Knee Pain – Osteoarthritis

Lasers Med Sci. 2015 Sep 29. [Epub ahead of print]

 

Does addition of low-level laser therapy (LLLT) in conservative care of knee arthritis successfully postpone the need for joint replacement?  

Ip D1.
Author information
1Asia Medical Pain Centre, Whole of 4th Floor, Grand Plaza, Mong Kok, Hong Kong. ipdavid@hotmail.com.hk.

Abstract
The current study evaluates whether the addition of low-level laser therapy into standard conventional physical therapy in elderly with bilateral symptomatic tri-compartmental knee arthritis can successfully postpone the need for joint replacement surgery. A prospective randomized cohort study of 100 consecutive unselected elderly patients with bilateral symptomatic knee arthritis with each knee randomized to receive either treatment protocol A consisting of conventional physical therapy or protocol B which is the same as protocol A with added low-level laser therapy. The mean follow-up was 6 years. Treatment failure was defined as breakthrough pain which necessitated joint replacement surgery. After a follow-up of 6 years, patients clearly benefited from treatment with protocol B as only one knee needed joint replacement surgery, while nine patients treated with protocol A needed surgery (p<0.05). We conclude low-level laser therapy should be incorporated into standard conservative treatment protocol for symptomatic knee arthritis.

Laser Ther. 2014 Dec 27;23(4):273-7. doi: 10.5978/islsm.14-OR-21.

Low Level Laser Therapy for chronic knee joint pain patients.

Nakamura T1, Ebihara S2, Ohkuni I2, Izukura H2, Harada T2, Ushigome N2, Ohshiro T3, Musha Y4, Takahashi H1, Tsuchiya K1, Kubota A1.

Author information

  • 1Department of Orthopaedic Surgery, Toho University School of Medicine.
  • 2Department of Rehabilitation Medicine, Toho University School of Medicine.
  • 3Japan Medical Laser Laboratory.
  • 4Department of Orthopaedic Surgery, Ohashi Hospital, Toho University School of Medicine

Abstract

BACKGROUND AND AIMS:

Chronic knee joint pain is one of the most frequent complaints which is seen in the outpatient clinic in our medical institute. In previous studies we have reported the benefits of low level laser therapy (LLLT) for chronic pain in the shoulder joints, elbow, hand, finger and the lower back. The present study is a report on the effects of LLLT for chronic knee joint pain.

MATERIALS AND METHODS:

Over the past 5 years, 35 subjects visited the outpatient clinic with complaints of chronic knee joint pain caused by the knee osteoarthritis-induced degenerative meniscal tear. They received low level laser therapy. A 1000 mW semi-conductor laser device was used to deliver 20.1 J/cm(2) per point in continuous wave at 830nm, and four points were irradiated per session (1 treatment) twice a week for 4 weeks.

RESULTS:

A visual analogue scale (VAS) was used to determine the effects of LLLT for the chronic pain and after the end of the treatment regimen a significant improvement was observed (p<0.001). After treatment, no significant differences were observed in the knee joint range of motion. Discussions with the patients revealed that it was important for them to learn how to avoid postures that would cause them knee pain in everyday life in order to have continuous benefits from the treatment.

CONCLUSION:

The present study demonstrated that 830 nm LLLT was an effective form of treatment for chronic knee pain caused by knee osteoarthritis. Patients were advised to undertake training involving gentle flexion and extension of the knee.

J Lasers Med Sci. 2014 Fall;5(4):176-82.

Monochromatic Infrared Photo Energy versus Low Level Laser Therapy in Patients with Knee Osteoarthritis.

Ammar TA1.

Author information

  • 1Department of Basic Science, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.

Abstract

INTRODUCTION:

Knee osteoarthritis (KO) is the most common joint disease for which there is no optimal treatment. Monochromatic infrared photo energy (MIPE) is a relatively new light modality used to reduce pain and increase circulation. Low Level Laser Therapy (LLLT) is another light modality used to reduce pain in KO.

METHODS:

The aim of this study was to compare the effects of the MIPE and LLLT in improving pain and function in KO. Sixty participants with KO completed the program and were randomly assigned into two groups. Group 1 (experimental, n=30) received MIPE and exercises. Group 2 (control, n=30) received LLLT and exercises. Both groups received two visits per week for six weeks. Outcome included pain intensity measured on a visual analogue scale and physical function measured with the lower extremity functional scale, before and after the 12 therapy sessions (6 weeks after the start of the intervention).

RESULTS:

There were statistically significant improvements in pain intensity and lower extremity functional scale scores (p<0.05) in each group. However, no significant differences were recorded between the groups (p>0.05).

CONCLUSION:

Therefore, MIPE and LLLT reduce pain and improve function in KO; however, there are no differences between the two modalities in reducing pain and increasing physical function in KO.

Am J Phys Med Rehabil. 2014 Oct 8. [Epub ahead of print]

Musculoskeletal Atrophy in an Experimental Model of Knee Osteoarthritis: The Effects of Exercise Training and Low-Level Laser Therapy.

Assis L1, Almeida T, Milares LP, Dos Passos N, Araújo B, Bublitz C, Veronez S, Renno AC.

Author information

  • 1From the Department of Bioscience, Federal University of São Paulo, Santos, Sao Paulo, Brazil.

Abstract

OBJECTIVE:

The aim of this study was to evaluate the effects of an exercise training protocol and low-level laser therapy (and the association of both treatments) on musculoskeletal atrophy using an experimental model of knee osteoarthritis (OA).

