST Guidelines. Italy: University of Florence; 2019.
  10. Rompe JD, Meurer A, Nafe B, Hofmann A, Gerdesmeyer L. Repetitive low-energy shock wave application without local anesthesia is more efficient than repetitive low-energy shock wave application with local anesthesia in the treatment of chronic plantar fasciitis. J Orthop Res 2005;23:931-41.
  11. Labek G, Auersperg V, Ziernhöld M, Poulios N, Böhler N. Influence of local anesthesia and energy level on the clinical outcome of extracorporeal shock wave-treatment of chronic plantar fasciitis. Z Orthop Ihre Grenzgeb 2005;143:240-6.
  12. Furia JP. High-energy extracorporeal shock wave therapy as a treatment for insertional Achilles tendinopathy. Am J Sports Med 2006;34:733-40.
  13. Klonschinski T, Ament SJ, Schlereth T, Rompe JD, Birklein F. Application of local anesthesia inhibits effects of low-energy extracorporeal shock wave treatment (ESWT) on nociceptors. Pain Med 2011;12:1532-7..
  14. Ramon S, Español A, Yebra M, Morillas JM, Unzurrunzaga R, Freitag K, et al. Current evidences in shockwave treatment. SETOC (spanish society of shockwave treatment) recommendations. Rehabilitacion (Madr) 2021;55:291-300.
  15. Schultheiss R. Stoßwellen-technologie in orthop¨adie undunfallchirurgie. In: Chaussy C, Eisenberger F, Jocham D, Wilbert D, editors. Die Stoßwelle. Forschung und Klinik. Germany: Attempto, Tubingen; 1995.
  16. Lohrer H, Nauck T, Korakakis V, Malliaropoulos N. Historical ESWT paradigms are overcome: A narrative review. Biomed Res Int 2016;2016:3850461.
  17. Maier M, Averbeck B, Milz S, Refior HJ, Schmitz C. Substance P and prostaglandin E2 release after shock wave application to the rabbit femur. Clin Orthop Relat Res 2003;406:237-45.
  18. Hausdorf J, Lemmens MA, Kaplan S, Marangoz C, Milz S, Odaci E, et al. Extracorporeal shockwave application to the distal femur of rabbits diminishes the number of neurons immunoreactive for substance P in dorsal root ganglia L5. Brain Res 2008;1207:96-101.
  19. Schmitz C, DePace R. Pain relief by extracorporeal shockwave therapy: An update on the current understanding. Urol Res 2009;37:231-4.
  20. Weber M, Birklein F, Neundorfer B, Schmelz M. Facilitated neurogenic inflammation in complex regional pain syndrome. Pain 2001;91:251-7.
  21. Hsieh ST, Lin WM. Modulation of keratinocyte proliferation by skin innervation. J Invest Dermatol 1999;113:579-86.
  22. Goto T, Yamaza T, Kido MA, Tanaka T. Light-and electron-microscopic study of the distribution of axons containing substance P and the localization of neurokinin-1 receptor in bone. Cell Tissue Res 1998;293:87-93.
  23. Brain SD, Williams TJ. Substance P regulates the vasodilator activity of calcitonin gene-related peptide. Nature 1988;335:73-5.
  24. Fischer AA. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain 1987;30:115-26.

 

 

How to Cite this article: Santos PRD, Dos Santos BS, Mansur NSB | Shockwave therapy and anesthesia: What evidence is there? | Journal of Regenerative Science | December 2021;1(1):13-15.

[Full Text HTML] [Full Text PDF] [XML]

Quality Standards and Techniques for the Application of Focused Shockwaves and Radial Pressure Waves in Musculoskeletal Disorders

/0 Comments/in /by

Review Article | Volume 1 | Issue 1 | JRS December 2021 | Page 9-12 | José Eid, Daniel Moya DOI: 10.13107/jrs.2021.v01.i01.007

Author: José Eid [1], Daniel Moya [2]

[1] Médico Assistente do corpo clínico do Hospital Hcor São Paulo, Brazil.

[2] Department of Orthopaedic, Servicio de Ortopedia y Traumatología, Hospital Británico de Buenos Aires.

Address of Correspondence:
Dr. José Eid, MD.
Médico Assistente do corpo clínico do Hospital Hcor São Paulo, Brazil.
E-mail: j.eid@uol.com.br

Abstract

Focused shockwaves and radial pressure waves are safe and effective if used correctly. Nevertheless, poor results and complications have been described due to missdiagnosis and technical errors. The aim of this review is to introduce the basic principles of quality and technical recommendations for each method.

Keywords: Shock waves, Radial pressure waves, Quality standards

Reference:

