无血管区域中的半月板撕裂被认为很少愈合并且是治疗的相当大的挑战。尽管脉冲电磁场(PEMF)的治疗效果已在各种骨科疾病中得到了广泛的研究,尚未报道PEMF对半月板愈合的影响。
PEMF治疗将促进半月板愈合并防止骨关节炎进展。
对照实验室研究。
将72只12周龄雄性Sprague-Dawley大鼠在无血管区域出现全层纵向内侧半月板撕裂,分为3组:对照组(Gcon),用经典信号PEMF(Gclassic)治疗,和用高摆率信号PEMF(GHSR)治疗。对半月板和关节软骨进行宏观观察和组织学分析,以评估骨关节炎的半月板愈合和进展。收获滑膜用于组织学和免疫荧光分析以评估关节内炎症。半月板愈合,关节软骨退变,和滑膜炎根据其评分系统进行定量评估。
在Gcon的粗略观察和组织学评估中,在8周时注意到半月板和关节软骨的急剧变性变化。然而,2个治疗组的半月板均恢复正常形态,具有光滑的表面和闪亮的白色。特别是,HSR信号显着增强了纤维软骨的形成,并加速了再生组织的重塑过程。PEMF治疗组的半月板愈合评分在8周时显著高于Gcon。具体来说,在第8周,HSR信号显示半月板修复评分明显高于经典信号(P<0.01)。此外,与对照组相比,HSR信号显着下调半月板和滑膜中白细胞介素1β(IL-1β)和肿瘤坏死因子α(TNF-α)的分泌水平。与2个治疗组相比,Gcon的变性得分明显较高(GconvsGclassic,P<.0001;Gcon与GHSR,P<.0001)。与其他两组相比,HSR信号还表现出明显较低的滑膜炎评分(GconvsGclassic,P<.0001;GclassicvsGHSR,P=.0002)。
在大鼠模型中,PEMF促进无血管区域中的半月板撕裂的愈合,并使损伤的半月板恢复至其结构完整性。与经典信号相比,HSR信号显示促进纤维软骨组织形成和调节炎症环境的能力增加,因此保护膝关节免受创伤后骨关节炎的发展。
辅助PEMF疗法可提供一种治疗半月板撕裂的新方法,其归因于增强的半月板修复和改善的骨关节炎进展。
Meniscal tears in the avascular region are thought to rarely heal and are a considerable challenge to treat. Although the therapeutic effects of a pulsed electromagnetic field (PEMF) have been extensively studied in a variety of orthopaedic disorders, the effect of a PEMF on meniscal healing has not been reported.
PEMF treatment would promote meniscal healing and prevent osteoarthritis progression.
Controlled laboratory study.
A total of 72 twelve-week-old male Sprague-Dawley rats with full-thickness longitudinal medial meniscal tears in the avascular region were divided into 3 groups: control (Gcon), treatment with a classic signal PEMF (Gclassic), and treatment with a high-slew rate signal PEMF (GHSR). Macroscopic observation and histological analysis of the meniscus and articular cartilage were performed to evaluate the meniscal healing and progression of osteoarthritis. The synovium was harvested for histological and immunofluorescent analysis to evaluate the intra-articular inflammation. Meniscal healing, articular cartilage degeneration, and synovitis were quantitatively evaluated according to their scoring systems.
Dramatic degenerative changes of the meniscus and articular cartilage were noticed during gross observation and histological evaluation in Gcon at 8 weeks. However, the menisci in the 2 treatment groups were restored to normal morphology, with a smooth surface and shiny white color. Particularly, the HSR signal remarkably enhanced the fibrochondrogenesis and accelerated the remodeling process of the regenerated tissue. The meniscal healing scores of the PEMF treatment groups were significantly higher than those in Gcon at 8 weeks. Specifically, the HSR signal showed a significantly higher meniscal repair score than did the classic signal at week 8 (P < .01). Additionally, the HSR signal significantly downregulated the secretion levels of interleukin 1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) in the meniscus and synovium as compared with the control group. When compared with the 2 treatment groups, Gcon had significantly higher degeneration scores (Gcon vs Gclassic, P < .0001; Gcon vs GHSR, P < .0001). The HSR signal also exhibited significantly lower synovitis scores compared with the other two groups (Gcon vs Gclassic, P < .0001; Gclassic vs GHSR, P = .0002).
A PEMF promoted the healing of meniscal tears in the avascular region and restored the injured meniscus to its structural integrity in a rat model. As compared with the classic signal, the HSR signal showed increased capability to promote fibrocartilaginous tissue formation and modulate the inflammatory environment, therefore protecting the knee joint from posttraumatic osteoarthritis development.
Adjuvant PEMF therapy may offer a new approach for the treatment of meniscal tears attributed to the enhanced meniscal repair and ameliorated osteoarthritis progression.