DESIGN:

Fifty male Wistar rats were randomly divided into five groups: control group, knee OA control group, OA plus exercise training group, OA plus low-level laser therapy group, and OA plus exercise training associated with low-level laser therapy group. The exercise training and the laser irradiation started 4 wks after the surgery, 3 days per week for 8 wks. The exercise was performed at a speed of 16 m/min, 3 days per week, 50 mins per day, for 8 wks. Laser irradiation was applied at two points of the left knee joint (medial and lateral), for 24 sessions.

RESULTS:

The results showed that both trained groups (irradiated or not) presented a significant increase in the muscle cross-sectional area and a decrease in muscle fiber density compared with the knee OA control group. Moreover, both trained and laser-irradiated groups demonstrated decreased muscle-specific ring-finger protein 1 and atrogin-1 immunoexpression.

CONCLUSIONS:

These results suggest that exercise training and low-level laser therapy were effective in preventing musculoskeletal alterations related to atrophy caused by the degenerative process induced by knee OA.

Lasers Med Sci. 2014 Jun 3. [Epub ahead of print]

Effects of low-level laser therapy on joint pain, synovitis, anabolic, and catabolic factors in a progressive osteoarthritis rabbit model.

Wang P1, Liu C, Yang X, Zhou Y, Wei X, Ji Q, Yang L, He C.

Author information

  • 1Rehabilitation Medicine Center of West China Hospital, Sichuan University, ChengDu, People’s Republic of China, wangpu0816@qq.com.

Abstract

The aim of this study was to investigate the effect of low-level laser therapy (LLLT) on short-term and long-term joint pain, synovitis, anabolic, and catabolic factors in the cartilage of a rabbit model with progressive osteoarthritis (OA) induced by anterior cruciate ligament transection (ACLT). A total of 160 New Zealand white rabbits were randomly assigned into two groups (ACLT group and LLLT group). All rabbits received ACLT surgery, and 2-, 4-, 6-, and 8-week treatment after the surgery, with 20 rabbits being tested biweekly over every study period. The LLLT group received LLLT with a helium-neon (He-Ne) laser (830 nm) of 1.5 J/cm2 three times per week, and the ACLT group received placebo LLLT with the equipment switched off. Long-term and short-term pain was tested via weight-bearing asymmetry; synovitis was assessed histologically; and knee joint cartilage was evaluated by gross morphology, histology, and gene expression analysis of anabolic and catabolic factors. The histological assessment of pain and synovitis showed that at least 6-week intermittent irradiation of LLLT could relief knee pain and control synovium inflammation. Gross morphologic inspection and histological evaluation showed that 6 weeks of LLLT could decrease cartilage damage of medical femoral condyle and 8 weeks of LLLT could decrease cartilage damage of medical and lateral femoral condyles and medical tibial plateau. Gene expression analysis revealed two results: At least 6 weeks of LLLT could decrease production of catabolic factors, for example, interleukin 1? (IL-1?), inducible nitric oxide synthase (iNOS), and MMP-3, and slow down the loss of anabolic factors, mainly TIMP-1. Eight weeks of LLLT treatment could slow down the loss of collagen II, aggrecan, and anabolic factors, mainly transforming growth factor beta (TGF-?). The study suggests that LLLT plays a protective role against cartilage degradation and synovitis in rabbits with progressive OA by virtue of the regulation of catabolic and anabolic factors in the cartilage.

Lasers Med Sci. 2014 May 21. [Epub ahead of print]

Adjunctive use of combination of super-pulsed laser and light-emitting diodes phototherapy on nonspecific knee pain: double-blinded randomized placebo-controlled trial.

Leal-Junior EC1, Johnson DS, Saltmarche A, Demchak T.

Author information

  • 1Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 01504-001, São Paulo, SP, Brazil, ernesto.leal.junior@gmail.com.

Abstract

Phototherapy with low-level laser therapy (LLLT) and light-emitting diode therapy (LEDT) has arisen as an interesting alternative to drugs in treatments of musculoskeletal disorders. However, there is a lack of studies investigating the effects of combined use of different wavelengths from different light sources like lasers and light-emitting diodes (LEDs) in skeletal muscle disorders. With this perspective in mind, this study aimed to investigate the effects of phototherapy with combination of different light sources on nonspecific knee pain. It was performed a randomized, placebo-controlled, double-blinded clinical trial. Eighty-six patients rated 30 or greater on the pain visual analogue scale (VAS) were recruited and included in study. Patients of LLLT group received 12 treatments with active phototherapy (with 905 nm super-pulsed laser and 875 and 640 nm LEDs, Manufactured by Multi Radiance Medical, Solon, OH, USA) and conventional treatment (physical therapy or chiropractic care), and patients of placebo group were treated at same way but with placebo phototherapy device. Pain assessments (VAS) were performed at baseline, 4th, 7th, and 10th treatments, after the completion of treatments and at 1-month follow-up visit. Quality of life assessments (SF-36®) were performed at baseline, after the completion of treatments and at 1-month follow-up visit. Our results demonstrate that phototherapy significantly decreased pain (p?<?0.05) from 10th treatment to follow-up assessments and significantly improved (p?<?0.05) SF-36® physical component summary at posttreatments and follow-up assessments compared to placebo. We conclude that combination of super-pulsed laser, red and infrared LEDs is effective to decrease pain and improve quality of life in patients with knee pain.

Lasers Med Sci.  2012 Oct 24. [Epub ahead of print]

Low-level laser therapy in meniscal pathology: a double-blinded placebo-controlled trial.

Malliaropoulos N, Kiritsi O, Tsitas K, Christodoulou D, Akritidou A, Del Buono A, Maffulli N.

