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Topic:Tendons

Tendons in horses are fibrous connective tissues that attach muscles to bones, facilitating movement and providing stability to the musculoskeletal system. They are composed primarily of collagen fibers, which confer strength and flexibility, allowing horses to perform various physical activities. Equine tendons are subject to significant mechanical stress during locomotion, making them susceptible to injury, particularly in performance horses. Common tendon injuries include strains, tears, and tendinitis, which can impact a horse's mobility and performance. This page compiles peer-reviewed research studies and scholarly articles that explore the structure, function, and pathology of tendons in horses, as well as advancements in diagnostic and therapeutic approaches for tendon injuries.
RNA sequencing and immunofluorescence of the myotendinous junction of mature horses and humans.
American journal of physiology. Cell physiology    July 14, 2021   Volume 321, Issue 3 C453-C470 doi: 10.1152/ajpcell.00218.2021
Jakobsen JR, Schjerling P, Svensson RB, Buhl R, Carstensen H, Koch M, Krogsgaard MR, Kjær M, Mackey AL.The myotendinous junction (MTJ) is a specialized interface for transmitting high forces between the muscle and tendon and yet the MTJ is a common site of strain injury with a high recurrence rate. The aim of this study was to identify previously unknown MTJ components in mature animals and humans. Samples were obtained from the superficial digital flexor (SDF) muscle-tendon interface of 20 horses, and the tissue was separated through a sequential cryosectioning approach into muscle, MTJ (muscle tissue enriched in myofiber tips attached to the tendon), and tendon fractions. RT-PCR was performed...
Evaluation of Autologous Protein Solution Injection for Treatment of Superficial Digital Flexor Tendonitis in an Equine Model.
Frontiers in veterinary science    July 5, 2021   Volume 8 697551 doi: 10.3389/fvets.2021.697551
Gaesser AM, Underwood C, Linardi RL, Even KM, Reef VB, Shetye SS, Mauck RL, King WJ, Engiles JB, Ortved KF.Autologous protein solution (APS) has been used anecdotally for intralesional treatment of tendon and ligament injuries, however, its use in these injuries has never been studied . Our objective was to evaluate the effect of APS on tendon healing in an equine superficial digital flexor (SDF) tendonitis model. We hypothesized intralesional injection of APS would result in superior structural and biomechanical healing. SDF tendonitis was induced in both forelimbs of eight horses using collagenase injection. One forelimb was randomly assigned to receive an intralesional injection of APS, while th...
Deep digital flexor tendon lesions in the pastern are associated with the presence of distal tendinopathy.
Equine veterinary journal    June 28, 2021   Volume 54, Issue 3 502-512 doi: 10.1111/evj.13470
Acutt EV, Contino EK, Frisbie DD, Barrett MF.Correct diagnosis and characterisation of deep digital flexor tendon (DDFT) lesions in equine athletes allows targeted treatment and improved prognostication. Objective: To assess the prevalence and character of pathological change within the DDFT in the pastern with concurrent tendon injury distally. It is hypothesised that tendon lesions in the pastern will be associated with tendinopathy within the hoof capsule. Methods: Retrospective descriptive case series. Methods: Cases with DDFT lesions in the pastern and magnetic resonance imaging (MRI) or ultrasonography of the foot were evaluated re...
Cyclic tensile tests of Shetland pony superficial digital flexor tendons (SDFTs) with an optimized cryo-clamp combined with biplanar high-speed fluoroscopy.
BMC veterinary research    June 25, 2021   Volume 17, Issue 1 223 doi: 10.1186/s12917-021-02914-w
Wagner FC, Reese S, Gerlach K, Böttcher P, Mülling CKW.Long-term cyclic tensile testing with equine palmar/plantar tendons have not yet been performed due to problems in fixing equine tendons securely and loading them cyclically. It is well established that the biomechanical response of tendons varies during cyclic loading over time. The aim of this study was to develop a clamping device that enables repetitive cyclic tensile testing of equine superficial digital flexor tendon for at least 60 loading cycles and for 5 min. Results: A novel cryo-clamp was developed and built. Healthy and collagenase-treated pony SDFTs were mounted in the custom-ma...
Species variations in tenocytes’ response to inflammation require careful selection of animal models for tendon research.
