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Medical News Today are reporting: Shock Wave Therapy Useful For Stress Fractures
Quote:
Extracorporeal shock wave therapy (ESWT), a noninvasive technique that uses sound waves to stimulate healing, is an effective way to treat resistant stress fractures in athletes, according to a report of five cases in the American Journal of Sports Medicine.
Between 1997 and 2003, a total of 62 patients were treated with ESWT at the researchers' hospital, including five athletes with chronic stress fractures that failed to heal after medical or surgical therapy.
The athletes were between 13 and 22 years of age and fractures were located in the leg, pubic bone, ankle or foot. The patients were participants in baseball, basketball, marathon or soccer.
On average, the patients' fracture symptoms began 1 year prior to undergoing ESWT, lead author Dr. Masanori Taki, from Zensyukai Hospital Gunma Sports Medicine Research Center in Japan, and colleagues note. Each patient underwent one session of ESWT, performed under spinal anesthesia in an operating room.
Successful bone union was achieved in all cases roughly 3 months after ESWT and the subjects were then able to return to their sports after 3 to 6 months.
"We require additional basic and clinical studies to understand the effectiveness of ESWT," along with studies to determine the optimal energy level and impulse rate for the device, Taki's group concludes. "Nevertheless, when appropriately used, ESWT can be a safe and effective treatment for stress fractures, especially in resistant cases."
Background: Extracorporeal shock wave therapy is indicated for treatment of chronic injuries of soft tissues and delayed fracture healing and nonunion. No investigation has been conducted to study the effect of shock wave on delayed healing at the bone-tendon junction.
Hypothesis: Shock wave promotes osteogenesis, regeneration of fibrocartilage zone, and remodeling of healing tissue in delayed healing of bone-tendon junction surgical repair.
Study Design: Controlled laboratory study.
Methods: Twenty-eight mature rabbits were used for establishing a delayed healing model at the patella–patellar tendon complex after partial patellectomy and then divided into control and shock wave groups. In the shock wave group, a single shock wave treatment was given at week 6 postoperatively to the patella–patellar tendon healing complex. Seven samples were harvested at week 8 and 7 samples at week 12 for radiologic, densitometric, histologic, and mechanical evaluations.
Results: Radiographic measurements showed 293.4% and 185.8% more new bone formation at the patella–patellar tendon healing junction in the shock wave group at weeks 8 and 12, respectively. Significantly better bone mineral status was found in the week 12 shock wave group. Histologically, the shock wave group showed more advanced remodeling in terms of better alignment of collagen fibers and thicker and more mature regenerated fibrocartilage zone at both weeks 8 and 12. Mechanical testing showed 167.7% and 145.1% higher tensile load and strength in the shock wave group at week 8 and week 12, respectively, compared with controls.
Conclusion: Extracorporeal shock wave promotes osteogenesis, regeneration of fibrocartilage zone, and remodeling in the delayed bone-to-tendon healing junction in rabbits.
Clinical Relevance: These results provide a foundation for future clinical studies toward establishment of clinical indication for treatment of delayed bone-to-tendon junction healing.
In soccer players, lower extremity stress fractures are common injuries and are the result of repetitive use damage that exceeds the intrinsic ability of the bone to repair itself. They may be treated conservatively but this may cause long-term complications, such as delayed union, muscle atrophy and chronic pain. Stress fractures that fail to respond to this management require surgical treatment, which is also not without risks and complications. Extracorporeal shock wave therapy (ESWT) has been used successfully on fracture complications, such as delayed union and nonunion. As such, we want to examine ESWT in the management of stress fractures. In this article, we present a retrospective study of 10 athletes affected by chronic stress fractures of the fifth metatarsus and tibia that received three to four sessions of low-middle energy ESWT. At the follow-up (8 wk on average), the clinical and radiography results were excellent and enabled all players to gradually return to sports activities. These reports show that ESWT is a noninvasive and effective treatment for resistant stress fractures in soccer players
Shock Wave Therapy Useful For Stress Fractures
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