  1. Delius M, Brendel W. Historical roots of lithotripsy. J Lithotr Stone Dis 1990;2:161-3.
  2. 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.
  3. Loske AM. Medical and Biomedical Applications of Shock Waves. Cham, Switzerland: Springer International; 2017. p. 19-42.
  4. Novak P. Physics: F-SW and R-SW. Basic information on focused and radial shock wave physics. In: Lohrer H, Gerdesmeyer L, editors. Multidisciplinary Medical Applications. Heilbronn: Buchverlag; 2014. p. 28-49.
  5. Consenso de la Federación Ibero-Latinoamericana de Ondas de Choque e Ingeniería Tisular Sobre las Bases Físicas de las Ondas de Choque Focales y de las Ondas de Presión Radial. Available from: https://onlat.net/?page_id=2497 [Last accessed on 2021 June 09].
  6. Eid J. ISMST Consensus Statement Terms and Definitions. https://www.shockwavetherapy.org/fileadmin/user_upload/dokumente/PDFs/Formulare/Consensus_MBRadial_pressure_wave_2017_SS.pdf [Last accessed on 2021 June 09].
  7. European Commission DG Health and Consumer. Medical Devices: Guidance document. Classification of medical devices. MEDDEV 2. 4/1. Available from: https://pdf4pro.com/download/medical-devices-guidance-document-6fa97.html [Last accessed on 2021 June 09].
  8. Digest Guidelines for Extracorporeal Shockwave Therapy. Available from: https://www.shockwavetherapy.org/fileadmin/user_upload/ISMST_Guidelines.pdf [Last accessed on 2021 June 09].
  9. Kibler WB. Value on the front end: Making the effective diagnosis for optimal treatment. Arthroscopy 2017;33:493-5.
  10. Moya D, Ramón S, Guiloff L, Terán P, Eid J, Serrano E. Malos resultados y complicaciones en el uso de ondas de choque focales y ondas de presión radial en patología musculoesquelética [Poor results and complications in the use of focused shockwaves and radial pressure waves in musculoskeletal pathology]. Rehabilitacion (Madr) 2021;2021:00031-1.
  11. International Society for Medical Shockwave Treatment. Consensus Statement on ESWT Indications and Contraindications. Available from: https://www.shockwavetherapy.org/fileadmin/user_upload/dokumente/PDFs/Formulare/ISMST_consensus_statement_on_indications_and_contraindications_20161012_final.pdf [Last accessed on 2021 June 09].
  12. Wright JG. Revised grades of recommendation for summaries or reviews of orthopaedic surgical studies. J Bone Joint Surg Am 2006;88:1161-2.
  13. Ramon S, Español A, Yebra M, Morillas JM, Unzurrunzaga R, Freitag K, et al. Current evidences in shockwave treatment. SETOC (Spanish Society of Shockwave Treatment) recommendations. Rehabilitacion (Madr) 2021;55(4):291-300.
  14. Wang CJ, Huang HY, Yang K, Wang FS, Wong M. Pathome-chanism of shock wave injuries on femoral artery, vein andnerve. An experimental study in dogs. Injury. 2002;33:439-46.
  15. Buchbinder R, Ptasznik R, Gordon J, Buchanan J, Prabaharan V, Forbes A. Ultrasound-guided extracorporeal shock wave therapy for plantar fasciitis: A randomized controlled trial. JAMA. 2002;288:1364-72.
  16. Njawaya MM, Moses B, Martens D, Orchard JJ, Driscoll T, Negrine J, et al. Ultrasound guidance does not improve the results of shock wave for plantar fasciitis or calcific achilles tendinopathy: A randomized control trial. Clin J Sport Med 2018;28:21-7.
  17. Charrin JE, Noel ER. Shockwave therapy under ultrasonographic guidance in rotator cuff calcific tendinitis. Jt. Bone Spine 2001;68:241-4.
  18. Sabeti-Aschraf M, Dorotka R, Goll A, Trieb K. Extracorporeal shock wave therapy in the treatment of calcific tendinitis of the rotator cuff. Am J Sports 2005;33:1365-8.

 

How to Cite this article: Eid J, Moya D | Quality Standards and Techniques for the Application of Focused Shockwaves and Radial Pressure Waves in Musculoskeletal Disorders. | Journal of Regenerative Science | December 2021; 1(1): 9-12.

[Full Text HTML] [Full Text PDF] [XML]

Ultrasound Intervention Techniques in Patellar Tendinopathy: A Review

/0 Comments/in /by

Review Article | Volume 1 | Issue 1 | JRS December 2021 | Page 35-38 | Paul German Terán, Estefania Anabel Lozada, Juan Felipe Giraldo. DOI: 10.13107/jrs.2021.v01.i01.019

Author: Paul German Terán [1], Estefania Anabel Lozada [1], Juan Felipe Giraldo [2]

[1] Traumatología y Ortopedia, Centro de Especialidades Ortopédicas, Quito, Ecuador.

[2] Medicina del Deporte, Instituto Colombiano del Dolor INCODOL, Medellín, Antioquia, Colombia.

 

Address of Correspondence
Dr. Paul German Terán MD,
Traumatología y Ortopedia, Centro de Especialidades Ortopédicas, Quito, Ecuador.
E-mail: paulteranmd@gmail.com

Abstract

Patellar tendinopathy is a very common, yet very difficult pathology to treat. Its’ frequency in elite athletes, especially in jumping sports, can go as high as 14%. Recently it has been suggested that chronic tendinopathy may be an active process of ongoing tendon degeneration bearing close relation with inflammation-mediated responses, the intensity of pain in patellar tendinopathy appears to have a stronger relation with the number of newly formed blood vessels observed on Doppler ultrasound. This article is a descriptive review of the available information which was obtained during a 1-month period (September 2021) and the following search keywords were used: interventional ultrasonography; patellar ligament; tendinopathy. Based on the information obtained, a total of 787 articles were revied, mainly published in the last 10 years in Pubmed, Medline, and SciELO databases; out of these, a total of 15 articles were used as citations. Even though conservative treatment is preferred as a first-line treatment, if, during a 6-month period it fails, then surgical treatment is proposed; however, recovery time is a crucial issue for elite athletes. Treatment by ultrasound-guided interventionism is presented as an effective alternative and allows athletes to return to their regular activities in less time, with optimal results. In the literature there are not many articles that describe the various techniques of ultrasound-guided interventionism for the treatment of patellar tendinopathy, thus, we have carried out this bibliographic review.

Keywords: Interventional ultrasonography, Patellar ligament, Tendinopathy.