Scientific reports    June 14, 2021   Volume 11, Issue 1 12451 doi: 10.1038/s41598-021-91914-9
Oreff GL, Fenu M, Vogl C, Ribitsch I, Jenner F.For research on tendon injury, many different animal models are utilized; however, the extent to which these species simulate the clinical condition and disease pathophysiology has not yet been critically evaluated. Considering the importance of inflammation in tendon disease, this study compared the cellular and molecular features of inflammation in tenocytes of humans and four common model species (mouse, rat, sheep, and horse). While mouse and rat tenocytes most closely equalled human tenocytes' low proliferation capacity and the negligible effect of inflammation on proliferation, the wound...
Tenogenic Potential of Equine Fetal Mesenchymal Stem Cells Under The In Vitro Effect of Bone Morphogenetic Protein-12 (BMP-12).
Journal of equine veterinary science    June 11, 2021   Volume 104 103681 doi: 10.1016/j.jevs.2021.103681
Oliva R, Núñez I, Segunda MN, Peralta OA.Equine adult bone marrow-derived MSCs (BM-MSCs) may be induced into the tenogenic lineage after exposure with bone morphogenetic protein-12 (BMP-12). Despite fetal BM-MSCs have showed a greater differentiation potential compared to adults, the tenogenic differentiation capacity of equine fetal BM-MSC have not been reported. Thus, the aim of the present study was to evaluate the in vitro tenogenic differentiation potential of equine fetal BM-MSCs under the effect of BMP-12. Equine fetal BM-MSCs were exposed to three concentrations of BMP-12 (25, 50 and 100 ng/mL) during a 21-day culture period....
Longitudinal tendon healing assessed with multi-modality advanced imaging and tissue analysis.
Equine veterinary journal    June 8, 2021   doi: 10.1111/evj.13478
Johnson SA, Valdés-Martínez A, Turk PJ, Wayne McIlwraith C, Barrett MF, McGilvray KC, Frisbie DD.The range of diagnostic modalities available to evaluate superficial digital flexor tendon (SDFT) injury includes magnetic resonance imaging (MRI), computed tomography (CT) and ultrasonography (US). Direct, comprehensive comparison of multi-modality imaging characteristics to end-point data has not previously been performed using a model of tendinopathy but is required to obtain a better understanding of each modality's diagnostic capabilities. Objective: To compare CT, MRI and US evaluation to outcome measures for histologic, biochemical and biomechanical parameters using an equine surgical m...
Ex vivo mechanical testing of various suture patterns for use in tendon plating.
Veterinary surgery : VS    June 2, 2021   Volume 50, Issue 6 1296-1303 doi: 10.1111/vsu.13659
Hale MJ, Zellner EM, Naiman JH, Kraus KH.To determine the influence of suture patterns on resistance to gap formation after tendon plating STUDY DESIGN: Ex vivo study SAMPLE POPULATION: Suspensory ligament and superficial and deep digital flexor tendons harvested from 16 neonatal cadaver foal limbs. Methods: Each tendon/ligament from a given limb was randomly assigned to one of three treatment groups consisting of a 7-hole veterinary cuttable plate fixed with alternating simple interrupted, figure-8, or hybrid suture patterns. The constructs were distracted at a rate of 1.0 mm/s to failure, as determined by the formation of a 1 m...
Biplanar High-Speed Fluoroscopy of Pony Superficial Digital Flexor Tendon (SDFT)-An In Vivo Pilot Study.
Veterinary sciences    May 27, 2021   Volume 8, Issue 6 92 doi: 10.3390/vetsci8060092
Wagner FC, Gerlach K, Geiger SM, Gittel C, Böttcher P, Mülling CKW.The superficial digital flexor tendon (SDFT) is the most frequently injured structure of the musculoskeletal system in sport horses and a common cause for early retirement. This project's aim was to visualize and measure the strain of the sound, injured, and healing SDFTs in a pony during walk and trot. For this purpose, biplanar high-speed fluoroscopic kinematography (FluoKin), as a high precision X-ray movement analysis tool, was used for the first time in vivo with equine tendons. The strain in the metacarpal region of the sound SDFT was 2.86% during walk and 6.78% during trot. When injured...
Development of An Anybody Musculoskeletal Model of The Thoroughbred Forelimb.