Source

National Track & Field Centre, Sports Injury Clinic, Sports Medicine Clinic of S.E.G.A.S., Thessaloniki, Greece, contact@sportsmed.gr

Abstract

We performed a randomized, double-blinded, placebo-controlled study (ISRCTN24203769) to assess the effectiveness of low-level laser therapy (LLLT) in patients with meniscal pathology, including only symptomatic patients with tiny focus of grade 3 attenuation (seen only on 0.7 thickness sequences) or intrasubstance tears with spot of grade 3 signal intensity approaching the articular surface. None of the patients in the study group underwent arthroscopy or new magnetic resonance imaging investigation. Paired-samples t test was used to detect significant changes in subjective knee pain over the experimental period within groups, and ANOVA was used to detect any significant differences between the two groups. Pain was significantly improved for the LLLT group than for the placebo group (F=154, p<0.0001). Pain scores were significantly better after LLLT. Four (12.5 %) patients did not respond to LLLT. At baseline, the average Lysholm score was 77±4.6 for the LLLT group and 77.2±2.6 for the placebo group (p>0.05). Four weeks after LLLT or placebo therapy, the laser group reported an average Lysholm score of 82.5±4.6, and the placebo group scored 79.0±1.9. At 6 months, the laser group had an average Lysholm score of 82.2±5.7, and after 1 year, they scored 81.6±6.6 (F=14.82923, p=0.002). Treatment with LLLT was associated with a significant decrease of symptoms compared to the placebo group: it should be considered in patients with meniscal tears who do not wish to undergo surgery.

Clin Rehabil.  2011 Dec 14. [Epub ahead of print]

Efficacy of low level laser therapy associated with exercises in knee osteoarthritis: a randomized double-blind study.

Alfredo PP, Bjordal JM, Dreyer SH, Meneses SR, Zaguetti G, Ovanessian V, Fukuda TY, Junior WS, Martins RA, Casarotto RA, Marques AP.

Source

Department of Speech Therapy, Physical Therapy and Occupational Therapy, School of Medicine, Sao Paulo University, Sao Paulo, Brazil.

Abstract

Objectives: To estimate the effects of low level laser therapy in combination with a programme of exercises on pain, functionality, range of motion, muscular strength and quality of life in patients with osteoarthritis of the knee.

Design: A randomized double-blind placebo-controlled trial with sequential allocation of patients to different treatment groups.

Setting: Special Rehabilitation Services.Subjects: Forty participants with knee osteoarthritis, 2-4 osteoarthritis degree, aged between 50 and 75 years and both genders.Intervention: Participants were randomized into one of two groups: the laser group (low level laser therapy dose of 3 J and exercises) or placebo group (placebo laser and exercises).

Main measures: Pain was assessed using a visual analogue scale (VAS), functionality using the Lequesne questionnaire, range of motion with a universal goniometer, muscular strength using a dynamometer, and activity using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire at three time points: (T1) baseline, (T2) after the end of laser therapy (three weeks) and (T3) the end of the exercises (11 weeks).

Results: When comparing groups, significant differences in the activity were also found (P = 0.03). No other significant differences (P > 0.05) were observed in other variables. In intragroup analysis, participants in the laser group had significant improvement, relative to baseline, on pain (P = 0.001), range of motion (P = 0.01), functionality (P = 0.001) and activity (P < 0.001). No significant improvement was seen in the placebo group.

Conclusion: Our findings suggest that low level laser therapy when associated with exercises is effective in yielding pain relief, function and activity on patients with osteoarthritis of the knees.

Lasers Med Sci.  2011 Apr 12. [Epub ahead of print]

Infrared (810-nm) low-level laser therapy on rat experimental knee inflammation.

Pallotta RC, Bjordal JM, Frigo L, Leal Junior EC, Teixeira S, Marcos RL, Ramos L, de Moura Messias F, Lopes-Martins RA.

Source

Laboratory of Pharmacology and Experimental Therapeutics, Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil, 05508-900.

Abstract

Arthritis of the knee is the most common type of joint inflammatory disorder and it is associated with pain and inflammation of the joint capsule. Few studies address the effects of the 810-nm laser in such conditions. Here we investigated the effects of low-level laser therapy (LLLT; infrared, 810-nm) in experimentally induced rat knee inflammation. Thirty male Wistar rats (230-250 g) were anesthetized and injected with carrageenan by an intra-articular route. After 6 and 12 h, all animals were killed by CO(2) inhalation and the articular cavity was washed for cellular and biochemical analysis. Articular tissue was carefully removed for real-time PCR analysis in order to evaluate COX-1 and COX-2 expression. LLLT was able to significantly inhibit the total number of leukocytes, as well as the myeloperoxidase activity with 1, 3, and 6 J (Joules) of energy. This result was corroborated by cell counting showing the reduction of polymorphonuclear cells at the inflammatory site. Vascular extravasation was significantly inhibited at the higher dose of energy of 10 J. Both COX-1 and 2 gene expression were significantly enhanced by laser irradiation while PGE(2) production was inhibited. Low-level laser therapy operating at 810 nm markedly reduced inflammatory signs of inflammation but increased COX-1 and 2 gene expression. Further studies are necessary to investigate the possible production of antiinflammatory mediators by COX enzymes induced by laser irradiation in knee inflammation.

Rheumatol Int. 2010 Dec 28. [Epub ahead of print]

The effect of low-level laser to apoptosis of chondrocyte and caspases expression, including caspase-8 and caspase-3 in rabbit surgery-induced model of knee osteoarthritis.

Lin HD, He CQ, Luo QL, Zhang JL, Zeng DX.