References:

1. Maffulli N, Del Buono A, Oliva F, Testa V, Capasso G, Maffulli G. High-volume image-guided injection for recalcitrant patellar tendinopathy in athletes. Clin J Sport Med 2016;26:12-6.
2. Willberg L, Sunding K, Forssblad M, Fahlström M, Alfredson H. Sclerosing polidocanol injections or arthroscopic shaving to treat patellar tendinopathy/jumper’s knee? A randomised controlled study. Br J Sports Med 2011;45:411-5.
3. Abat F, Diesel WJ, Gelber PE, Polidori F, Monllau JC, Sanchez-Ibañez JM. Effectiveness of the intratissue percutaneous electrolysis (EPI®) technique and isoinertial eccentric exercise in the treatment of patellar tendinopathy at two years follow-up. Muscles Ligaments Tendons J 2014;4:188-93.
4. Moura JL, Abreu FG, Queirós CM, Pisanu G, Clechet J, Vieira TD, et al. Ultrasound-guided electrocoagulation of neovessels for chronic patellar tendinopathy. Arthrosc Tech 2020;9:e803-7.
5. Fogli M, Giordan N, Mazzoni G. Efficacy and safety of hyaluronic acid (500-730kDa) ultrasound-guided injections on painful tendinopathies: A prospective, open label, clinical study. Muscles Ligaments Tendons J 2017;7:388-95.
6. Lee WC, Zhang ZJ, Masci L, Ng GY, Fu SN. Alterations in mechanical properties of the patellar tendon is associated with pain in athletes with patellar tendinopathy. Eur J Appl Physiol 2017;117:1039-45.
7. Rodriguez-Merchan EC. The treatment of patellar tendinopathy. J Orthop Traumatol 2013;14:77-81.
8. Wang JH, Iosifidis MI, Fu FH. Biomechanical basis for tendinopathy. Clin Orthop Relat Res 2006;443:320-32.
9. Hall MM, Rajasekaran S. Ultrasound-guided scraping for chronic patellar tendinopathy: A case presentation. PM R 2016;8:593-6.
10. Masci L, Alfredson H, Neal B, Bee WW. Ultrasound-guided tendon debridement improves pain, function and structure in persistent patellar tendinopathy: Short term follow-up of a case series. BMJ Open Sport Exerc Med 2020;6:e000803.

11. Nielsen TG, Miller LL, Mygind-Klavsen B, Lind M. High-volume image-guided injection in the chronic recalcitrant non-insertional patellar tendinopathy: A retrospective case series. J Exp Orthop 2020;7:80.
12. Crisp T, Khan F, Padhiar N, Morrissey D, King J, Jalan R, et al. High volume ultrasound guided injections at the interface between the patellar tendon and Hoffa’s body are effective in chronic patellar tendinopathy: A pilot study. Disabil Rehabil 2008;30:1625-34.
13. Morton S, Chan O, King J, Perry D, Crisp T, Maffulli N, et al. High volume image-guided Injections for patellar tendinopathy: A combined retrospective and prospective case series. Muscles Ligaments Tendons J 2014;4:214-9.
14. Balius R, Díaz FJ. Ecografía Intervencionista en Traumatología del Deporte. Madrid: Editorial Médica Panamericana; 2015. p. 146.
15. Abat F, Gelber PE, Polidori F, Monllau JC, Sanchez-Ibañez JM. Clinical results after ultrasound-guided intratissue percutaneous electrolysis (EPI®) and eccentric exercise in the treatment of patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc 2015;23:1046-52.

 

How to Cite this article: Terán PG, Lozada EA, Giraldo JF | Ultrasound intervention techniques in patellar tendinopathy: A review. | Journal of Regenerative Science | Dec 2021; 1(1): 35-38.

[Full Text HTML] [Full Text PDF] [XML]

New Trends in Ultrasound-Guided Musculoskeletal Injuries Approaches

/0 Comments/in /by

Review Article | Volume 1 | Issue 1 | JRS December 2021 | Page 30-34 | Bernáldez Domínguez Pedro, Dallo Lazzarini Ignacio. DOI: 10.13107/jrs.2021.v01.i01.017

Author: Bernáldez Domínguez Pedro [1], Dallo Lazzarini Ignacio [1]

[1] Department of Orthopaedic Surgery and Sports Medicine, SportMe Medical Center, Unit of Biological Therapies, Seville, Spain.

 

Address of Correspondence
Dr. Bernáldez Domínguez Pedro, MD
Tabladilla, 2, 41013, Seville, Spain.
E-mail: pedrobernaldez@gmail.com

Abstract

The ultrasound not only allows us to diagnose musculoskeletal injuries but is also a fantastic tool to assist us when performing different therapies on the tissues. Multiple studies compare the classic blind versus ultrasound-guided infiltrations, with a significant difference in the results. In this article, we present the different indications for ultrasound-guided therapies, including ultrasound-guided local infiltration, percutaneous needle tenotomy, intracapsular hydrodilatation, hydrodissection, high-volume injection, percutaneous needle scraping and ultrasound-guided surgery (EAS). We describe the techniques, their advantages, and disadvantages, as well as possible complications. These procedures require a good learning curve, but once achieved, it will allow us to use them to obtain good clinical results, and in many cases avoiding the operating room. We have included these therapies in the so-called “SUBA Protocol” that includes the application of the concepts of modern Sports trauma, the use of musculoskeletal Ultrasounds, consider Biological therapies as one more tool in the therapeutic arsenal, and finally, the use of Arthroscopic surgeries, minimally invasive procedures with minor tissue damage.

Keywords: Musculoskeletal ultrasound, Ultrasound-guided therapies, Percutaneous needle tenotomy, Intracapsular hydrodilatation,
Hydrodissection, Percutaneous needle scraping, Ultrasound-guided surgery, SUBA protocol.

