Biophysical stimulation
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Uses methods and theories from the field of physics to study biological systems
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Studies how non-ionising physical stimuli interact with biological systems
Biophysical stimulation: in vitro studies
Effects of biophysical stimulation on bone cells
Author | Physical method | In vitro models | Results |
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Jansen JH, BMC Musculoskelet Disord. 2010 | PEMFs | hBMSCs | ↑ TGF-β1 ↑ BMP-2mRNA ↑ Differentiation |
Esposito M, In Vivo. 2012 | PEMFs | hBMSCs | ↑ Proliferation ↑ Differentiation |
Ceccarelli G, Biores Open Access. 2013 | PEMFs | hBMSCs | ↑ Proliferation ↑ ECM deposition |
Zhou J, Bioelectromagnetics. 2013 | PEMFs | Rat calvarial osteoblasts | ↑ Proliferation |
Hartig M, Eur Biophys J. 2000 | CCEF | Osteoblast from periosteum explants | ↑ Proliferation ↑ Differentiation |
Wang Z, J Bone Joint Surg Am. 2006 | CCEF | Osteoblastic cells (MC3T3-E1) | ↑ BMP-2,4,5,6,7 mRNA |
Bisceglia B, Bioelectromagnetics. 2011 | CCEF | Osteoblast-like cell lines (SAOS-2) | ↑ Proliferation |
Clark CC, J Orthop Res. 2014 | CCEF | Human calvarial osteoblasts | ↑ BMP-2,4 mRNA ↑ TGF-β1, β2, β3 mRNA ↑ FGF-2 |
Hauser J, J Orthop Res. 2009 | LIPUS | Osteoblast-like cell lines (SAOS-2) | ↑ Proliferation |
Fassina L, Bioinorg Chem Appl. 2010 | LIPUS | SAOS-2 human osteoblasts | ↑ Proliferation ↑ ECM deposition |
Xue H, PLoS One. 2013 | LIPUS | Alveolar bone in vivo | ↑ BMP-2 mRNA |
Carina V, J Appl Biomater Funct Mater. 2017 | LIPUS | Human mesenchymal stem cells | ↑ Proliferation ↑ MgHA/coll hybrid composite scaffold ↑ VEGF gene expression |
Effects of biophysical stimulation on articular cells
Culture | PEMF effects |
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Bovine chondrocytes and synovial fibroblasts | Increase of A2A and A3 receptors |
Increase of cellular proliferation | |
Inhibition PGE2 release | |
Bovine articular cartilage explants | Increase of proteoglycan synthesis |
Chondroprotective effect | |
Human synovial fibroblasts | Inhibition of PGE2 IL-6, IL-8, and TNF-α release |
Stimulation of IL-10 release | |
Human articular cartilage explants | Increase of proteoglycan synthesis |
Counteract the catabolic activity of IL-1b | |
Increase of cartilage explant anabolic activities | |
Human T/C-28a2 chondrocytes and hFOB 1.19 osteoblasts | Increase of A2A and A3 receptors |
Inhibition of PGE2 IL-6, IL-8, and VEGF release | |
Increase of cellular proliferation | |
Increase of osteoprotegerin (OPG) production | |
Inhibition of NF-κB activation | |
Reduction of cAMP levels |
Biophysical stimulation: in vivo studies
Effects of biophysical stimulation on bone repair
Effects of biophysical stimulation on articular cartilage
Biophysical stimulation: clinical experiences on bone tissue
Osteotomy
Fractures at risk of non-union
Non-unions
Author | Design of the study | Non-union, treatment | Groups | Number | Results: success rate and healing time |
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De Haas WG, J Bone Joint Surg Br. 1980 | Case series | Tibial non-union, cast | Stimulated | 17 patients | 88.2% in 5.9 months |
Bassett CA, J Bone Joint Surg Am. 1981 | Case series | Tibial non-union | Stimulated | 125 patients | 87% |
Simonis RB, Injury 1984 | Case series | Non-union of long bone, external fixator | Stimulated | 15 non-unions | 87% in 4 months |