West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, The People’s Republic of China.

Abstract

The purpose of this study was to observe the effect of 810-nm low-level laser to apoptosis of chondrocyte and related proteins, including caspase-3 and caspase-8, in rabbit surgery-induced model of knee osteoarthritis. A total of 24 New Zealand White rabbits were randomly assigned into 3 groups: test group, model group, and normal group. The rabbits in test group and model group received anterior cruciate ligament transection in the right knee. Six weeks after transection, the rabbits in test group were given 10-session 810-nm laser illumination. Eight weeks after transection, all animal were killed. Modified Mankin Score was made for histological assessment. The caspases expressions and chondrocytes apoptosis were tested using the immunohistochemistry and TUNEL assessment, respectively. The modified Mankin Score of test group was significantly lower than model group (P < 0.01) and higher than normal group (P < 0.01). The caspase-8 expression of test group was lower than model group and higher than normal group, but no significant difference was found (P > 0.05). This study revealed that the 810-nm low-level laser can improve cartilage structure, prevent articular cartilage degradation and significantly decrease the expression of caspase-3 in this surgery-induced OA model. Further studies are needed.

Photomed Laser Surg. 2010 Apr;28(2):227-32.

Anti-inflammatory effect of low-level laser and light-emitting diode in zymosan-induced arthritis.

de Morais NC<>, Barbosa AM<>, Vale ML<>, Villaverde AB<>, de Lima CJ<>, Cogo JC<>, Zamuner SR<>.

Laboratory of Inflammation, Institute of Research and Development, University of Vale do Paraíba, Sáo José dos Campos, Brazil.

Abstract

OBJECTIVE: The aim of this work was to investigate the effect of low-level laser therapy (LLLT) and light-emitting diode (LED) on formation of edema, increase in vascular permeability, and articular joint hyperalgesia in zymosan-induced arthritis.

BACKGROUND DATA: It has been suggested that low-level laser and LED irradiation can modulate inflammatory processes.

MATERIAL AND METHODS: Arthritis was induced in male Wistar rats (250-280 g) by intra-articular injection of zymosan (1 mg in 50 microL of a sterile saline solution) into one rear knee joint. Animals were irradiated immediately, 1 h, and 2 h after zymosan administration with a semiconductor laser (685 nm and 830 nm) and an LED at 628 nm, with the same dose (2.5 J/cm(2)) for laser and LED. In the positive control group, animals were injected with the anti-inflammatory drug dexamethasone 1 h prior to the zymosan administration. Edema was measured by the wet/dry weight difference of the articular tissue, the increase in vascular permeability was assessed by the extravasation of Evans blue dye, and joint hyperalgesia was measured using the rat knee-joint articular incapacitation test.

RESULTS: Irradiation with 685 nm and 830 nm laser wavelengths significantly inhibited edema formation, vascular permeability, and hyperalgesia. Laser irradiation, averaged over the two wavelengths, reduced the vascular permeability by 24%, edema formation by 23%, and articular incapacitation by 59%. Treatment with LED (628 nm), with the same fluence as the laser, had no effect in zymosan-induced arthritis.

CONCLUSION: LLLT reduces inflammatory signs more effectively than LED irradiation with similar irradiation times (100 sec), average outputs (20 mW), and energy doses (2 J) in an animal model of zymosan-induced arthritis. The anti-inflammatory effects of LLLT appear to be a class effect, which is not wavelength specific in the red and infrared parts of the optical spectrum.

Physiother Res Int. 2010 Mar;15(1):16-23.

Choice of treatment modalities was not influenced by pain, severity or co-morbidity in patients with knee osteoarthritis.

Jamtvedt G<>, Dahm KT<>, Holm I<>, Odegaard-Jensen J<>, Flottorp S<>.

Norwegian Knowledge Centre for the Health Services, Oslo, Norway. grj@kunnskapssenteret.no

Abstract

BACKGROUND AND PURPOSE: Patients with knee osteoarthritis (OA) are commonly treated by physiotherapists in primary care. The physiotherapists use different treatment modalities. In a previous study, we identified variation in the use of transcutaneous electrical nerve stimulation (TENS), low level laser or acupuncture, massage and weight reduction advice for patients with knee OA. The purpose of this study was to examine factors that might explain variation in treatment modalities for patients with knee OA.

METHODS: Practising physiotherapists prospectively collected data for one patient with knee osteoarthritis each through 12 treatment sessions.We chose to examine factors that might explain variation in the choice of treatment modalities supported by high or moderate quality evidence, and modalities which were frequently used but which were not supported by evidence from systematic reviews. Experienced clinicians proposed factors that they thought might explain the variation in the choice of these specific treatments. We used these factors in explanatory analyses.

RESULTS: Using TENS, low level laser or acupuncture was significantly associated with having searched databases to help answer clinical questions in the last six months (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.08-3.42). Not having Internet access at work and using more than four treatment modalities were significant determinants for giving massage (OR = 0.36, 95% CI = 0.19-0.68 and OR = 8.92, 95% CI = 4.37-18.21, respectively). Being a female therapist significantly increased the odds for providing weight reduction advice (OR = 3.60, 95% CI = 1.12-11.57). No patient characteristics, such as age, pain or co-morbidity, were significantly associated with variation in practice.

CONCLUSIONS: Factors related to patient characteristics, such as pain severity and co-morbidity, did not seem to explain variation in treatment modalities for patients with knee OA. Variation was associated with the following factors: physiotherapists having Internet access at work, physiotherapists having searched databases for the last six months and the gender of the therapist. There is a need for more studies of determinants for physiotherapy practice.