Journal of equine veterinary science    May 24, 2021   Volume 103 103666 doi: 10.1016/j.jevs.2021.103666
Bardin AL, Tang L, Panizzi L, Rogers CW, Colborne GR.Musculoskeletal injuries in horses are the main cause of retirement, rest, and death. To understand these injuries, it is necessary to study loads in muscles, tendons and ligaments. A musculoskeletal model makes it possible to consider all structures simultaneously and avoids invasive measurements. At present, most computational models of the equine limb described in the literature have been limited to the distal limb. The aim of this study was to create a preliminary musculoskeletal model of the whole equine forelimb and to run it with kinematic data collected during gait. The model was devel...
An ex vivo biomechanical comparison of two suture materials and two pattern combinations for equine superficial digital flexor tendon tenorrhaphy.
Veterinary surgery : VS    May 13, 2021   Volume 50, Issue 5 1137-1146 doi: 10.1111/vsu.13658
Giacchi A, McMaster MA.To compare biomechanical characteristics of three-loop pulley (3LP) pattern versus Bunnell technique (BT) using polydioxanone (PDS) suture; to determine the influence of polyester tape (PT) versus PDS on the BT for equine superficial digital flexor tendon (SDFT) tenorrhaphy; to compare BT with PT versus 3LP with PDS. Methods: Ex vivo biomechanical study. Methods: Forty equine forelimb SDFT. Methods: Two experiments were performed: (1) 10 SDFT pairs were repaired with 3LP or BT using PDS; (2) 10 SDFT pairs were repaired with PDS or PT using BT. Load at failure, mode of failure, load at 2 mm g...
A Case Series of Five Horses with Superficial Digital Flexor Tendon Lesions in the Carpal Canal.
Journal of equine veterinary science    May 11, 2021   Volume 103 103656 doi: 10.1016/j.jevs.2021.103656
Gates S, Hinnigan G, Rich A, Ricci E, Owen K.This case series discusses the clinical presentation, ultrasonographic findings, treatment, and outcome of 5 horses with superficial digital flexor tendon (SDFT) lesions within the carpal canal. The horses' ages ranged from 11-28 years, and presented with an acute, unilateral forelimb lameness which worsened following proximal limb flexion. The presence of a lesion within the SDFT of the carpal canal was accompanied by a mild swelling of the palmar carpal region in most cases. Diagnostic anesthesia of the ulnar nerve, when performed, abolished the lameness. Ultrasound evaluation revealed an in...
Equine Antebrachial Compartment Syndrome Secondary to Flexor Muscle Myopathy With Subsequent Muscle Atrophy And Tendonitis: A Case Report.
Journal of equine veterinary science    April 8, 2021   Volume 101 103462 doi: 10.1016/j.jevs.2021.103462
Costa F, Brunsting J, Corrêa F.This case report describes a 16-year-old jumping stallion that had a marked swelling over the left antebrachial area along with substantial lameness after a fall. The horse was weight bearing but lame (4/5; AAEP scale) at the walk with marked enlargement in the caudal aspect of the antebrachial region. After a static musculoskeletal examination, radiography and ultrasonography the horse was diagnosed with flexor muscle myopathy and presumptive extremity compartment syndrome. Following medical treatment, the horse improved clinically over several days. Six-months post injury the horse showed fl...
An equine tendon model for studying intra-tendinous shear in tendons that have more than one muscle contribution.
Acta biomaterialia    April 6, 2021   Volume 127 205-212 doi: 10.1016/j.actbio.2021.03.072
Yin NH, McCarthy I, Birch HL.Human Achilles tendon is composed of three smaller sub-tendons and exhibits non-uniform internal displacements, which decline with age and after injury, suggesting a potential role in the development of tendinopathies. Studying internal sliding behaviour is therefore important but difficult in human Achilles tendon. Here we propose the equine deep digital flexor tendon (DDFT) and its accessory ligament (AL) as a model to understand the sliding mechanism. The AL-DDFT has a comparable sub-bundle structure, is subjected to high and frequent asymmetric loads and is a natural site of injury similar...
“One Health” in tendinopathy research: Current concepts.
Journal of orthopaedic research : official publication of the Orthopaedic Research Society    April 2, 2021   Volume 39, Issue 8 1596-1602 doi: 10.1002/jor.25035
Smith RKW, McIlwraith CW.Tendinopathy remains one of the most common musculoskeletal disorders affecting both human and equine athletes and presents a considerable therapeutic challenge. The following workshop report comes from the third Dorothy Havemeyer Symposium of Tendinopathy which provided a unique overview of our current understanding of both the basic science and the clinical challenges for diagnosing and treating tendinopathy in both species. Pathologically, tendon demonstrates alterations in both cellular, molecular, structural, and biomechanical features, leading to a spectrum of pathological endotypes. To ...
