1. Angiogenesis A key factor in Shockwave Medicine Prof Dr Carlos Leal MD Bosque University & Fenway Medical – Bogota, Colombia Prof Dr. Manuel Brañes Chile University – Santiago de Chile

3. Meidling - Vienna - 2000

4. Clinica el Bosque Agosto 1, 2000

5. Musculoskeletal Shockwave Therapy Joint Meeting of the Austrian, Swiss, and German Societies for Orthopaedic ESWT DIGEST Deutsche und internationale Gesellschaft für extrakorporale Stoßwellentherapie Venue University Hospital Lecture Hall, Building 505 Langenbeckstr. 1 D-55101 Mainz Germany Orthopaedic Hospital Kassel Dept. of Orthopaedics Preliminary Programme March 30 – 31, 2001

6. Scientific Organization: Dr. Jan D. Rompe, MD, Associate Professor Dept. of Orthopaedics, Johannes Gutenberg University, Mainz Prof. Werner Siebert, MD, Chief Orthopaedic Hospital, Kassel Prof. Jochen Heine, MD, Chief Dept. of Orthopaedics, Johannes Gutenberg University, Mainz General Information: Dr. Carsten Schoellner, MD Mrs. Doris Becker Tel. 0049-06131-172748 Fax: 0049-06131-176679 e-mail: [email_address] Web: http://www.uni-mainz.de/FB/Medizin/Orthopaedie/ESWT.htm Dept. of Orthopaedics, Johannes Gutenberg University School of Medicine, Langenbeckstr. 1, D-55101 Mainz, Germany Dear colleagues, for ten years extracorporeal shockwaves have been used in clinical and experimental studies at the Department of Or-thopaedics of the Johannes Gutenberg University School of Medicine in Mainz, Germany. During the past decade various working groups have been founded in Austria, Switzerland, and Germany to concen-trate national and international efforts on training, quality management, basic research and organization of multi-center studies. For the first time the five leading national and international societies come together to exchange their vast experience with regard to ESWT in Orthopaedics. So there will be a unique opportunity to be informed about the present role of ESWT in comparison with generally recognized conservative or operative procedures. This is particularly interesting as one shockwave device recently received FDA approval for treatment of heel pain We would like to welcome you here in Mainz, Germany, to learn with us about chances and limits of this new tech-nology. Yours sincerly, Jan-Dirk Rompe Werner Siebert Jochen Heine Welcome 11.00 - 12.00 am Future Developments Chairmen: H. Kuderna, Wien, U. Dreisilker, Velbert Storz Medical - Direx – HMT - Dornier - EMS - Exogen - Shock Waves Inc. - MTS - Wolf - Siemens 12.00 - 1.00 pm Experimental Forum Chairmen: S. Wanke, Wiener Neustadt, P. Eysel, Mainz M. Maier, T. Saisu, C. Schmitz, S. Milz, J. Beckmann and H.J. Refior, Munich A. Thon, M. Bette and M. Haake, Marburg K. Peers, P. Brys, R. Lysens, Leuven, Belgium L. Gerdesmeyr, E. Steinhauser and W. Mittelmeier, Munich T. Rosendahl, P. Eysel and J.-D. Rompe, Mainz C. Leal, Bosque University, Bogota Colombia 1.30 - 3.00 pm ESWT for Calcifying Tendinitis Chairmen: J. Zoellner, Mainz, W. Siebert, Kassel S. Rupp, Homburg M. Daecke and M. Loew, Heidelberg M. Haake, and P. Griss, Marburg B. Dubs, Zürich R. Rädel, Herne H. Durst, St. Gallen 3.15 – 5.15 pm ESWT for Tennis Elbow Chairmen: B. Dubs, Zürich, R. Thiele, Berlin J. Fritze, Cologne L. Gerdesmeyr, R. Garve, K. Bachfischer and R. Gradinger, Munich C. Riedel, J.-D. Rompe and J. Heine, Mainz M. Haake and I. Boeddeker, Marburg D. Steeger v. Keitz, Rüsselsheim M. Maier, C. Schmitz, M. Steinborn, A. Stäbler and H.J. Refior, Munich G. Haupt, Cologne J. Haist, Wörrstadt 5.30 - 7.00 pm Advances in Musculoskeletal ESWT Chairmen:L. Gerdesmeyr, Munich, M. Haake, Marburg R. Thiele, Berlin, Germany S.P. Jacobs, Markham, Canada S. Lauber, J. Ludwig and J. Krämer, Kassel/Bochum, Germany M.Berta, L. Berta and R. Frairia, Torino, Italy S. McClure, McCarroll, D. VanSickle, West Lafayette, USA S. Donati, L. Fusetti, R. Ferrario, M. Berta, and R. Frairia, Torino, Italy S. Wanke, Wiener Neustadt, W. Schaden Austria Programme Friday, 30th March 2001 1.00 - 2.00 pm Registration 2.00 - 2.15 pm Welcome J. Heine, Mainz W. Siebert, Kassel, C. Schöllner, Mainz 2.15 - 2.45 pm Presentation of the Societies Chairmen: L. Gerdesmeyr, Munich, V. Auersperg, Linz Working Group of the ÖGO - Swiss Society for Shockwave Therapy (SGST) – German and International Society for Shockwave Therapy (DIGEST) - ISMST - Working Group ESWT of the DGOT 2.45 - 3.30 pm Guest Lectures Chairmen: P. Galle, Mainz, G. Haupt, Cologne S. Melchior and J.W. Thüroff, Mainz M. Sackmann, München 4.00 - 4.45 pm Basics Chairmen: M. Buch, Kassel, M. Haake, Marburg R. Prümmer, Karlsruhe O. Wess, Kreuzlingen 5.00 – 6.30 pm ESWT for Non-Unions Chairmen: P.M. Rommens, Mainz, R. Rädel, Herne P. Eysel, Mainz W. Schaden and H. Kuderna, Wien R. Wirsching, W. Eich, and P. Lang, Regensburg V. Auersperg and N. Böhler, Linz R. Diesch, Friedrichshafen H.-C. Pape and H. Tscherne, Hannover H.W. Ditzen and M. Börner, Frankfurt Saturday, 31st March 2001 9.00 - 10.45 am ESWT for Plantar Fasciitis Chairmen: J. Heine, Mainz, M. Maier, Munich H.-H. Küster, Gütersloh M. Buch and W. Siebert, Kassel L.S. Weil,Vernon Hills, USA R. Seil, S. Rupp and D.M. Kohn, Homburg L. Perlick and J. Grifka, Regensburg U. Dreisilker, Velbert C. Schoellner, T. Walz and J. Heine, Mainz J. Ogden, R. Alvarez, and R. Levitt, Atlanta, USA OWC