References:

1. Domínguez B, Martos TA. El ecógrafo: El fonendo del Traumatólogo: Utilidad diagnostica y terapéutica. Rev S Traum Ort 2017;34:17-26.
2. De Zordo T, Lill SR, Fink C, Feuchtner GM, Jaschke W, Bellmann-Weiler R, et al. Real-time sonoelastography of lateral epicondylitis: Comparison of findings between patients and healthy volunteers. AJR Am J Roentgenol 2009;193:180-5.
3. Nazarian LN. The top 10 reasons musculoskeletal sonography is an important complementary or alternative technique to MRI. AJR Am J Roentgenol 2008;190:1621-6.
4. Daley EL, Bajaj S, Bisson LJ, Cole BJ. Improving injection accuracy of the elbow, knee, and shoulder: Does injection site and imaging make a difference? A systematic review. Am J Sports Med 2011;39:656-62.
5. Daniels EW, Cole D, Jacobs B, Phillips SF. Existing evidence on ultrasound-guided injections in sports medicine. Orthop J Sports Med 2018;6:2325967118756576.
6. Peck E, Jelsing E, Onishi K. Advanced ultrasound-guided interventions for tendinopathy. Phys Med Rehabil Clin N Am 2016;27:733-48.
7. Hall MM, Rajasekaran S. Ultrasound-guided scraping for chronic patellar tendinopathy: A case presentation. PM R 2016;8:593-6.
8. Patel R, Urits I, Wolf J, Murthy A, Cornett EM, Jones MR, et al. A comprehensive update of adhesive capsulitis and minimally invasive treatment options. Psychopharmacol Bull 2020;50 4 Suppl 1:91-107.
9. Lam KH, Hung CY, Chiang YP, Onishi K, Su DC, Clark TB, et al. Ultrasound-guided nerve hydrodissection for pain management: rationale, methods, current literature, and theoretical mechanisms. J Pain Res 2020;13:1957-68..
10. Boesen AP, Hansen R, Boesen MI, Malliaras P, Langberg H. Effect of high-volume injection, platelet-rich plasma, and sham treatment in chronic midportion achilles tendinopathy: A randomized double-blinded prospective study. Am J Sports Med 2017;45:2034-43.

11. Tafti D, Byerly DW. Ultrasound Guided Barbotage. Treasure Island, FL: StatPearls Publishing; 2021.
12. Henning PT, Yang L, Awan T, Lueders D, Pourcho AM. Minimally invasive ultrasound-guided carpal tunnel release: Preliminary clinical results. J Ultrasound Med 2018;37:2699-706.
13. Gao L, Madry H, Chugaev DV, Denti M, Frolov A, Burtsev M, et al. Advances in modern osteotomies around the knee: Report on the association of sports traumatology, arthroscopy, orthopaedic surgery, rehabilitation (ASTAOR) Moscow International Osteotomy Congress 2017. J Exp Orthop 2019;6:9.
14. Sabeti-Aschraf M, Lemmerhofer B, Lang S, Schmidt M, Funovics PT, Ziai P, et al. Ultrasound guidance improves the accuracy of the acromioclavicular joint infiltration: A prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2011;19:292-5.
15. Berkoff DJ, Miller LE, Block JE. Clinical utility of ultrasound guidance for intra-articular knee injections: A review. Clin Interv Aging 2012;7:89-95.
16. Aly AR, Rajasekaran S, Ashworth N. Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: A systematic review and meta-analysis. Br J Sports Med 2015;49:1042-9.
17. Wu T, Song HX, Dong Y, Li JH. Ultrasound-guided versus blind subacromial-subdeltoid bursa injection in adults with shoulder pain: A systematic review and meta-analysis. Semin Arthritis Rheum 2015;45:374-8.
18.Hoeber S, Aly AR, Ashworth N, Rajasekaran S. Ultrasound-guided hip joint injections are more accurate than landmark-guided injections: A systematic review and meta-analysis. Br J Sports Med 2016;50:392-6.
19. Domínguez MP. Bridging the Gap between Surgical and Conservative Treatment. The SUBA Protocol (Sports, Ultrasound, Biologics, Arthroscopy). TOBI (The Orthobiologic Institute) Conference; 2021.

 

How to Cite this article: Pedro BD, Ignacio DL | New Trends in Ultrasound-Guided Musculoskeletal Injuries Approaches. | Journal of Regenerative Science | Dec 2021; 1(1): 30-34.

[Full Text HTML] [Full Text PDF] [XML]

Shock Waves and Radial Pressure Waves: Time to Put a Clear Nomenclature into Practice

/0 Comments/in /by

Review Article | Volume 1 | Issue 1 | JRS December 2021 | Page 4-8 | Achim M. Loske, Daniel Moya DOI: 10.13107/jrs.2021.v01.i01.005

Author: Achim M. Loske [1], Daniel Moya [2]

[1] Centro de Física Aplicada y Tecnología Avanzada, Universidad Nacional Autónoma de México, Blvd. Juriquilla 3001, Querétaro, Qro., 76230, México.

[2] Department of Orthopaedic, Servicio de Ortopedia y Traumatología, Hospital Británico de Buenos Aires.

Address of Correspondence:
Dr. Daniel Moya, MD
Department of Orthopaedic, Servicio de Ortopedia y Traumatología, Hospital Británico de Buenos Aires.
E-mail: drdanielmoya@yahoo.com.ar

Abstract

Extracorporeal focused shock wave therapy and radial pressure wave therapy are noninvasive approaches with high success rates that hold promise for treating a rapidly increasing number of clinical indications. However, reports, presentations at scientific meetings, and information published by manufacturers reflect confusion in the terminology used. This situation is worrisome because both desired and undesired biological effects depend on the pressure profile and the physical parameters used. Moreover, in many cases, the detailed biological mechanisms involved are yet not fully understood. Only a clear knowledge of the physical concepts can enable comparison among and improvement of treatment protocols and technology. Fortunately, specific definitions and recommendations have been agreed upon by scientific societies promoting international standardization. The main goal of this article is to raise awareness of the importance of having a clear nomenclature worldwide and explain some of the concepts based on the international consensus that has been accepted to date.

Keywords: Shock waves, Radial pressure waves, Physical parameters .