Zonal characterization and differential trilineage potentials of equine intrasynovial deep digital flexor tendon-derived cells.
BMC veterinary research    April 1, 2021   Volume 17, Issue 1 138 doi: 10.1186/s12917-021-02793-1
Quam VG, Altmann NN, Brokken MT, Durgam SS.Intrasynovial deep digital flexor tendon (DDFT) injuries occur frequently and are often implicated in cases of navicular disease with poor outcomes and reinjuries. Cell-based approaches to tendon healing are gaining traction in veterinary medicine and ultimately may contribute to improved DDFT healing in horses. However, a better understanding of the innate cellular characteristics of equine DDFT is necessary for developing improved therapeutic strategies. Additionally, fibrocartilaginous, intrasynovial tendons like the DDFT are common sites of injury and share a poor prognosis across species,...
Mechanical Effect of Performance Pressure Boots on Cadaveric Equine Hindlimb Fetlock Biomechanics.
Animals : an open access journal from MDPI    March 30, 2021   Volume 11, Issue 4 958 doi: 10.3390/ani11040958
Symons J.Pressure boots are applied to hind limbs of showjumping horses with the intent to enhance jumping form. Manufacturers claim acupressure points enhance proprioception of hind limbs. With this increased awareness, horses are expected to retract their hind limbs to clear jump rails. This research aimed to investigate a more direct, mechanical effect of pressure boots on hind limb biomechanics. Cadaveric hind limbs ( = 6) were mechanically loaded in axial compression (3 cycles at 0.25 Hz, displacement control ~3300 N) with (2 trials) and without (2 trials) a pressure boot applied. During mechanica...
Diagnostic Imaging and Cytological Analysis Aid the Clinical Investigation of Long Digital Extensor Tendon Subtendinous Bursitis in a Horse.
Journal of equine veterinary science    March 16, 2021   Volume 101 103449 doi: 10.1016/j.jevs.2021.103449
Lapjit C, Charoenchanikran P, Petchkaew P, Sukpipattanamongkol S, Yodsheewan R, Theerapan W, Chanda M.The fetlock joint is a high mobility structure that accommodates enormous loading during locomotion. An injury of the superficial constituent such as subtendinous bursitis may occur due to repeated trauma. An 8-year old school riding horse was presented with dorsomedial distension in the left hindlimb fetlock region. The lesion was noted following routine exercise. The horse demonstrated no lameness and a negative response to the fetlock flexion test. Radiographic findings revealed a smooth surface cortical thickening on the medial aspect of the distal third metatarsal bone. Furthermore, the u...
The Use of Platelet-Rich Plasma for Treatment of Tenodesmic Lesions in Horses: A Systematic Review and Meta-Analysis of Clinical and Experimental Data.
Animals : an open access journal from MDPI    March 12, 2021   Volume 11, Issue 3 doi: 10.3390/ani11030793
Montano C, Auletta L, Greco A, Costanza D, Coluccia P, Del Prete C, Meomartino L, Pasolini MP.The use of platelet-rich plasma (PRP) to enhance tenodesmic lesion healing has been questioned over the years. The aim of this study was to evaluate current literature to establish the effectiveness of PRP for treating tenodesmic lesions through a systematic review, in accordance with the PRISMA guidelines, and a meta-analysis. Studies comparing PRP with placebo or other treatments for horses with tenodesmic injuries or evaluated PRP effect on tendon and ligament explants were included. Outcomes were clinical, ultrasound, histologic, molecular evaluation, and adverse effects. Two authors indep...
Strain Elastography of Injured Equine Superficial Digital Flexor Tendons: A Reliability Study of Manual Measurements.
Animals : an open access journal from MDPI    March 12, 2021   Volume 11, Issue 3 795 doi: 10.3390/ani11030795
Secchi V, Masala G, Corda A, Corda F, Potop E, Barbero Fernandez A, Pinna Parpaglia ML, Sanna Passino E.Early diagnosis of tendon injuries and accurate long-term monitoring of the healing process are key for equine veterinarians that use conventional ultrasonography. The development of strain elastography could improve the management of clinical cases. The aim of the study was to assess the intraobserver repeatability and interobserver reproducibility of manual measurements of the colored areas of the tendons within elastograms and to standardize this manual modality by comparing the analysis of the images with ImageJ. Twenty elastograms of the injured superficial digital flexor tendons (SDFTs) ...
