Memorial Weekend: reporting winners in rehab research for our wounded warriors
As we mourn the fallen, let's also remember the suffering of the living.
"As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them." - John F. Kennedy
It is Memorial Day weekend. Time to recognize and honor all those who sacrificed for our freedom and constitutional rights. We owe them so much.
For those still living warriors, wounded and unhealed, we recognize your suffering and sacrifices, too. Here are a few highlights of research from the rehab field to brighten the outlook for this brave group.
Achilles Injury: To cut or not to cut, that is the question
Norway reported outcomes from a large study of 526 mostly male patients, who ruptured their Achilles tendon. They were randomized into three treatment groups: 1. minimally invasive surgery, 2. standard surgery or, 3. non-surgical treatment, [a brace to immobilize the affected foot and physical therapy]. All patients received post treatment rehab therapy for six months. Results a year later showed only slight differences in recovery between the groups. Those who reinjured: no surgery 6.2% versus 0.6% of those who had an operation. Those with nerve injuries: 5% of those who had the minimally invasive surgery compared to 2.8% of those who had the standard surgery and 0.6% of those who skipped surgery. Clearly, no surgery is a very viable option.
If you straighten out, it will grow
Many injuries sustained by soldiers result in crooked legs. By correcting the misaligned joint—unloading pressure on it—a research team discovered they could restore function and reduce pain. In a clinical case study, they provide evidence of osteochondral recovery upon unloading symptomatic isolated medial tibiofemoral knee osteoarthritis (OA) associated with varus malalignment.
Osteoarthritis (OA) is characterized by subchondral bone thickening in addition to cartilage degeneration. But if you unload the knee joint of a patient with varus malalignment using high tibial osteotomy, correcting axial malalignment, you can reduce pain. Results show improved cartilage microstructure and reduced subchondral bone thickness. Therapeutic unloading shifted the articular cartilage and subchondral bone phenotype to normal and restored several physiological correlations disturbed in neutral and varus OA, projecting a protective effect on the integrity of the entire osteochondral unit
Shake, rattle and roll
Rehabbing from broken bones requires hard exercise, right? Well, whole-body vibration training can also improve physical function for many of the same reasons exercise does. Research shows it can improve muscle and bone quality, increase bone mineral density and even improve neuromuscular integration, making bones and muscles stronger and more efficient.
And what could be the molecular mechanism explaining these effects? Studies involving the use of dynamic mechanical cues driven by vibrational excitation show that stem cell fate can be directed to bone differentiation, via the application of external physical stimuli. High frequency MHz-order mechanostimulation can trigger differentiation of human mesenchymal stem cells into an osteoblast lineage. Early, short duration stimuli induced long-term osteogenic cell commitment. Rapid treatments [10 min daily over 5 days] of the high frequency (10 MHz) mechanostimulation triggered upregulation in early osteogenic markers [RUNX2, COL1A1] and a sustained increase in late markers [osteocalcin, osteopontin] through a pathway that involved activating the piezo channel and subsequent Rho-associated protein kinase signaling.
Another study, this one in rabbits, used a piezo electric scaffolding to zap the growth of new joint cartilage. Researchers created a biodegradable scaffold using PLLA [poly(l-lactic acid)] nanofibers that, when placed under applied force, could generate a piezoelectric charge; this stimulated chondrogenesis in in vitro experiments. The experimental model of osteochondral defects in the medial femoral condyle of the rabbit, were treated with the PLLA scaffold. Results were: improved cartilage regeneration and subchondral bone regeneration after 1 or 2 months of exercise that generated the piezoelectric charge arising from the joint loading. This study showed that biodegradable piezoelectric scaffolds can use joint-loading to directly treat osteoarthritis.
This newsletter focussed on limbering up your limbs. Now go and rock out at all those Memorial Day festivities!
REFERENCES
Ståle B. Myhrvold et al, Nonoperative or Surgical Treatment of Acute Achilles' Tendon Rupture, New England Journal of Medicine (2022). DOI: 10.1056/NEJMoa2108447
Tamás Oláh et al, Axial alignment is a critical regulator of knee osteoarthritis, Science Translational Medicine (2022). DOI: 10.1126/scitranslmed.abn0179
Standing on a vibrating platform could deliver some of the same benefits as exercise. (2022, March 3) https://medicalxpress.com/news/2022-03-vibrating-platform- benefits.html
Lizebona August Ambattu et al, Short?Duration High Frequency MegaHertz?Order Nanomechanostimulation Drives Early and Persistent Osteogenic Differentiation in Mesenchymal Stem Cells, Small (2022). DOI: 10.1002/smll.202106823
Exercise-induced piezoelectric stimulation for cartilage regeneration in rabbits, Science Translational Medicine (2022). www.science.org/doi/10.1126/scitranslmed.abi7282