{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T15:06:08Z","timestamp":1784041568162,"version":"3.55.0"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Kaohsiung J of Med Scie"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Extracorporeal shock wave therapy (ESWT) improves tendon\u2010bone healing after rotator cuff injury (RCI), but its underlying cellular mechanisms remain unknown. This study aimed to explore the therapeutic effects of ESWT on RCI, with a particular focus on endothelial cells and tenocytes. The RCI model was established in rabbits by rotator cuff tear surgery, followed by ESWT intervention. Histological evaluation, blood perfusion analysis, biomechanical testing, and assessment of inflammation and extracellular matrix (ECM) degradation were performed in RCI\u2010treated rabbits at week (W) 2, W4, and W8. For the in\u00a0vitro experiments, human umbilical vein endothelial cells (HUVECs) and human tenocytes were treated with ESWT. ESWT reduced Bonar scores, increased the fibrocartilage area and collagen\u2010positive area, and enhanced blood perfusion and biomechanical strength at most time points in RCI rabbits (all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). Moreover, ESWT reduced inflammation and ECM degradation, as reflected by reduced tumor necrosis factor (TNF)\u2010\u03b1, interleukin (IL)\u20101\u03b2, and IL\u20106 and decreased matrix metalloproteinase (MMP)\u20101 and MMP\u20109 at most time points in RCI rabbits (all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). In HUVECs, ESWT increased proliferation, invasion, branch points, MMP\u20102, MMP\u20109, vascular endothelial growth factor A (VEGFA), and fibroblast growth factor 2 (FGF2) (all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). In tenocytes, ESWT increased proliferation, collagen I, thrombospondin\u20104 (TSP4), VEGFA, FGF2, tenomodulin (TNMD), and scleraxis (SCX) (all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). ESWT improves tendon integrity, blood perfusion, and biomechanical strength while reducing inflammation and ECM degradation after RCI, possibly via enhanced angiogenic activity in endothelial cells and maintenance of the tenogenic phenotype in tenocytes.\n                  <\/jats:p>","DOI":"10.1002\/kjm2.70260","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T14:35:40Z","timestamp":1784039740000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Extracorporeal Shock Wave Therapy on Tendon Integrity, Biomechanical Strength, Matrix Remodeling, Inflammation, Angiogenesis, and Tenogenic Differentiation in Rotator Cuff Injury"],"prefix":"10.1002","author":[{"given":"Hua","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Orthopedics Putuo People's Hospital, School of Medicine, Tongji University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Putuo People's Hospital, School of Medicine, Tongji University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0736-8242","authenticated-orcid":false,"given":"Jia\u2010Qing","family":"Miao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Putuo People's Hospital, School of Medicine, Tongji University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"issue":"1","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1038\/s41572-024-00492-3","article-title":"Rotator Cuff Tears","volume":"10","author":"Bedi A.","year":"2024","journal-title":"Nature Reviews Disease Primers"},{"issue":"10","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"647","DOI":"10.2519\/jospt.2022.11306","article-title":"Diagnosing, Managing, and Supporting Return to Work of Adults With Rotator Cuff Disorders: A Clinical Practice Guideline","volume":"52","author":"Lafrance S.","year":"2022","journal-title":"Journal of Orthopaedic and Sports Physical Therapy"},{"issue":"2","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.apmr.2023.09.022","article-title":"A Systematic Review of Clinical Practice Guidelines on the Diagnosis and Management of Various Shoulder Disorders","volume":"105","author":"Lowry V.","year":"2024","journal-title":"Archives of Physical Medicine and Rehabilitation"},{"issue":"2","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.pmr.2022.12.002","article-title":"Nonoperative Treatment of Rotator Cuff Tears","volume":"34","author":"Dickinson R. N.","year":"2023","journal-title":"Physical Medicine and Rehabilitation Clinics of North America"},{"issue":"3","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1097\/JSA.0000000000000372","article-title":"Conservative Management of Partial Thickness Rotator Cuff Tears: A Systematic Review","volume":"31","author":"Longo U. G.","year":"2023","journal-title":"Sports Medicine and Arthroscopy Review"},{"issue":"1","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.csm.2022.08.004","article-title":"Arthroscopic Rotator Cuff Repair: A Review of Surgical Techniques and