The equine navicular apparatus as a premier enthesis organ: Functional implications.
Veterinary surgery : VS    March 12, 2021   Volume 50, Issue 4 713-728 doi: 10.1111/vsu.13620
Osborn ML, Cornille JL, Blas-Machado U, Uhl EW.Navicular syndrome has been traditionally characterized by progressive lameness with chronic degeneration of the navicular bone. Advances in imaging techniques have revealed that its associated soft tissue structures are also affected. This distribution of lesions is explained by conceptualizing the equine navicular apparatus as an enthesis organ that facilitates the dissemination of mechanical stress throughout the tissues of the foot. The navicular apparatus has the same structural adaptations to mechanical stress as the human Achilles tendon complex. These adaptations efficiently dissipate ...
Minimally invasive tenotomy of the tibial insertion of the semitendinosus muscle: An ex vivo study in horses.
Veterinary surgery : VS    March 11, 2021   Volume 50, Issue 4 843-847 doi: 10.1111/vsu.13609
Zetterström SM, Boone LH, Weatherall KM, Caldwell FJ.To describe a minimally invasive technique for semitendinosus tenotomy with ultrasonographic guidance and to evaluate procedural complications. Methods: Experimental study. Methods: Cadaveric equine hind limbs (n = 16). Methods: A stab incision was performed distocaudal to the tibial insertion of the semitendinosus muscle with ultrasonographic assistance. After transection of the tendon with an arthroscopic retrograde knife, the tendon edges palpably retracted, and complete transection was confirmed by ultrasound. Limbs were dissected to confirm the degree of tendon transection and to identify...
The Evaluation of Equine Allogeneic Tenogenic Primed Mesenchymal Stem Cells in a Surgically Induced Superficial Digital Flexor Tendon Lesion Model.
Frontiers in veterinary science    March 5, 2021   Volume 8 641441 doi: 10.3389/fvets.2021.641441
Depuydt E, Broeckx SY, Van Hecke L, Chiers K, Van Brantegem L, van Schie H, Beerts C, Spaas JH, Pille F, Martens A. Tendon injuries are very common in horses and jeopardize the athletic performance, and due to the high risk of reinjury may lead to early retirement. The use of mesenchymal stem cells for the treatment of equine tendon disease is widely investigated because of their regenerative potential. The objective of this study is to investigate the safety and efficacy of equine allogeneic tenogenic primed mesenchymal stem cells (tpMSCs) for the management of tendinitis in horses. A core lesion was surgically induced in the superficial digital flexor tendon of both forelimbs of eight horses. After 7 da...
Equine Tenocyte Seeding on Gelatin Hydrogels Improves Elongated Morphology.
Polymers    February 28, 2021   Volume 13, Issue 5 747 doi: 10.3390/polym13050747
Meeremans M, Van Damme L, De Spiegelaere W, Van Vlierberghe S, De Schauwer C.(1) Background: Tendinopathy is a common injury in both human and equine athletes. Representative in vitro models are mandatory to facilitate translation of fundamental research into successful clinical treatments. Natural biomaterials like gelatin provide favorable cell binding characteristics and are easily modifiable. In this study, methacrylated gelatin (gel-MA) and norbornene-functionalized gelatin (gel-NB), crosslinked with 1,4-dithiotreitol (DTT) or thiolated gelatin (gel-SH) were compared. (2) Methods: The physicochemical properties (H-NMR spectroscopy, gel fraction, swelling ratio, an...
Syndromic clubfoot beyond arthrogryposis and myelomeningocele: orthopedic treatment with Ponseti method.
Revista espanola de cirugia ortopedica y traumatologia (English ed.)    February 26, 2021   Volume 65, Issue 3 180-185 doi: 10.1016/j.recot.2020.09.005
Ferrando Meseguer E, Roig Sánchez S, Pino Almero L, Romano Bataller A, Mínguez Rey MF.Talipes equinovarus or clubfoot is a congenital deformity of the foot with bone, muscle, and tendon involvement. It's one of the most frequent foot malformations in pediatric orthopedics. Although generally idiopathic, it may have a syndromic cause and be associated with musculoskeletal, neurological, or connective tissue conditions. The treatment of choice in idiopathic clubfoot is the Ponseti method based on manipulation and fixation with serial casts that seek progressive correction of the deformity. The Ponseti method effectiveness has been demonstrated in arthrogryposis and myelomeningoce...