Sedel L, Rev. Chir Orthop Reparatrice Appar Mot. 1981 | Case series | Non-union, different treatment | Stimulated | 37 patients | 83% |
Bassett CA, JAMA. 1982 | Case series (cross-sectional international study) | Non-union and failed arthrodesis | Stimulated | 1007 non-unions, 71 failed arthrodesis | 85% |
Sharrard WJ, J Bone Joint Surg Br. 1982 | Case series | Non-union of tibia, femur, ulna, radius, humerus, capitellum, knee, ankle | Stimulated | 53 non-unions | 71.7% (86.7% tibia) in 6 months |
Marcer M, Clin Orthop Relat Res. 1984 | Case series | Non-union of tibia, femur, humerus, external fixator | Stimulated | 147 patients | 73% |
Hinsenkamp M, Reconstr Surg Traumatol. 1985 | Case series | Non union | Stimulated | 308 patients | 70% |
Frykman GK, J Hand Surg [Am]. 1986 | Case series | Non-united scaphoid fracture, cast | Stimulated | 44 non-unions | 79% |
Traina GC, Giornale Italiano di Ortopedia. 1986 | Case series | Non-union, cast, external fixator, other | Stimulated | 248 patients | 84% in 4.3 months |
Garland DE, Contemp Orthop. 1991 | Case series | Non-union, external and fixator | Stimulated | 139 non-unions | 80% (> 3 h/die) vs 35.7% (< 3 h/die) in 12 weeks |
Gupta AK, Indian J Orthop. 2009 | Case series | Tibial non-union, cast | Stimulated | 45 fractures | 85%, in 4 months |
Assiotis A, J Orthop Surg Res. 2012 | Case series | Tibial non-union, plates, nail, plaster of Paris | Stimulated | 44 patients | 77.3% |
Punt BJ, Eur J Orthop Surg Traumatol. 2008 | Prospective comparative study | Non-union of long bone, non-long bone cast, external fixator, other | Stimulated (long bone vs non-long bone) | 93 patients | 76 vs 79% |
Cebrian JL, International Orthopaedics. 2010 | Prospective comparative study | Tibial non-union, intramedullary nailing | Stimulated vs stimulated + surgery | 22 vs 35 patients | 91 vs 83%, in 3.3 vs 4.9 months |
Poli G, J Bioelectricity. 1985 | Randomised controlled double-blind study | Congenital non-union, endomedullary nail fixation | Stimulated vs surgery | 6 vs 6 patients | Lengthening of the limb, stop imbalance between legs |
Sharrard WJ, J Bone Joint Surg Br. 1990 | Randomised controlled double-blind study | Tibial non-union, cast | Active vs placebo | 20 vs 25 fractures | 45 vs 12% at 12 weeks |
Simonis RB [44], Injury. 2003 | Randomised controlled double-blind study | Tibial non-union, osteotomy, and external fixator | Active vs placebo | 18 vs 16 patients | 89 vs 50% |
Shi HF, BMC Musculoskelet Disord. 2013 | Randomised controlled double-blind study | Non-union of long bone, nail, plate | Active vs placebo | 31 vs 27 non-unions | 77.4 vs 48.1% in 4.8 months |
Traina GC [45], J Bioelectricity. 1991 | Retrospective controlled | Non-union leg, femur, forearm, humerus, metatarsal, clavicle different treatment | Stimulated vs surgery | 41 vs 26 patients | 87.8 vs 69% in 5.7 vs 7.8 months |
Vaquero DH, Revista de ortopedia y Traumatologia. 2000 | Retrospective cohort | Non-union tibia, femur, humerus, radio, other | Stimulated | 137 non-unions | 74.5% |
Hip prostheses
Vertebral fractures
Osteonecrosis
Ficat | Hip replacement/number of hips | Number of hips (Ficat progression) |
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I | 0/31 (0%) | 3 (I ➝ II) |
II | 3/22 (14%) | 5 (II ➝ III) |
III | 12/23 (52%) | 12 (III ➝ IV) |
Summary
Biophysical stimulation: clinical experience on joint
Author | Design of the study | Disease/treatment | Groups | Patients | Results | Long-term follow-up results |