J Rehabil Res Dev. 2009;46(9):1135-42.

Effect of He-Ne laser radiation on healing of osteochondral defect in rabbit: a histological study.

Bayat M<>, Javadieh F<>, Dadpay M<>.

Cellular and Molecular Biology Research Center, Medical Faculty, Shahid Beheshti University, MC, PO Box 19395/4719, Tehran, 1985717443, Iran. bayat_m@yahoo.com

Abstract

This study examined the influence of low-level laser therapy (LLLT) on the healing of a large osteochondral defect in rabbits.An osteochondral defect with 5 mm diameter was surgically induced in the right femoral patellar groove of 48 adult male rabbits. They were divided into a control and an experimental group. The rabbits were treated at 2, 4, 8, and 16 weeks after surgery, with six rabbits in each study period being tested at each biweekly period. The experimental group received LLLT with a helium-neon (He-Ne) laser (632.8 nm, 10 mW) of 148.4 J/cm(2) three times a week, and the control group received placebo LLLT with equipment switched off. The defects were examined macroscopically and microscopically. The results of the histological examination 2 weeks after surgery showed that the osteochondral healing of the control group was significantly accelerated compared with that of the experimental group. However, the osteochondral healing of the experimental group 4 weeks and 16 weeks after surgery showed that healing accelerated significantly compared with that of the control group. The conclusion was that LLLT with an He-Ne laser could not significantly accelerate healing of a large osteochondral defect in rabbits of the experimental group compared with that of the control group throughout the duration of the present study.

Photomed Laser Surg. 2009 Jun 16. [Epub ahead of print]

The Effect of Low-Level Laser in Knee Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Trial.

Heged?s B<>, Viharos L<>, Gervain M<>, Gálfi M<>.

1 Physio- and Balneotherapy Center , Orosháza-Gyopáros, Hungary .

Abstract Introduction: Low-level laser therapy (LLLT) is thought to have an analgesic effect as well as a biomodulatory effect on microcirculation. This study was designed to examine the pain-relieving effect of LLLT and possible microcirculatory changes measured by thermography in patients with knee osteoarthritis (KOA). Materials and Methods: Patients with mild or moderate KOA were randomized to receive either LLLT or placebo LLLT. Treatments were delivered twice a week over a period of 4 wk with a diode laser (wavelength 830 nm, continuous wave, power 50 mW) in skin contact at a dose of 6 J/point. The placebo control group was treated with an ineffective probe (power 0.5 mW) of the same appearance. Before examinations and immediately, 2 wk, and 2 mo after completing the therapy, thermography was performed (bilateral comparative thermograph by AGA infrared camera); joint flexion, circumference, and pressure sensitivity were measured; and the visual analogue scale was recorded. Results: In the group treated with active LLLT, a significant improvement was found in pain (before treatment [BT]: 5.75; 2 mo after treatment : 1.18); circumference (BT: 40.45; AT: 39.86); pressure sensitivity (BT: 2.33; AT: 0.77); and flexion (BT: 105.83; AT: 122.94). In the placebo group, changes in joint flexion and pain were not significant. Thermographic measurements showed at least a 0.5 degrees C increase in temperature-and thus an improvement in circulation compared to the initial values. In the placebo group, these changes did not occur. Conclusion: Our results show that LLLT reduces pain in KOA and improves microcirculation in the irradiated area.

Photomed Laser Surg. 2009 Apr 30. [Epub ahead of print]

Efficacy of Interferential Low-Level Laser Therapy Using Two Independent Sources in the Treatment of Knee Pain.

Montes-Molina R<>, Madroñero-Agreda MA<>, Romojaro-Rodríguez AB<>, Gallego-Mendez V<>, Prados-Cabiedas C<>, Marques-Lucas C<>, Pérez-Ferreiro M<>, Martinez-Ruiz F<>.

1 Unit of Physiotherapy, Hospital Ramón y Cajal , Madrid, Spain .

Abstract Objective: The aim of this study was to evaluate the effectiveness of an interferential pattern generated by two identical and independent lasers in the relief of knee pain. Background Data: Low-level laser therapy (LLLT) is generally applied by a single probe. Materials and Methods: A double-blind controlled clinical trial was performed on 152 patients with knee pain who were randomly assigned into two different groups. Group I patients (n = 76) received interferential laser therapy generated by two identical laser probes located opposite each other on the knee joint. Group II patients (n = 76) received one live probe in conventional laser therapy and one dummy probe. The device used in both groups was an AlGaAs laser (wavelength 810 nm, power 100 mW, in continuous mode). Fifteen laser sessions were applied transcutaneously on 5 knee points (6 J/point) per session. In addition, patients in both groups received a quadriceps strength program based on isometric exercises. A visual analogue scale (VAS) was used for pain evaluation in different situations, such as in standing, in knee flexion/extension, and when going up and down stairs. VAS pain scores were evaluated before, in the middle of, and after treatment. Results: ANOVA results showed no significant differences between groups for all VAS scores or in the interaction with the sessions (p > 0.05). The VAS score results showed a statistically significant pain reduction throughout all sessions (p = 0.000). Conclusions: Interferential laser therapy is safe and effective in reducing knee pain. However, the results of the study indicate that it is not superior to the use of a single conventional laser.

Med Tr Prom Ekol. 2009;(4):20-3.

Prevention of occupational diseases of lower limbs joints

[Article in Russian]

Ushkova IN<>, Mal’kova NIu<>.

Abstract

Study covered 84 personal computer users, 48 jewelry female polishers, 92 metallic ships body assemblers. Objective investigations revealed lower limbs joints stiffness. After prevention measures based on low-intensity laser rays, the joints functions recovered.