Reference:

  1. Britannica, the Editors of Encyclopaedia. International System of Units. Encyclopedia Britannica, 30 Jul; 2020. Available from: https://www.britannica.com/science/International-System-of-Units [Last accessed on 2021 May 8].
  2. Metric Convention of 1875. US Metric Association. Available from: https://usma.org/laws-and-bills/metric-convention-of-1875 [Last accessed on 2021 May 8].
  3. Delius M, Brendel W. Historical roots of lithotripsy. J Lithotr Stone Dis 1990;2:161-3.
  4. Chaussy C, Eisenberger F, Forssmann B. Epochs in endourology; extracorporeal shockwave lithotripsy (ESWL): A chronology. J Endourol 2007;21:1249-53.
  5. Loske AM. Medical and Biomedical Applications of Shock Waves. Cham, Switzerland: Springer International; 2017. p. 19-42.
  6. Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, et al. Guidelines on Urolithiasis. Arnhem, Netherlands: European Association of Urology; 2015. Available from: https://uroweb.org/wp-content/uploads/22-Urolithiasis_LR_full.pdf [Last accessed on 2021 May 8].
  7. Graff J, Richter KD, Pastor J. Effect of high energy shock waves on bony tissue. Urol Res 1988;16:252-8.
  8. Karpmann RR, Magee FP, Gruen TWS, Mobley T. The lithotriptor and its potential use in the revision of total hip arthroplasty. Orthop Rev 1987;16:38-42.
  9. Valchanou VD, Michailov P. High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop 1991;15:181-4.
  10. Rompe JD, Rumler F, Hopf C, Nafe B, Heine J. Extracorporal shock wave therapy for calcifying tendinitis of the shoulder. Clin Orthop Relat Res 1995;321:196-201.
  11. Haupt G. Use of extracorporeal shock waves in the treatment of pseudarthrosis, tendinopathy and other orthopedic diseases. J Urol 1997;158:4-11.
  12. Lohrer H, Gerdesmeyer L, editors. Shock wave therapy in practice. In: Multidisciplinary Medical Applications. Heilbronn: Buchverlag; 2014. p. 50-69.
  13. Speed C. A systematic review of shockwave therapies in soft tissue conditions: Focusing on the evidence. Br J Sports Med 2014;48:1538-42.
  14. Mittermayr R, Antonic V, Hartinger J, Kaufmann H, Redl H, Téot L, et al. Extracorporeal shock wave therapy (ESWT) for wound healing: Technology, mechanisms, and clinical efficacy. Wound Repair Regen 2012;20:456-65..
  15. 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.
  16. Auersperg V. DIGEST Guidelines for Extracorporeal Shock Wave Therapy. Physics and Technology of ESWT. Available from: http://www.setoc.es/docs/DIGEST%20guidelines_June%202019_E_A.pdf [Last accessed on 2021 May 8].
  17. IEC 61846 International Standard Ultrasonics/Pressure Pulse Lithotripters/Characteristics of Fields. Vol. 18. Geneva, Switzerland: International Electrotechnical Commission; 1998.
  18. Ueberle F, Rad AJ. Ballistic pain therapy devices: Measurement of pressure pulse parameters. Biomed Tech 2012;57:700-3.
  19. International Society for Medical Shockwave Therapy: Physical principles of ESWT Basic Physical Principles. Available from: https://www.shockwavetherapy.org/about-eswt/physical-principles-of-eswt [Last accessed on 2021 May 8].
  20. Novak P. Physics: F-SW and R-SW. Shock wave therapy in practice. Basic information on focused and radial shock wave physics. In: Lohrer H, Gerdesmeyer L, editors. Multidisciplinary Medical Applications. Heilbronn: Buchverlag; 2014. p. 28-49.
  21. Federación Ibero-Latinoamericana de Ondas de Choque e Ingeniería Tisular (Onlat) Ondas de Choque en Medicina: La Nueva Frontera. Available from: https://onlat.net/?page_id=2491 [Last accessed on 2021 May 8].
  22. European Commission DG Health and Consumer. Medical Devices: Guidance Document. Classification of medical devices. MEDDEV 2. 4/1 Rev. 9 June 2010. Available from: https://pdf4pro.com/download/medical-devices-guidance-document-6fa97.html [Last accessed on 2021 May 8].
  23. Eid J. ISMST Consensus Statement Terms and Definitions. Available from: https://www.shockwavetherapy.org/fileadmin/user_upload/dokumente/PDFs/Formulare/Consensus_MBRadial_pressure_wave_2017_SS.pdf [Last accessed on 2021 May 8].
  24. Consenso de la Federación Ibero-Latinoamericana de Ondas de Choque e Ingeniería Tisular Sobre las Bases Físicas de las Ondas de Choque Focales y de las Ondas de Presión Radial. Available from: https://onlat.net/?page_id=2497 [Last accessed on 2021 May 8].
  25. Consensus Statement on ESWT Indications and Contraindications. Available from: https://www.shockwavetherapy.org/fileadmin/user_upload/dokumente/PDFs/Formulare/ISMST_consensus_statement_on_indications_and_contraindications_20161012_final.pdf [Last accessed on 2021 May 8].
  26. Recommendation Statement of the Conjoint Physics Working Group of ISMST and DIGEST on ESWT study design and publication. ISMST Recommendations. Available from: https://www.shockwavetherapy.org/about-eswt/ismst-recommendations [Last accessed on 2021 May 8].
  27. Ramon S, Español A, Yebra M, Morillas JM, Unzurrunzaga R, Freitag K, et al. Ondas de choque. Evidencias y recomendaciones SETOC (Sociedad Española de Tratamientos con Ondas de Choque). Rehabilitación (Madr) 2021;55:291-300.
  28. Sociedade Médica Brasileira de Tratamento por Ondas de Choque. Physical Features. Available from: https://www.sbtoc.org.br/aspectos-fisicos [Last accessed on 2021 May 8].
  29. Deutschsprachige Internationale Gesellschaft für Extrakorporale Stoßwellentherapie: Technology, Technical Differences. Available from: https://www.digest-ev.de/gesellschaft/geschichte.html [Last accessed on 2021 May 8].

