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In this study, we reported that an optimal ESW treatment promoted healing of Achilles tendintis by inducing TGF\u2010\u03b21 and IGF\u2010I. Rats with the collagenease\u2010induced Achilles tendinitis were given a single ESW treatment (0.16 mJ\/mm<jats:sup>2<\/jats:sup> energy flux density) with 0, 200, 500 and 1000 impulses. Achilles tendons were subjected to biomechanical (load to failure and stiffness), biochemical properties (DNA, glycosaminoglycan and hydroxyproline content) and histological assessment. ESW with 200 impulses restored biomechanical and biochemical characteristics of healing tendons 12 weeks after treatment. However, ESW treatments with 500 and 1000 impulses elicited inhibitory effects on tendinitis repair. Histological observation demonstrated that ESW treatment resolved edema, swelling, and inflammatory cell infiltration in injured tendons. Lesion site underwent intensive tenocyte proliferation, neovascularization and progressive tendon tissue regeneration. Tenocytes at the hypertrophied cellular tissue and newly developed tendon tissue expressed strong proliferating cell nuclear antigen (PCNA) after ESW treatment, suggesting that physical ESW could increase the mitogenic responses of tendons. Moreover, the proliferation of tenocytes adjunct to hypertrophied cell aggregate and newly formed tendon tissue coincided with intensive TGF\u2010\u03b21 and IGF\u2010I expression. Increasing TGF\u2010\u03b21 expression was noted in the early stage of tendon repair, and elevated IGF\u2010I expression was persisted throughout the healing period. Together, low\u2010energy shock wave effectively promoted tendon healing. TGF\u2010\u03b21 and IGF\u2010I played important roles in mediating ESW\u2010stimulated cell proliferation and tissue regeneration of tendon. \u00a9 2003 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.<\/jats:p>","DOI":"10.1016\/j.orthres.2003.10.013","type":"journal-article","created":{"date-parts":[[2003,12,4]],"date-time":"2003-12-04T12:02:13Z","timestamp":1070539333000},"page":"854-861","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":233,"title":["Extracorporeal shock waves promote healing of collagenase\u2010induced Achilles tendinitis and increase TGF\u2010\u03b21 and IGF\u2010I expression"],"prefix":"10.1002","volume":"22","author":[{"given":"Yeung\u2010Jen","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching\u2010Jen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuender 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