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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.
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
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.
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
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.
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)
Materials and Methods
• Achilles tendon is sharply
transected
•Achilles tendon is exposed
and isolated
Surgical Procedures
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.
Surgical Procedures cont.
•Casting and window was done at the site of the
tenotomy for wound dressing and MES application
Treatment
•Application of MES using anode at the tenotomy site and
cathode proximally placed.
1- Biomechanical evaluation
Biomechanical measurements included, load
at break, stiffness, ultimate tensile strength,
elastic modulus, and work done
Analysis
Analysis
2- Histopathological analysis
Included the condition of
fibroblasts and collagen of the
neotendon
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/mm2
Control Cathodal Anodal
Lod at Break
0
30
60
90
120
150
3 rd w 5 th w 8 th w
Newton
Control Cathodal Anodal
Stiffness
0
30
60
90
120
3 rd w 5 th w 8 th w
N/mm
Control Cathodal Anodal
Ultimate tensile strength
0
50
100
150
200
250
3 rd w 5 th w 8 th w
Newton
Control Cathodal Anodal
Histopathological results
RESULTS
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
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.
CathodalControl Anodal
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.
CathodalControl Anodal
• 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
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 .
Polarity effect of microcurrent electrical stimulation on tendon healing biomechanical and histopathological studies

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Polarity effect of microcurrent electrical stimulation on tendon healing biomechanical and histopathological studies

  • 1. Polarity Effect of Microcurrent Electrical Stimulation on Tendon Healing: Biomechanical and Histopathological Studies Ahmed A.,Sherein,S. Elgayed, Ibrahim I., M, A.
  • 2. 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
  • 3. 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.
  • 4. 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
  • 5. 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.
  • 6. 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)
  • 7. Materials and Methods • Achilles tendon is sharply transected •Achilles tendon is exposed and isolated Surgical Procedures
  • 8. 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.
  • 9. Surgical Procedures cont. •Casting and window was done at the site of the tenotomy for wound dressing and MES application
  • 10. Treatment •Application of MES using anode at the tenotomy site and cathode proximally placed.
  • 11. 1- Biomechanical evaluation Biomechanical measurements included, load at break, stiffness, ultimate tensile strength, elastic modulus, and work done Analysis
  • 12. Analysis 2- Histopathological analysis Included the condition of fibroblasts and collagen of the neotendon
  • 13. 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/mm2 Control Cathodal Anodal Lod at Break 0 30 60 90 120 150 3 rd w 5 th w 8 th w Newton Control Cathodal Anodal Stiffness 0 30 60 90 120 3 rd w 5 th w 8 th w N/mm Control Cathodal Anodal Ultimate tensile strength 0 50 100 150 200 250 3 rd w 5 th w 8 th w Newton Control Cathodal Anodal
  • 15. 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
  • 16. 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. CathodalControl Anodal
  • 17. 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. CathodalControl Anodal
  • 18. • 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
  • 19. 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 .