Abstract
IntroductionBiophysical stimulation is a non-invasive therapy used in orthopaedic practice to increase and enhance reparative and anabolic activities of tissue.MethodsA sistematic web-based search for papers was conducted using the following titles: (1) pulsed electromagnetic field (PEMF), capacitively coupled electrical field (CCEF), low intensity pulsed ultrasound system (LIPUS) and biophysical stimulation; (2) bone cells, bone tissue, fracture, non-union, prosthesis and vertebral fracture; and (3) chondrocyte, synoviocytes, joint chondroprotection, arthroscopy and knee arthroplasty.ResultsPre-clinical studies have shown that the site of interaction of biophysical stimuli is the cell membrane. Its effect on bone tissue is to increase proliferation, synthesis and release of growth factors. On articular cells, it creates a strong A2A and A3 adenosine-agonist effect inducing an anti-inflammatory and chondroprotective result. In treated animals, it has been shown that the mineralisation rate of newly formed bone is almost doubled, the progression of the osteoarthritic cartilage degeneration is inhibited and quality of cartilage is preserved. Biophysical stimulation has been used in the clinical setting to promote the healing of fractures and non-unions. It has been successfully used on joint pathologies for its beneficial effect on improving function in early OA and after knee surgery to limit the inflammation of periarticular tissues.DiscussionThe pooled result of the studies in this review revealed the efficacy of biophysical stimulation for bone healing and joint chondroprotection based on proven methodological quality.ConclusionThe orthopaedic community has played a central role in the development and understanding of the importance of the physical stimuli. Biophysical stimulation requires care and precision in use if it is to ensure the success expected of it by physicians and patients.
Highlights
Biophysical stimulation is a non-invasive therapy used in orthopaedic practice to increase and enhance reparative and anabolic activities of tissue
Numerous studies have analysed the effects of biophysical stimulation on osteoblast proliferation and have highlighted a dose-response effect for exposure times, pulsed electromagnetic field (PEMF) intensity, frequencies and signal waveforms [1, 2] (Fig. 2)
In Dunkin Hartley guinea pigs [30], treatment with PEMFs was demonstrated as being capable of halting the progression of osteoarthrosis, of limiting cartilage surface clefts and fibrillation, of preserving cartilage thickness and of preventing sclerosis of the subchondral bone
Summary
Biophysical stimulation is the result of solid scientific research. As reported in 2018 by Yuan et al, biophysical stimulation, as a prospective, non-invasive and safe physical therapy strategy to accelerate bone repair, has received tremendous attention in recent decades [71]. The promotion effect has shown strikingly positive benefits in the treatment of various skeletal diseases. In the USA and Europe, research on the use of physical energy for bone repair processes has been ongoing throughout the past century. Tens of thousands of patients undergo treatment all over the world. An inquiry to medical hospitals in the USA found that 72% of interviewed were offering biophysical stimulation to patients with fractures not yet healed at. Collarile M [61], Knee Surg Prospective Sports Traumatol Arthrosc. Grade III–IV cartilage knee lesions/partial medial meniscectomy and microfractures
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