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Marcheggiani Muccioli G [66], European Journal of Radiology. 2013 | Case series | Spontaneous osteonecrosis of the knee | Stimulated | 28 | Pain relief, better functional recovery and necrosis area reduced | 86% of knees preserved from prosthetic surgery at 2 years FU |
Gobbi A [64], Cartilage. 2014 | Case series | Early OA | Stimulated | 22 | Improvement in symptoms, knee function and activity | At 2-year follow-up, 80% of patients were satisfied and willing to repeat the treatment |
Moretti B [62], BMC Musculoskeletal Disorders. 2012 | Prospective comparative study | Grade 4 osteoarthrosis/total knee arthroplasty | Surgery + stimulated vs surgery | 15 vs 15 | Pain, joint swelling and knee score were significantly better and lower NSAID use | |
Adravanti P [63], International Orthopaedics. 2014 | Prospective comparative study | Grade 4 osteoarthrosis/total knee arthroplasty | Surgery + stimulated vs surgery | 16 vs 17 | Pain, knee swelling and functional score were significantly better | Severe pain and occasional walking limitations were reported in a lower number at 3 years FY (p < 0.05) |
Cadossi M [60], Foot & Ankle International. 2014 | Prospective comparative study | Osteochondral lesions in talar/bone marrow-derived cell transplantation | Surgery + stimulated vs surgery | 15 vs 15 | Pain relief, better functional recovery | |
Iammarrone CS [65], Bioelectromagnetics. 2016 | Prospective comparative study | Patellofemoral pain | Stimulated vs controlled | 13 vs 17 | Pain relief, better functional recovery and lower NSAID use | |
Collarile M [61], Knee Surg Sports Traumatol Arthrosc. 2018 | Prospective comparative study | Chondral knee lesions/matrix-assisted autologous chondrocyte implantation | Surgery + stimulated vs surgery | 15 vs 15 | Pain relief, better functional recovery | Better clinical outcome up to 5 years of FU (p < 0.05) |
Zorzi C [58], Knee Surg Sports Traumatol Arthrosc. 2007 | Randomised controlled double-blind study | Cartilage knee lesions, chondroabrasion/perforation | Active vs placebo | 19 vs 12 | Pain relief, better functional recovery and lower NSAID use | Completely recovered higher in the active group (p < 0.05) at 3 years of FU |
Benazzo F [59], Knee Surg Sports Traumatol Arthrosc. 2008 | Randomised controlled double-blind study | Anterior cruciate ligament lesion/reconstruction and meniscectomy | Active vs placebo | 31 vs 29 | Pain relief, better functional recovery and lower NSAID use | Complete functional recovery, no knee pain and return to sport activity higher in the active group (p = ns) 2 years of FU |
Osti L, International Orthopaedics. 2015 | Randomised controlled double-blind study | Grade III–IV cartilage knee lesions/partial medial meniscectomy and microfractures | Active vs placebo | 34 vs 34 | IKDC and Lysholm and constant scores were significantly improved in both groups with no significant intergroup differences | Clinical and functional outcomes were better in the PEMF-treated group at 5 years of FU |
Osti L, Orthopaedics. 2017 | Randomised controlled double-blind study | Small to medium rotator cuff tears/arthroscopic rotator cuff repair | Active vs placebo | 32 vs 34 | Pain relief, better ROM and stiffness and lower NSAID use | Clinical and functional outcomes were further improved in both groups, with no significant intergroup differences at 2 years of FU |