Photomed Laser Surg. 2008 Aug;26(4):301-6.

Laser-needle therapy for spontaneous osteonecrosis of the knee.

Banzer W<>, Hübscher M<>, Schikora D<>.

Department of Sports Medicine, Goethe-University Frankfurt/Main, University of Paderborn, Frankfurt/Main, Germany. banzer@sport.uni-frankfurt.de

Abstract

OBJECTIVE: This case report describes the treatment of a 63-year-old patient with spontaneous osteonecrosis of the knee (SONK).

BACKGROUND DATA: SONK usually appears in the elderly patient without the typical risk factors for osteonecrosis. It is characterized by acute and sudden pain, mostly occurring at the medial side of the knee joint. Symptoms usually worsen with physical activity and improve with rest. Besides physical therapy, limited weight-bearing and the use of analgesics and nonsteroidal anti-inflammatory drugs, we propose low-level laser therapy (LLLT) as a conservative treatment option.

METHODS: LLLT was carried out using laser needles emitting radiation with wavelengths of 685 and 885 nm, and a power density of 17.8 W/cm(2). Therapy sessions lasted 60 min and were performed daily over a period of 3 mo. The total irradiation dose emitted by 8 laser needles in 60 min of treatment was 1008 J.

RESULTS: Magnetic resonance imaging revealed distinct restitution of the spongiosa edema 5 wk after treatment onset, and the final check-up at 35 wk demonstrated complete restoration of integrity.

CONCLUSION: The present case report provides the first indication that laser-needle therapy may be a promising tool for complementary and alternative therapeutic intervention for those with SONK.

BMC Health Serv Res. 2008 Jul 8;8:145

Measuring physiotherapy performance in patients with osteoarthritis of the knee: a prospective study.

Jamtvedt G<>, Dahm KT<>, Holm I<>, Flottorp S<>.

Norwegian Knowledge Centre for Health Services, PO Box 7004, St. Olavs plass, 0103Oslo, Norway. grj@kunnskapssenteret.no

BACKGROUND: Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews. METHODS: We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA. RESULTS: A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching. CONCLUSION: Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be identified and evaluated.

Lasers Med Sci. 2008 Jan 5. [Epub ahead of print]

Effect of combined laser acupuncture on knee osteoarthritis: a pilot study.

Shen X<>, Zhao L<>, Ding G<>, Tan M<>, Gao J<>, Wang L<>, Lao L<>.

Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai, 201203, China.

Our objective was to assess the efficacy and safety of combined 10.6 mum and 650 nm laser irradiation on patients with knee osteoarthritis (OA). Forty patients with OA were randomly allocated to an active laser group or to a placebo laser group (20 per group). They either received active or sham laser treatment at acupoint Dubi (ST 35) in a total of 12 sessions. There was significant difference between the two groups in the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index pain score change from baseline after 2 weeks of treatment (P = 0.047). The pain reduction of the active laser treatment group was 49%, whereas that of the placebo control group was only 13%. However, due to the high patient drop-out rate, the 4-week assessment could not be analyzed. Combined laser treatment seems beneficial to patients with knee OA. However, due to the small sample size and the high drop-out rate of patients in the placebo group, a large sample-size clinical trial is warranted to determine further the therapeutic efficacy of the device.

Phys Ther. 2007 Nov 6; [Epub ahead of print]

Physical Therapy Interventions for Patients With Osteoarthritis of the Knee: An Overview of Systematic Reviews.

Jamtvedt G<>, Dahm KT<>, Christie A<>, Moe RH<>, Haavardsholm E<>, Holm I<>, Hagen KB<>.

Norwegian Centre for the Health Services, PO Box 7004, St Olavs Plass, N-0130 Oslo, Norway.

Patients with osteoarthritis of the knee are commonly treated by physical therapists. Practice should be informed by updated evidence from systematic reviews. The purpose of this article is to summarize the evidence from systematic reviews on the effectiveness of physical therapy for patients with knee osteoarthritis. Systematic reviews published between 2000 and 2007 were identified by a comprehensive literature search. We graded the quality of evidence across reviews for each comparison and outcome. Twenty-three systematic reviews on physical therapy interventions for patients with knee osteoarthritis were included. There is high-quality evidence that exercise and weight reduction reduce pain and improve physical function in patients with osteoarthritis of the knee. There is moderate-quality evidence that acupuncture, transcutaneous electrical nerve stimulation, and low-level laser therapy reduce pain and that psychoeducational interventions improve psychological outcomes. For other interventions and outcomes, the quality of evidence is low or there is no evidence from systematic reviews.

J Photochem Photobiol B. 2007 Jul 27;88(1):11-5. Epub 2007 May 1.

The therapeutic effect of low-level laser on repair of osteochondral defects in rabbit knee.

Kamali F<>, Bayat M<>, Torkaman G<>, Ebrahimi E<>, Salavati M<>.

Department of Physical Therapy, University of Social Welfare and Rehabilitation, Tehran, Iran. fahimehkamali@hotmail.com

Abstract

INTRODUCTION: Low level laser therapy (LLLT) has been shown to enhance collagen production and wound healing but its effect on cartilage repair from biomechanical point of view is not known yet. The aim of present study was to evaluate the biomechanical behaviour of repairing osteochondral defect in rabbits which received a pulsed low-level gallium-arsenide (Ga-As) laser irradiation.