Training Young Horses: The Science behind the Benefits.
Animals : an open access journal from MDPI    February 9, 2021   Volume 11, Issue 2 463 doi: 10.3390/ani11020463
Logan AA, Nielsen BD.Conflicting research and anecdotal evidence have created disagreement among equestrians as to whether two-year-old horses should be trained and raced. The objective of this literature review is to evaluate epidemiological studies, as well as physiological data on equine bone, articular cartilage, and tendons to better determine the impact of training and racing two-year-old horses. The evaluation of numerous studies on the topic provides evidence that a horse which is trained or raced as a two-year-old has a lower risk of injury and better adapted tissues for the rigors of racing. Unfortunatel...
Regenerative Medicine for Equine Musculoskeletal Diseases.
Animals : an open access journal from MDPI    January 19, 2021   Volume 11, Issue 1 234 doi: 10.3390/ani11010234
Ribitsch I, Oreff GL, Jenner F.Musculoskeletal injuries and chronic degenerative diseases commonly affect both athletic and sedentary horses and can entail the end of their athletic careers. The ensuing repair processes frequently do not yield fully functional regeneration of the injured tissues but biomechanically inferior scar or replacement tissue, causing high reinjury rates, degenerative disease progression and chronic morbidity. Regenerative medicine is an emerging, rapidly evolving branch of translational medicine that aims to replace or regenerate cells, tissues, or organs to restore or establish normal function. It...
Comparative Analysis of Tenogenic Gene Expression in Tenocyte-Derived Induced Pluripotent Stem Cells and Bone Marrow-Derived Mesenchymal Stem Cells in Response to Biochemical and Biomechanical Stimuli.
Stem cells international    January 13, 2021   Volume 2021 8835576 doi: 10.1155/2021/8835576
Yang F, Richardson DW.The tendon is highly prone to injury, overuse, or age-related degeneration in both humans and horses. Natural healing of injured tendon is poor, and cell-based therapeutic treatment is still a significant clinical challenge. In this study, we extensively investigated the expression of tenogenic genes in equine bone marrow mesenchymal stem cells (BMSCs) and tenocyte-derived induced pluripotent stem cells (teno-iPSCs) stimulated by growth factors (TGF-3 and BMP12) combined with ectopic expression of tenogenic transcription factor MKX or cyclic uniaxial mechanical stretch. Western blotting reveal...
Navicular Syndrome-related changes to collagen proportion of different cross-sections of the flexor tendons in equine distal forelimb.
Research in veterinary science    January 5, 2021   Volume 135 106-112 doi: 10.1016/j.rvsc.2021.01.002
Salinas P, Lira-Velásquez D, Bongiorno A, Sandoval C.The aim of this study was to quantify the distribution of aligned and non-aligned collagen in cross-sections of the superficial digital flexor tendon (SDFT) and deep digital flexor tendon (DDFT) in different levels of the distal forelimb of equines diagnosed with NS (Navicular Syndrome). Sixty equine forelimbs were collected. Was compared two groups (NA, Not affected vs. NS-group) by t-Student. Diagnosis of NS was based on clinical and lameness examination, diagnostic analgesia and radiological findings. The proportion of aligned and non-aligned collagens at 2 levels for the SDFT and 3 levels ...
Extracorporeal Shock Wave Therapy Enhances the In Vitro Metabolic Activity and Differentiation of Equine Umbilical Cord Blood Mesenchymal Stromal Cells.
Frontiers in veterinary science    December 4, 2020   Volume 7 554306 doi: 10.3389/fvets.2020.554306
Salcedo-Jiménez R, Koenig JB, Lee OJ, Gibson TWG, Madan P, Koch TG.Extracorporeal shock wave therapy (ESWT) has been shown to induce different biological effects on a variety of cells, including regulation and stimulation of their function and metabolism. ESWT can promote different biological responses such as proliferation, migration, and regenerations of cells. Recent studies have shown that mesenchymal stromal cells (MSCs) secrete factors that enhance the regeneration of tissues, stimulate proliferation and differentiation of cells, and decrease inflammatory and immune reactions. Clinically, the combination of these two therapies has been used as a treatme...
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