polarity effect of microcurrent electrical stimulation on tendon healing biomechanical and...
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Polarity Effect of Microcurrent
Electrical Stimulation on Tendon
Healing: Biomechanical and
Histopathological Studies
Ahmed A.,Sherein,S. Elgayed, Ibrahim I., M, A.
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Introduction
• Tendon injuries are common clinical
problems. The tendon tissues heal at a
slower rate than other connective tissue
• Microcurrent electrical stimulation (MES) is
a low level of electrical current that mirrors
the body’s own natural current, so it may
be a particularly beneficial where
endogenous healing has failed
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Introduction
• MES has been used for stimulation of soft
tissue healing
• Despite the presence of many studies on
the effect of MES on tendon healing, more
comparative studies are needed to
compare and standardize the ideal polarity
at each stage of tendon healing.
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Purpose of the study
The purpose of the current study was to
Investigate the effect of (MES)
applied with different polarity on the
biomechanical properties of injured
tendons and to correlate results
with histopathological studies
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Relevance
This study focuses the attention of the
physical therapists in their clinical
practice to the importance of the
polarity of MES according to the stage
of healing during treatment of tendons
injuries.
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Materials and Methods Experimental design
Cathodal MES
(n=30)
3rd week (n=10)
5th week (n=10)
8th week (n=10)
Anodal MES
(n=30)
Normal intact
tendons
(n=6)
96 male white
New Zealand
rabbits were
used in the
study
Control
(n=30)
3rd week (n=10)
5th week (n=10)
8th week (n=10)
3rd week (n=10)
5th week (n=10)
8th week (n=10)
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Materials and Methods
• Achilles tendon is sharply transected
•Achilles tendon is exposed and isolated
Surgical Procedures
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Surgical Procedures cont.
• Closure of the skin after the incision following suture of the Achilles tendon.
• Ends of Achilles tendon are approximated and immediately sutured.
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Surgical Procedures cont.
•Casting and window was done at the site of the
tenotomy for wound dressing and MES application
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Treatment
•Application of MES using anode at the tenotomy site and
cathode proximally placed.
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1- Biomechanical evaluation
Biomechanical measurements included, load
at break, stiffness, ultimate tensile strength,
elastic modulus, and work done
Analysis
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Analysis
2- Histopathological analysis
Included the condition of
fibroblasts and collagen of the
neotendon
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RESULTS
Biomechanical results •There were sig increase of all
biomechanical measures for
cathodal & anodal groups than
control at all study periods.
• When comparing cathodal &
anodal groups, there were sig
increases of all biomechanical
measurement in the cathodal
group than the anodal group at
the 3 week period, while there
was significant increase of the
anodal group more than the
cathodal at 5 and 8 week.
Elastic Modulus
0
10
20
30
40
50
3 rd w 5 th w 8 th wN
/mm
2
Control Cathodal Anodal
Lod at Break
0
30
60
90
120
150
3 rd w 5 th w 8 th w
New
to
n
Control Cathodal Anodal
Stiffness
0
30
60
90
120
3 rd w 5 th w 8 th w
N/m
m
Control Cathodal Anodal
Ultimate tensile strength
0
50
100
150
200
250
3 rd w 5 th w 8 th w
New
to
n
Control Cathodal Anodal
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Histopathological results
RESULTS
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Photomicrograph of a three week neotendon
(H&E X 200)
Control neotendon showing less-organized fibroploriferative changes with poorly aligned collagen bands, inflammatory tissue reaction is clearly noticed
Cathodal neotendon showing well-developed granulation tissue with a properly aligned pattern of collagen bands.
Anodal neotendon showing well-organized fibroploriferative changes. Newly formed blood vessels and few numbers of inflammatory cells are noticed.
Control Cathodal Anodal
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Photomicrograph of a five weeks neotendon
(H&E X 200)
Control neotendon showing high cellularity in relation to the fibers. Attempts to form bundles with parallel fibers but still in disarray.
Cathodal group showing cellular neotendon, small blood vessels and collagen fibers appears scattered and in loose bundles
Anodal group showing mature collagen fibers with fibrocystes in-between.
Cathodal Control Anodal
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Photomicrograph of a eight weeks neotendon
(H&E X 200)
Control group showing poorly aligned collagen bundles. inflammatory tissue reaction is observed.
Cathodal group showing diminished granulation tissue with formation of properly aligned mature collagen bundles.
Anodal group showing closely packed collagen bundles with compressed fibrocytes. Both of them are well oriented along the longitudinal axis of the tendon.
Cathodal Control Anodal
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• MES improved the healing
process of tendon
• and the polarity of MES could be
an important factor to be
considered in treating tendon
injuries.
Conclusion
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Implementations
Utilization of combination of polarity
may be better than using one polarity
throughout the healing process of
injured tendons , i.e.: cathodal polarity
of MES at the early healing stage,
followed by anodal polarity at the late
healing stage .
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