 

How to Cite this article: Loske AM, Moya D | Shock waves and radial pressure waves: time to put a clear nomenclature into practice. | Journal of Regenerative Science | December 2021; 1(1): 4-8.

[Full Text HTML] [Full Text PDF] [XML]

Case Report: Focused Shock Waves as a Treatment Option in Failed Rotator Cuff Calcification Surgery

/0 Comments/in /by

Case Report | Volume 1 | Issue 1 | JRS December 2021 | Page 51-54 | Daniel Moya. DOI: 10.13107/jrs.2021.v01.i01.027

Author: Daniel Moya [1]

[1] Department of Orthopaedic, Servicio de Ortopedia y Traumatología, Hospital Británico de Buenos Aires, Argentina.

Address of Correspondence
Dr. Daniel Moya, MD
Department of Orthopaedic, Servicio de Ortopedia y Traumatología, Hospital Británico de Buenos Aires, Argentina.
E-mail: drdanielmoya@yahoo.com.ar

Abstract

Introduction: Focused extracorporeal shock wave treatment has emerged as an alternative therapy before invasive procedures when conservative treatment has failed in rotator cuff calcifications. It can also be used when surgery has failed.
Case Report: We report a case of failed surgery in which focused shock waves were used for treatment. We applied three sessions of focused electromagnetic waves (Dornier Compact Alpha) with an energy level of 0.20 mJ/mm2, 2000 pulses per sesión, every 2 weeks. The pain gradually disappeared and mobility was regaining. The radiographic control 2 months after the last session showed the total disappearance of the calcification. The end result was the complete disappearance of the symptoms.
Conclusion: The effectiveness of shock waves, their non-invasiveness, safety, and cost efficiency justify their use both as an option before an invasive technique and when surgery has failed in the treatment of rotator cuff calcifications.
Keywords: Rotator cuff calcifications, Shock waves, Failed surgery.

References:

1. Bosworth BM. Calcium deposits in the shoulder and subacromial bursitis a survey of 12, 122 shoulders. JAMA1942;116:2477-82.
2. Ruttiman G. Uber die Haufigkeit rontgenologischer Veranderungen beiPatienten mit Typischer Periarthritis Humeroscapularis und Schultergesunden. Zurich: Inaugural Dissertation; 1959.
3. Codman EA. The Shoulder: Rupture of the Supraspinatus Tendon and Other Lesions in or About the Subacromial Bursa. Boston: Thomas Todd Company; 1934.
4. Hajiroussou VJ, Webley M. Familial calcific periarthritis. Ann Rheum Dis 1983;42:469-70.
5. De Sèze S, Welfling J. Tendinites calcifiantes. Rhumatologie 1970;22:45-50..
6. Sengar DP, McKendry RJ, Uhthoff HK. Increased frequency of HLA-A1 in calcifying tendinitis. Tissue Antigens 1987;29:173-4.
7. Oliva F, Barisani D, Grasso A, Maffulli N. Gene expression analysis in calcific tendinopathy of the rotator cuff. Eur Cell Mater 2011;21:548-57.
8. Chaudhury S, Carr AJ. Lessons we can learn from gene expression patterns in rotator cuff tears and tendinopathies. J Shoulder Elbow Surg 2012;21:191-9.
9. Herberts P, Kadefors R, Högfors C, Sigholm G. Shoulder pain and heavy manual labor. Clin Orthop Relat Res 1984;19:166-78.
10. Mavrikakis ME. Calcific shoulder periarthritis (tendinitis) in adult onset diabetes mellitus: Acontrolled study. J Bone Joint Surg 2005;87-B:162

11. Harvie P. Calcific tendinitis: Natural history and association with endocrine disorders. J Bone Joint Surg 2005;87-B:162.
12. Uhthoff HK, Sarkar K, Maynard JA. Calcifying tendinitis: Anew concept of its pathogenesis. Clin Orthop Relat Res 1976;118:164-8.

13. 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.
14. Neer CS. Shoulder Reconstruction. Philadelphia, PA: WB Saunders; 1990. p. 43.
15. Gschwend N, Patte D, Zippel J. Therapy of calcific tendinitis of the shoulder. Arch Orthop Unfallchir 1972;73:120-35.
16. Wittenberg RH, Rubenthaler F, Wölk T, Ludwig J, Willburger RE, Steffen R. Surgical or conservative treatment for chronic rotator cuff calcifying tendinitis-a matched-pair analysis of 100 patients. Arch Orthop Trauma Surg 2001;121:56-9.
17. Maier D, Jaeger M, Izadpanah K, Bornebusch L, Suedkamp NP, et al. Rotator cuff preservation in arthroscopic treatment of calcific tendinitis. Arthroscopy 2013;29:824-31.
18. Litchman HM, Silver CM, Simon SD, Eshragi A. The surgical management of calcific tendinitis of the shoulder. Int Surg 1968;50:474-82.
19. McKendry RJ, Uhthoff HK, Sarkar K, Hyslop PS. Calcifying tendinitis of the shoulder: Prognostic value of clinical, histologic, and radiologic features in 57 surgically treated cases. J Rheumatol 1982;9:75-80.
20. Ark JW, Flock TJ, Flatow EL, Bigliani LU. Arthroscopic treatment of calcific tendinitis of the shoulder. Arthroscopy 1992;8:183-8.
21. Klein W, Gassen A, Laufenberg B. Endoskopische subacromiale dekompression und tendinitis calcarea. Arthoskopie 1992;5:247-51.
22. Lee TK, Shin SJ. Functional recovery of the shoulder after arthroscopic treatment for chronic calcific tendinitis. Clin Shoulder Elb 2018;21:75-81.
23. Balke M, Bielefeld R, Schmidt C, Dedy N, Liem D. Calcifying tendinitis of the shoulder: Midterm results after arthroscopic treatment. Am J Sports Med 2012;40:657-61.
24. Cho CH, Bae KC, Kim BS, Kim HJ, Kim DH. Recovery pattern after arthroscopic treatment for calcific tendinitis of the shoulder. Orthop Traumatol Surg Res 2020;106:687-91.
25. Verhaegen F, Brys P, Debeer P. Rotator cuff healing after needling of a calcific deposit using platelet-rich plasma augmentation: A randomized, prospective clinical trial. J Shoulder Elbow Surg 2016;25:169-73.
26. Wilson WK, Field LD. Management strategies for rotator cuff defects after calcific tendinitis debridement. Arthrosc Tech 2019;8:e1051-5.
27. Uththoff H, Loehr JW. Calcific tendinopathy of the rotator cuff: Pathogenesis, diagnosis and management. J Am Acad Orthop Surg1997;5:183-91.
28. Weber SC. Arthroscopic Treatment of Calcific Tendinitis AANA 17th Annual Fall Course Palm Desert; 1998.