MATERIALS AND METHODS: Osteochondral defects with 5mm diameter and 4mm in depth induced by drilling in right femoral patellar grooves of 41 adolescent male rabbits. They were divided into experimental and control groups. Experimental group received pulsed Ga-As (890nm) laser irradiation with energy density of 4.8J/cm(2). The rabbits in control group received placebo LLLT with shut-down equipment. The control defects were allowed to heal spontaneously. Each group were divided into three subgroups: A, B and C. Subgroups A, B and C were sacrificed on 4, 8, and 16 weeks after surgery. The knee joint were removed, and the defects were examined biomechanically by in situ-indentation method. The thickness, instantaneous and equilibrium indentation stiffness was measured during the test. Data were analysed using ANOVA and independent sample t-test.

RESULT: While no difference was observed in the repaired cartilage biomechanical properties among 4th, 8th, 16th weeks in study groups. The equilibrium indentation stiffness of experimental group was significantly higher in 8th week in comparison with control group.

CONCLUSION: LLLT significantly enhances the stiffness of repairing tissue in the 8th week post injury in osteochondral defects in rabbits.

Photomed Laser Surg. 2007 Jun;25(3):191-6.

Effect of low-level laser therapy on healing of medial collateral ligament injuries in rats: an ultrastructural study.

Delbari A<>, Bayat M<>, Bayat M<>.

Avicenna Hospital, Tehran, Iran.

Abstract

OBJECTIVE: This study sought to investigate whether low-level laser therapy (LLLT) with a helium-neon (He-Ne) laser would increase fibril diameter of transected medial collateral ligament (MCL) in rats.

BACKGROUND DATA: It has been shown that LLLT can increase ultimate tensile strength MCL healing.

METHODS: Thirty rats received surgical transect to their right MCL, and five were assigned as the control group. After surgery, the rats were divided into three groups: group 1 (n = 10) received LLLT with He-Ne laser and 0.01 J/cm(2) energy fluency per day, group 2 (n = 10) received LLLT with 1.2 J/cm(2) energy fluency (density) per day and group 3 (sham-exposed group; n = 10) received daily placebo laser with shut-down laser equipment, while control group received neither surgery nor LLLT. Transmission electron microscope (TEM) examination was performed on days 12 and 21 after surgery and dimension and density of ligament fibrils were measured. The data were analyzed by Student t-test and Mann-Whitney tests, respectively.

RESULTS: On day 12, the fibril dimension of group 2 and their density were higher than of groups 1 and 3.

CONCLUSION: LLLT with He-Ne laser on incised MCL in rats could not significantly increase fibril diameter and their density in comparison with sham-exposed group.

Photomed Laser Surg. 2007 Feb;25(1):14-20

Laser acupuncture in knee osteoarthritis: a double-blind, randomized controlled study.

Yurtkuran M<>, Alp A<>, Konur S<>, Ozçakir S<>, Bingol U<>.

Division of Rheumatology, Uludag University Atatürk Rehabilitation Center, Bursa, Turkey. merihcan@hotmail.com

OBJECTIVE: The purpose of this study was to investigate the effects and minimum effective dose of laser acupuncture in knee osteoarthritis (KOA), and to determine if it is superior to placebo treatment (sham) in the evaluation of clinical-functional outcome and quality of life. METHODS: In this randomized, placebo-controlled study, patients with grade 2 and 3 primary KOA were selected. Group I (n = 27) received 904-nm low-level laser irradiation with 10 mW/cm(2) power density, 4 mW output power, 0.4 cm(2) spot size, 0.48 J dose per session, and 120-sec treatment time on the medial side of the knee to the acupuncture point Sp9. Group II (n = 25) received placebo-laser therapy at the same place on the same point. Patients in both of the groups had treatment 5 days per week (total duration of therapy was 10 days) and 20 min per day. The study was comprised of a 2-week (10-session) intervention. Participants were evaluated before treatment (baseline), after treatment (2nd week), and at the 12th week. In this double-blind study, a blind examiner carried out all outcome assessments. The main outcome measures were as follows: pain on movement (pVAS), 50-foot walking time (50 foot w), knee circumference (KC), medial tenderness score (MTS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and Nottingham Health Profile (NHP). RESULTS: Statistically significant improvement was observed in PVAS, 50 foot w, and KC in group 1. In Group II, statistically significant improvement was observed in PVAS, 50 foot w, and WOMAC. When groups were compared with each other, the improvement observed in KC was superior in Group I at the 2(nd) week (p = 0.005). CONCLUSION: Laser acupuncture was found to be effective only in reducing periarticular swelling when compared with placebo laser.

J Photochem Photobiol B. 2007 Jul 27;88(1):11-5. Epub 2007 May 1

The therapeutic effect of low-level laser on repair of osteochondral defects in rabbit knee.

Kamali F<>, Bayat M<>, Torkaman G<>, Ebrahimi E<>, Salavati M<>.

Department of Physical Therapy, University of Social Welfare and Rehabilitation, Tehran, Iran. fahimehkamali@hotmail.com

INTRODUCTION: Low level laser therapy (LLLT) has been shown to enhance collagen production and wound healing but its effect on cartilage repair from biomechanical point of view is not known yet. The aim of present study was to evaluate the biomechanical behaviour of repairing osteochondral defect in rabbits which received a pulsed low-level gallium-arsenide (Ga-As) laser irradiation. MATERIALS AND METHODS: Osteochondral defects with 5mm diameter and 4mm in depth induced by drilling in right femoral patellar grooves of 41 adolescent male rabbits. They were divided into experimental and control groups. Experimental group received pulsed Ga-As (890nm) laser irradiation with energy density of 4.8J/cm(2). The rabbits in control group received placebo LLLT with shut-down equipment. The control defects were allowed to heal spontaneously. Each group were divided into three subgroups: A, B and C. Subgroups A, B and C were sacrificed on 4, 8, and 16 weeks after surgery. The knee joint were removed, and the defects were examined biomechanically by in situ-indentation method. The thickness, instantaneous and equilibrium indentation stiffness was measured during the test. Data were analysed using ANOVA and independent sample t-test. RESULT: While no difference was observed in the repaired cartilage biomechanical properties among 4th, 8th, 16th weeks in study groups. The equilibrium indentation stiffness of experimental group was significantly higher in 8th week in comparison with control group. CONCLUSION: LLLT significantly enhances the stiffness of repairing tissue in the 8th week post injury in osteochondral defects in rabbits.