Outcomes","volume":"42","author":"Mancini M. R.","year":"2023","journal-title":"Clinics in Sports Medicine"},{"issue":"7","key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/j.jse.2016.01.026","article-title":"Postoperative Pain Control After Arthroscopic Rotator Cuff Repair","volume":"25","author":"Uquillas C. A.","year":"2016","journal-title":"Journal of Shoulder and Elbow Surgery"},{"issue":"5","key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1007\/s00402-024-05323-4","article-title":"Incidence and Risk Factors for Shoulder Stiffness After Open and Arthroscopic Rotator Cuff Repair","volume":"144","author":"Salas M.","year":"2024","journal-title":"Archives of Orthopaedic and Trauma Surgery"},{"issue":"9","key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.1016\/j.jse.2023.01.026","article-title":"Timing of Retears After Arthroscopic Rotator Cuff Repair and Associated Factors: A Retrospective Analysis","volume":"32","author":"Yamaura K.","year":"2023","journal-title":"Journal of Shoulder and Elbow Surgery"},{"issue":"21","key":"e_1_2_10_11_1","doi-asserted-by":"crossref","DOI":"10.3390\/healthcare11212830","article-title":"Extracorporeal Shock Wave Therapy for the Treatment of Musculoskeletal Pain: A Narrative Review","volume":"11","author":"De la Corte\u2010Rodr\u00edguez H.","year":"2023","journal-title":"Health"},{"key":"e_1_2_10_12_1","doi-asserted-by":"crossref","DOI":"10.3389\/fvets.2025.1719123","article-title":"Extracorporeal Shock Wave Therapy for Equine Musculoskeletal Disorders: From Biological Mechanisms to Clinical Applications","volume":"12","author":"Qiu Z.","year":"2025","journal-title":"Frontiers in Veterinary Science"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2023.1193835","article-title":"The Effectiveness of Shockwave Therapy on Patellar Tendinopathy, Achilles Tendinopathy, and Plantar Fasciitis: A Systematic Review and Meta\u2010Analysis","volume":"14","author":"Charles R.","year":"2023","journal-title":"Frontiers in Immunology"},{"issue":"2","key":"e_1_2_10_14_1","doi-asserted-by":"crossref","DOI":"10.3390\/jcm15020471","article-title":"Radial Extracorporeal Shock Wave Therapy Versus Multimodal Physical Therapy in Non\u2010Traumatic (Degenerative) Rotator Cuff Tendinopathy With Partial Supraspinatus Tear: A Randomized Controlled Trial","volume":"15","author":"Wang Z.","year":"2026","journal-title":"Journal of Clinical Medicine"},{"issue":"1","key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1186\/s12891-024-07445-7","article-title":"Effect of Extracorporeal Shockwave Therapy for Rotator Cuff Tendinopathy: A Systematic Review and Meta\u2010Analysis","volume":"25","author":"Xue X.","year":"2024","journal-title":"BMC Musculoskeletal Disorders"},{"issue":"4","key":"e_1_2_10_16_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.rehab.2023.101730","article-title":"Radial Extracorporeal Shockwave Therapy Reduces Pain and Promotes Proximal Tendon Healing After Rotator Cuff Repair: Randomized Clinical Trial","volume":"66","author":"Shao H.","year":"2023","journal-title":"Annals of Physical and Rehabilitation Medicine"},{"issue":"6","key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1097\/PHM.0000000000002361","article-title":"Extracorporeal Shockwave Therapy for the Treatment of Noncalcific Rotator Cuff Tendinopathy: A Systematic Review and Meta\u2010Analysis","volume":"103","author":"Kamonseki D. H.","year":"2024","journal-title":"American Journal of Physical Medicine & Rehabilitation"},{"issue":"1","key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"5046","DOI":"10.1038\/s41598-026-35072-w","article-title":"Histological and Genetic Changes Induced by Extracorporeal Shockwave Therapy After Rotator Cuff Repair in a Rat Model With Tears","volume":"16","author":"Kamiyama M.","year":"2026","journal-title":"Scientific Reports"},{"issue":"1","key":"e_1_2_10_19_1","doi-asserted-by":"crossref","DOI":"10.1002\/jeo2.70622","article-title":"Comparative Effects of Bone Marrow Stimulation and Shockwave Therapy on Rotator Cuff Healing in Chronic Massive Rotator Cuff Tears: A Rat Model Study","volume":"13","author":"Demirta\u015f U.","year":"2026","journal-title":"Journal of Experimental Orthopaedics"},{"issue":"1","key":"e_1_2_10_20_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0262294","article-title":"Improved Biomechanics in Experimental Chronic Rotator Cuff Repair After Shockwaves Is Not Reflected by Bone Microarchitecture","volume":"17","author":"Feichtinger X.","year":"2022","journal-title":"PLoS One"},{"issue":"4","key":"e_1_2_10_21_1","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1016\/j.orthres.2003.10.013","article-title":"Extracorporeal Shock Waves Promote Healing of Collagenase\u2010Induced Achilles Tendinitis and Increase TGF\u2010beta1 and IGF\u2010I Expression","volume":"22","author":"Chen Y. 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