29. Yoo JC, Park WH, Koh KH, Kim SM. Arthroscopic treatment of chronic calcific tendinitis with complete removal and rotator cuff tendon repair. Knee Surg Sports Traumatol Arthrosc 2010;18:1694-9.

30. ElIman H, Bigliani LU, Flatow E, Esch IC, Snyder SJ, Oglivie-Harris D, et al. Arthroscopic Treatment of Calcifying Tendinitis: The American Experience. Paris, France: Presented, 5th International Conference on
Shoulder Surgery; 1992.
31. Maier D, Jaeger M, Izadpanah K, Köstler W, Bischofberger AK, Südkamp NP, et al. Arthroscopic removal of chronic symptomatic calcifications of the supraspinatus tendon without acromioplasty: Analysis of postoperative recovery and outcome factors. Orthop J Sports Med 2014;2 (5):1-9. doi: 10.1177/2325967114533646.

32. Moya D, Ramón S, Guiloff L, Gerdesmeyer L. Current knowledge on evidence-based shockwave treatments for shoulder pathology. Int J Surg 2015;24:171-8.
33. Gerdesmeyer L, Wagenpfeil S, Haake M, Maier M, Loew M, Wortler K, et al. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: A randomized controlled trial. JAMA 2003;290:2573-80.
34. 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.

35. Hsu CJ, Wang DY, Tseng KF, Fong YC, Hsu HC, Jim YF. Extracorporeal shock wave therapy for calcifying tendinitis of the shoulder. J Shoulder Elbow Surg. 2008;17:55-9.

36. Louwerens JK, Sierevelt IN, van Noort A, van den Bekerom MP. Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: A systematic review and metaanalysis. J Shoulder Elbow Surg 2014;23:1240-9.

37. Rompe JD, Zoellner J, Nafe B. Shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder. Clin Orthop Relat Res 2001;387:72-82

38. 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.

39. Dubs B. Efficacy and Economical Aspects: Comparison ESWT Versus Alternate Therapies in the Treatment of Calcifying Tendinitis. Orlando: 6th Congress of the International Society for Musculoskeletal Shockwave Therapy; 2003.

40. Eid J. Economic aspects in the treatment of tendinosis calcarea of the shoulder. In: 9th International Congress of the International Society for Musculoskeletal Shockwave Therapy; 2006.
41. Ramon S, Moya D, Alvarez P, Cugat R, Corbella X. Efficiency in the Treatment of Calcifying Tendinopathy of the Shoulder: Extracorporeal Shockwave Therapy vs. Surgery. Jeju, Korea: 13th International Congress of Shoulder and Elbow Surgery; 2016.
42. Cyteval C, Baron-Sarrabère MP, Jorgensen C, Cottin A, Benis J, Sany J, et al. MRI study before and after extracorporal shock wave therapy in calcifying tendinitis of the shoulder. J Radiol 2003;84:681-4.
43. Lorbach O, Kusma M, Pape D, Kohn D, Dienst M. Influence of deposit stage and failed ESWT on the surgical results of arthroscopic treatment of calcifying tendonitis of the shoulder. Knee Surg Sports Traumatol Arthrosc
2008;16:516-21.
44. Wright JG. Revised grades of recommendation for summaries or reviews of orthopaedic surgical studies. J Bone Joint Surg Am 2006;88:1161-2.

How to Cite this article: Moya D | Case Report: Focused Shock Waves as a Treatment Option in Failed Rotator Cuff Calcification Surgery | Journal of Regenerative Science | Dec 2021; 1(1): 51-54.

[Full Text HTML] [Full Text PDF] [XML]

Journal of Regenerative Science: A Step towards a more Biological Future

/0 Comments/in /by

Vol 1 | Issue 1 |  December 2021 | page:01-02 | Dr. Ashok Shyam. DOI: 10.13107/jrs.2021.v01.i01.001

Author: Dr. Ashok Shyam [1,2]

[1] Department of Orthopaedic, Sancheti Institute for Orthopaedics and Rehabilitation, India.
[2] Chief Researcher, Orthopaedic Research Group, India.

Address of Correspondence
Dr. Ashok Shyam, MS Ortho.
Department of Orthopaedic, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Email: drashokshyam@gmail.com

Editorial:

Journal of Regenerative Science: A Step towards a more Biological Future

Biology defines and forms basis of every disease and treatment modality, it is the fundamental on which the entire science of medicine stands upon.

Restoration of Biology is essentially the core principle of Regenerative medicine. Regenerative Medicine is defined as “Regenerative Medicine is an emerging interdisciplinary field of research and clinical applications focused on the repair, replacement or regeneration of cells, tissues or organs to restore impaired function resulting from any cause, including congenital defects, disease, trauma and aging.” [1]. From the definition is clear the optimal restoration of functional biology is the aim of Regenerative medicine as opposed to clinical medicine where most of the focus lies on treating the symptoms or the external causative factors.

