Extracorporeal shock wave therapy inhibits osteoclast differentiation by targeting NF-κB signaling pathway.

BACKGROUND: Extracorporeal shock wave therapy (ESWT) has been reported to promote osteoblast differentiation. However, the role of ESWT on osteoclast differentiation is still elusive. METHODS: This study analyzed the differentiation of osteoclasts in the shock wave group and the control group in vitro, and TRAP staining, RT-PCR, WB assays, and MTT assays were assessed between the two groups. Furthermore, we analyzed the bone formation in these two groups in vivo and micro-CT and trap staining were assessed between the two groups. RESULTS: We found that ESWT inhibited osteoclast maturation in vitro and ESW treatment of femur promoted bone formation in vivo. Mechanically, osteoclast differentiation was inhibited as the number of impulses increased and ESWT decreased endogenous levels of NTAFc1 and P65 protein. CONCLUSIONS: ESWT may be a potential therapy of osteoporosis through NF-κB signaling pathway.

The clinical outcomes of surgical treatment for chronic ankle instability by anatomical reconstruction of the anterior talofibular ligament with autologous half-bundle peroneal longus tendon: A retrospective study.

The anterior talofibular ligament is the weakest and most vulnerable lateral ligament to be injured, and it can replace anatomical position through anatomical reconstruction. The purpose of this study is to evaluate clinical outcomes after an autologous half-bundle peroneus longus tendon anatomical reconstruction. We conducted a retrospective analysis by enrolling 34 patients [22 male and 12 female, median age 21 (range 19-26) years] with anterior talofibular ligament injury from January 2018 to March 2020. All patients underwent a ligament anatomical reconstruction operation with autologous half-bundle peroneus longus tendon and followed up with an average time of 16.21 ± 3.20 (range 12-24) months, with no loss of patients to follow-up during the study period. The American Orthopedic Foot, Ankle Society Score (AOFAS), Visual Analogue Score (VAS), and Anterior Tibiotalar Translation were used to assess the curative effect. All the indexes were compared between the preoperative and at the final follow-up to discover the related statistical differences. The AOFAS score improved significantly from an average preoperative score of 56.91 ± 3.79 to 94.12 ± 2.51 at the final followed-up (p < 0.001). Meanwhile, the pre-operation VAS pain score decreased from 5.94 ± 1.32 to 1.71 ± 0.87 (p < 0.001). Additionally, the Anterior tibiotalar translation decreased from 16.40 ± 1.85 to 5.20 ± 0.57 mm at the final followed-up (p < 0.001). The anterior drawer test was negative for all patients after the operation. Considering the outcomes, we concluded that anatomical reconstruction of the anterior talofibular ligament with autologous half-bundle peroneal longus tendon was a proper and safe procedure for chronic lateral ankle instability, and it had good clinical results and minimal complications.

The effect of anteromedial support plate with three cannulated screws in the treatment of Pauwels type III femoral neck fracture in young adults.

PURPOSE: This study is aimed to evaluate the clinical effects of anteromedial support plate combined with three cannulated screws on Pauwels type III femoral neck fractures in young adults. METHODS: We conducted a retrospective study of 27 patients with Pauwels type III femoral neck fracture treated by anteromedial support plate combined with three cannulated screws. The results of fracture healing and complications for all patients were assessed by postoperative imaging examination. The Harris hip score was used to evaluate the functional outcome of the hip at the last follow-up. RESULTS: The fracture union was achieved in 25 patients (92.6%). However, two patients required reoperation (two for nonunion). Early implant failure occurred in one patient, neck shortening in one patient and coxa vara in one patient. The excellent or good outcome of the Harris hip score was 96% for the 25 patients with satisfactory fracture union. CONCLUSION: Our preliminary results indicate that anteromedial support plate combined with three cannulated screws is a good alternative in the treatment of Pauwels type III femoral neck fractures in young adults with high union rate and low incidence of complications including nonunion and avascular necrosis of the femoral head.

Extracorporeal Shock Wave Therapy Promotes Osteogenic Differentiation in a Rabbit Osteoporosis Model.

Extracorporeal shock wave therapy (ESWT) has been identified to accelerate bone formation. However, detailed mechanism has not been fully explained. In this study, we found that ESWT promoted osteoblast formation in vitro. Local ESW treatment of femur increased bone formation in vivo. Furthermore, changing the density or frequency of energy, there was no statistical difference in osteogenic differentiation. Therapeutically, local ESW therapy relieved bone loss and increased the number of bone trabecular in a rabbit osteoporosis model and promoted endogenous levels of SMAD2 protein expression. Thus, ESWT may be a potential therapy by promoting osteoblast maturation through TGF-ß/SMAD2 pathway.