Shock wave-enhanced neovascularization at the tendon-bone junction: an experiment in dogs

The purpose of the research was to study the phenomenon of neovascularization at the Achilles tendon-bone junction after low-energy shock wave application. The study was performed on eight mongrel dogs. The control specimens were obtained from the medial one-third of the right Achilles tendon-bone unit before shock wave application. Low-energy shock waves of 1000 impulses at 14 kV (equivalent to 0.18 mJ/mm2 energy flux density) were applied to the right Achilles bone-tendon junction. Biopsies were taken from the middle one-third of the Achilles tendon-bone junction at 4 weeks and from the lateral one-third at 8 weeks, respectively, after shock wave application. The features of microscopic examination included the number of new capillaries and muscularized vessels, the presence and arrangements of myofibroblasts, and the changes in bone. New capillary and muscularized vessels were seen in the study specimens which were obtained in 4 weeks and in 8 weeks after shock wave application, but none were seen in the control specimens before shock wave application. There was a considerable geographic variation in the number of new vessels within the same specimen. Myofibroblasts were not seen in the control specimens. Myofibroblasts with haphazard appearance and intermediate orientation fibers were seen in all study specimens obtained at 4 weeks and predominantly intermediate orientation myofibroblast fibers at 8 weeks. There were no changes in bone matrix, osteocyte activity, and vascularization within the bone. Two pathologists reviewed each specimen and concurrence was achieved in all cases. The results of the study suggested that low-energy shock wave enhanced the phenomenon of neovascularization at the bone-tendon junction in dogs.