Regenerative medicine is a multidisciplinary branch which includes principles from engineering as well as biological sciences to utilise the innate ability of body to heal itself. A major part of this branch is dedicated to harvesting this ability while other parts are focussed on enhancing this ability or even replacing this ability by artificial means. The fact that earliest use of regenerative medicine was in early 1900 to prolong life or more specifically to slow the aging process. Although the term Regenerative medicine was coined in 1992 it was made popular only in 1999 and has seen the attention as well as applications in the field grow exponentially since then [2].

The scope of regenerative medicine is ever expanding but broadly focused on tissue engineering and tissue regeneration [3]. The Journal of Regenerative Science will focus more on tissue regeneration part, although advances and research in tissue engineering will receive special attention. When talks about this journal started few months back with Dr Daniel Moya, we were talking mostly in terms of tissue regeneration specifically non-invasive tissue regeneration using shockwaves. We had together conducted special webinars and scheduled talk on Shockwave therapies on our portal OrthoTV where we go incredible response to the concept. Feedback from viewers and especially orthopaedic surgeons was fantastic. We realised that this specific branch of regenerative medicine can be utilised quite effectively in musculoskeletal areas and would create a lot of positive impact on patient outcomes too. From this realisation stemmed the idea of creating a dedicated academic platform in form of Journal of Regenerative Science. It took us time to solidify the idea and find people who are as passionate as us about the subject. It is our great privilege to introduce the Editorial board of the Journal with the launch of first issue of JRS. We planned the first issue in two months and thanks to great effort by every author, we were able to bring out the first issue is a very short time. The issue is an excellent collection of invited articles form experts from across the globe and we are sure that reader will find value in reading these articles.

Regenerative science is a very futuristic branch, and it is still in its development phase. This is the stage where both the branch and the practitioner of the branch need to support each other through good research. For any new branch, current research is the foundation on which the future will be decided on. JRS is aimed to provide a peer reviewed platform where researchers can publish their research and help in growth of the specialty. JRS editorial board and reviewers list consists of great experts in the field and more will be joining us. This will help in maintaining highest quality of articles and publication in the Journal. At the same time, we wish to keep the focus of the articles to practical patient care too. Keeping both the academic as well as clinical aspect in mind we would like to extend an open invitation to all researchers in the field of Regenerative science to submit their work to the Journal.

The first issue is in your hands, and it is a work of lot of Love and hard work form authors and the editorial team. We sincerely hope that you will enjoy reading the articles and send us your feedback.

Wishing you a Very Safe and Happy New Year.

 

Dr. Ashok Shyam, MS Ortho

 

How to Cite this article: Shyam A. Journal of Regenerative Science: A Step towards a more Biological Future.  Journal of Regenerative Science | December 2021; 1(1):01-02.

  Dr. Ashok Shyam, MS Ortho

(Abstract    Full Text HTML)   (Download PDF)

Why a New Journal on Regenerative Medicine?

/0 Comments/in /by

Vol 1 | Issue 1 |  December 2021 | page:03 | Dr. Daniel Moya. DOI: 10.13107/jrs.2021.v01.i01.003

Author: Dr. Daniel Moya [1]

[1] Department of Orthopaedic, Servicio de Ortopedia y Traumatología, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.

Address of Correspondence
Dr. Daniel Moya, MD,.
Department of Orthopaedic, Servicio de Ortopedia y Traumatología, Hospital Británico de Buenos Aires, Buenos Aires, Argentina..
Email: drdanielmoya@yahoo.com.ar

Editorial:

Why a New Journal on Regenerative Medicine?

“Strange times are these in which we live, when old and young are taught falsehoods in school. And the person that dares to tell the truth is called at once a lunatic and fool.” It sounds current, however, it was stated by Plato almost 2400 years ago.

Obviously, the collision between old and new ideas, different points of view, and scientific approaches has always been conflictive. In our times this situation is exacerbated by the enormous generation of information and by the indiscriminate access to it.

Educational offer includes scientific societies, universities, predatory editors, industry, and even beginners, who simply by having access to social media become opinion makers. The tenuous limits between scientific information, marketing, and entertainment have their maximum expression in the field of social media.

What can we do? The answer also comes from the golden age of Greece: The scientific method. Its basis is the search for truth. The truth cannot be modified by biases.

The findings of observation and experimentation should be disseminated.

Despite isolated initiatives, there has not been a coordinated effort or an editorial forum dedicated to techniques such as the use of mechanical waves in non-invasive regenerative medicine. That is the reason of this publication. This Journal will also include information on minimally invasive, and invasive techniques as long as they are related to tissue regeneration.

Any applied treatment has no value if it is not based on a precise diagnosis, so it will also be of interest to this Journal to include not only therapeutic concepts but also the discussion of the diagnostic criteria and the most commonly used complementary tests.

The heart and soul of a publication are the authors. I will be eternally grateful to them for trusting in this project and enthusiastically joining this first issue.

The circuit will be completed with readers, their opinion and contribution will be valued. We will develop a section dedicated to this. Interaction with the readers will surely give the publication more dynamics and enrich it.

It would have been impossible to make this initiative a reality without the encouragement and trust of Dr. Ashok Shyham Pasi, the technical and scientific contribution of The Indian Orthopedic Research Group, the support of the Ibero Latin American Federation of Shockwaves and Tissue Engineering, and the editing input of Ms. Kajal Mandalia.

If we manage to improve the practice of a colleague or benefit the quality of life of a patient anywhere in the world, our mission will be fulfilled.

 

Dr. Daniel Moya, MD

 

How to Cite this article: Moya D. Why a New Journal on Regenerative Medicine?.  Journal of Regenerative Science | December 2021; 1(1):3.

  Dr. Daniel Moya, MD

(Abstract    Full Text HTML)   (Download PDF)