7. Scientific Organization: Dr. Jan D. Rompe, MD, Associate Professor Dept. of Orthopaedics, Johannes Gutenberg University, Mainz Prof. Werner Siebert, MD, Chief Orthopaedic Hospital, Kassel Prof. Jochen Heine, MD, Chief Dept. of Orthopaedics, Johannes Gutenberg University, Mainz General Information: Dr. Carsten Schoellner, MD Mrs. Doris Becker Tel. 0049-06131-172748 Fax: 0049-06131-176679 e-mail: [email_address] Web: http://www.uni-mainz.de/FB/Medizin/Orthopaedie/ESWT.htm Dept. of Orthopaedics, Johannes Gutenberg University School of Medicine, Langenbeckstr. 1, D-55101 Mainz, Germany Dear colleagues, for ten years extracorporeal shockwaves have been used in clinical and experimental studies at the Department of Or-thopaedics of the Johannes Gutenberg University School of Medicine in Mainz, Germany. During the past decade various working groups have been founded in Austria, Switzerland, and Germany to concen-trate national and international efforts on training, quality management, basic research and organization of multi-center studies. For the first time the five leading national and international societies come together to exchange their vast experience with regard to ESWT in Orthopaedics. So there will be a unique opportunity to be informed about the present role of ESWT in comparison with generally recognized conservative or operative procedures. This is particularly interesting as one shockwave device recently received FDA approval for treatment of heel pain We would like to welcome you here in Mainz, Germany, to learn with us about chances and limits of this new tech-nology. Yours sincerly, Jan-Dirk Rompe Werner Siebert Jochen Heine Welcome 11.00 - 12.00 am Future Developments Chairmen: H. Kuderna, Wien, U. Dreisilker, Velbert Storz Medical - Direx – HMT - Dornier - EMS - Exogen - Shock Waves Inc. - MTS - Wolf - Siemens 12.00 - 1.00 pm Experimental Forum Chairmen: S. Wanke, Wiener Neustadt, P. Eysel, Mainz M. Maier, T. Saisu, C. Schmitz, S. Milz, J. Beckmann and H.J. Refior, Munich A. Thon, M. Bette and M. Haake, Marburg K. Peers, P. Brys, R. Lysens, Leuven, Belgium L. Gerdesmeyr, E. Steinhauser and W. Mittelmeier, Munich T. Rosendahl, P. Eysel and J.-D. Rompe, Mainz C. Leal, Bosque University, Bogota Colombia 1.30 - 3.00 pm ESWT for Calcifying Tendinitis Chairmen: J. Zoellner, Mainz, W. Siebert, Kassel S. Rupp, Homburg M. Daecke and M. Loew, Heidelberg M. Haake, and P. Griss, Marburg B. Dubs, Zürich R. Rädel, Herne H. Durst, St. Gallen 3.15 – 5.15 pm ESWT for Tennis Elbow Chairmen: B. Dubs, Zürich, R. Thiele, Berlin J. Fritze, Cologne L. Gerdesmeyr, R. Garve, K. Bachfischer and R. Gradinger, Munich C. Riedel, J.-D. Rompe and J. Heine, Mainz M. Haake and I. Boeddeker, Marburg D. Steeger v. Keitz, Rüsselsheim M. Maier, C. Schmitz, M. Steinborn, A. Stäbler and H.J. Refior, Munich G. Haupt, Cologne J. Haist, Wörrstadt 5.30 - 7.00 pm Advances in Musculoskeletal ESWT Chairmen:L. Gerdesmeyr, Munich, M. Haake, Marburg R. Thiele, Berlin, Germany S.P. Jacobs, Markham, Canada S. Lauber, J. Ludwig and J. Krämer, Kassel/Bochum, Germany M.Berta, L. Berta and R. Frairia, Torino, Italy S. McClure, McCarroll, D. VanSickle, West Lafayette, USA S. Donati, L. Fusetti, R. Ferrario, M. Berta, and R. Frairia, Torino, Italy S. Wanke, Wiener Neustadt, W. Schaden Austria Programme Friday, 30th March 2001 1.00 - 2.00 pm Registration 2.00 - 2.15 pm Welcome J. Heine, Mainz W. Siebert, Kassel, C. Schöllner, Mainz 2.15 - 2.45 pm Presentation of the Societies Chairmen: L. Gerdesmeyr, Munich, V. Auersperg, Linz Working Group of the ÖGO - Swiss Society for Shockwave Therapy (SGST) – German and International Society for Shockwave Therapy (DIGEST) - ISMST - Working Group ESWT of the DGOT 2.45 - 3.30 pm Guest Lectures Chairmen: P. Galle, Mainz, G. Haupt, Cologne S. Melchior and J.W. Thüroff, Mainz M. Sackmann, München 4.00 - 4.45 pm Basics Chairmen: M. Buch, Kassel, M. Haake, Marburg R. Prümmer, Karlsruhe O. Wess, Kreuzlingen 5.00 – 6.30 pm ESWT for Non-Unions Chairmen: P.M. Rommens, Mainz, R. Rädel, Herne P. Eysel, Mainz W. Schaden and H. Kuderna, Wien R. Wirsching, W. Eich, and P. Lang, Regensburg V. Auersperg and N. Böhler, Linz R. Diesch, Friedrichshafen H.-C. Pape and H. Tscherne, Hannover H.W. Ditzen and M. Börner, Frankfurt Saturday, 31st March 2001 9.00 - 10.45 am ESWT for Plantar Fasciitis Chairmen: J. Heine, Mainz, M. Maier, Munich H.-H. Küster, Gütersloh M. Buch and W. Siebert, Kassel L.S. Weil,Vernon Hills, USA R. Seil, S. Rupp and D.M. Kohn, Homburg L. Perlick and J. Grifka, Regensburg U. Dreisilker, Velbert C. Schoellner, T. Walz and J. Heine, Mainz J. Ogden, R. Alvarez, and R. Levitt, Atlanta, USA

8. ONLAT Sociedad Latinoamericana de Litotripcia Ortopedica por Ondas de Choque Sociedade Latinoamericana de Terapia por Ondas de Choque Latin American Society for Musculoskeletal Shockwave Therapy

9. ONLAT

10. ONLAT Sociedad Latinoamericana de Litotripcia Ortopedica por Ondas de Choque Latin American Society for Musculoskeletal Shockwave Therapy

13. Wound healing is a complex and sequential local cellular and molecular response It overlaps biological processes generally defined by… Inflammation Epithelialization Angiogenesis Matrix deposition

14. During early wound healing, a vigorous angiogenic response supports the increased metabolic demands of rapidly proliferating and migrating leukocytes, keratinocytes, fibroblasts, and endothelial cell (EC) precursors

15. These early angiogenic and inflammatory responses diminish as wound closure, fibrosis, and remodeling predominate

16. The inability to progress through the inflammatory phase of healing is characteristic of chronic lesions

17. Prolonged and aberrant accumulation of matrix metalloproteinases (MMPs) Impedes cell migration and downregulation of tissue inhibitors of MMPs, hinders neovascularization essential to restoration of local O2 delivery, and interferes with extra-cellular matrix (ECM) remodeling

18. Various therapeutic strategies have been proposed to accelerate epidermal cell proliferation and angiogenesis within the open wound bed however, attempts to use soluble mediators and growth factors have been unfulfilling

22. Recent studies have emphasized the importance of the wound stimulatory effects of micromechanical forces (‘‘cellular mechanotransduction’’) Ingber DE (2006) Cellular mechanotransduction: putting all the pieces together again. FASEB J 20:811 Pietramaggiori G, Liu P, Scherer SS, Kaipainen A, (2007) Tensile forces stimulate vascular remodeling and epidermal cell proliferation in living skin. Ann Surg 246:896

23. One such biomechanical modality is ESWT An acoustic pressure wave that penetrates tissue and produces favorable biological responses The target tissue response occurs through complex and incompletely understood Cellular and biochemical pathways.

25. Shock Waves for Tissue Repair C.J. Wang JBJS 87(11): 2380-7, Nov 2005

26. A single shock wave treatment immediately after skin grafting significantly augments recipient graft revascularization. This pro-angiogenic response to ESWT is associated with significantly increased CD31 positive EC proliferation and early post treatment VEGF-A expression, upregulation of angiogenesis pathway-specific genes in the skin graft. The early pro-angiogenic and anti-inflammatory effects of ESWT in ischemic tissue make it an attractive therapeutic modality for promoting wound healing.

32. (The Journal of Foot & Ankle Surgery 41(1):16-22,2002)

72. Thanks !