Lasers Surg Med. 2007 Jul;39(6):543-50.

Low-level laser therapy for zymosan-induced arthritis in rats: Importance of illumination time.

Castano AP<>, Dai T<>, Yaroslavsky I<>, Cohen R<>, Apruzzese WA<>, Smotrich MH<>, Hamblin MR<>.

Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.

BACKGROUND: It has been proposed for many years that low-level laser (or light) therapy (LLLT) can ameliorate the pain, swelling, and inflammation associated with various forms of arthritis. Light is thought to be absorbed by mitochondrial chromophores leading to an increase in adenosine triphosphate (ATP), reactive oxygen species and/or cyclic AMP production and consequent gene transcription via activation of transcription factors. However, despite many reports about the positive effects of LLLT in arthritis and in medicine in general, its use remains controversial. For all indications (including arthritis) the optimum optical parameters have been difficult to establish and so far are unknown. METHODS: We tested LLLT on rats that had zymosan injected into their knee joints to induce inflammatory arthritis. We compared illumination regimens consisting of a high and low fluence (3 and 30 J/cm(2)), delivered at high and low irradiance (5 and 50 mW/cm(2)) using 810-nm laser light daily for 5 days, with the positive control of conventional corticosteroid (dexamethasone) therapy. RESULTS: Illumination with 810-nm laser was highly effective (almost as good as dexamethasone) at reducing swelling and a longer illumination time (10 or 100 minutes compared to 1 minute) was more important in determining effectiveness than either the total fluence delivered or the irradiance. LLLT induced reduction of joint swelling correlated with reduction in the inflammatory marker serum prostaglandin E2 (PGE2). CONCLUSION: LLLT with 810-nm laser is highly effective in treating inflammatory arthritis in this model. Longer illumination times were more effective than short times regardless of total fluence or irradiance. These data will be of value in designing clinical trials of LLLT for various arthritides.

BMC Musculoskelet Disord. 2007 Jun 22;8:51.

Short-term efficacy of physical interventions in osteoarthritic knee pain.  A systematic review and meta-analysis of randomised placebo-controlled trials.

Bjordal JM<>, Johnson MI<>, Lopes-Martins RA<>, Bogen B<>, Chow R<>, Ljunggren AE<>.

Faculty of Health and Social Sciences, Institute of Physiotherapy, Bergen University College, Moellendalsvn, Bergen Norway. jmb@hib.no

BACKGROUND: Treatment efficacy of physical agents in osteoarthritis of the knee (OAK) pain has been largely unknown, and this systematic review was aimed at assessing their short-term efficacies for pain relief. METHODS: Systematic review with meta-analysis of efficacy within 1-4 weeks and at follow up at 1-12 weeks after the end of treatment. RESULTS: 36 randomised placebo-controlled trials (RCTs) were identified with 2434 patients where 1391 patients received active treatment. 33 trials satisfied three or more out of five methodological criteria (Jadad scale). The patient sample had a mean age of 65.1 years and mean baseline pain of 62.9 mm on a 100 mm visual analogue scale (VAS). Within 4 weeks of the commencement of treatment manual acupuncture, static magnets and ultrasound therapies did not offer statistically significant short-term pain relief over placebo. Pulsed electromagnetic fields offered a small reduction in pain of 6.9 mm [95% CI: 2.2 to 11.6] (n = 487). Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture (EA) and low level laser therapy (LLLT) offered clinically relevant pain relieving effects of 18.8 mm [95% CI: 9.6 to 28.1] (n = 414), 21.9 mm [95% CI: 17.3 to 26.5] (n = 73) and 17.7 mm [95% CI: 8.1 to 27.3] (n = 343) on VAS respectively versus placebo control. In a subgroup analysis of trials with assumed optimal doses, short-term efficacy increased to 22.2 mm [95% CI: 18.1 to 26.3] for TENS, and 24.2 mm [95% CI: 17.3 to 31.3] for LLLT on VAS. Follow-up data up to 12 weeks were sparse, but positive effects seemed to persist for at least 4 weeks after the course of LLLT, EA and TENS treatment was stopped. CONCLUSION: TENS, EA and LLLT administered with optimal doses in an intensive 2-4 week treatment regimen, seem to offer clinically relevant short-term pain relief for OAK.

J Photochem Photobiol B. 2007 May 25;87(2):81-7. Epub 2007 Feb 24

Effect of low-level helium-neon laser therapy on histological and ultrastructural features of immobilized rabbit articular cartilage.

Bayat M<>, Ansari E<>, Gholami N<>, Bayat A<>.

Cellular and Molecular Biology Research Center and Anatomy Department, Medical Faculty, Shaheed Beheshti Medical University, Tehran, Iran. bayat_m@yahoo.com <bayat_m@yahoo.com>

The present study investigates whether low-level helium-neon laser therapy can increase histological parameters of immobilized articular cartilage in rabbits or not. Twenty five rabbits were divided into three groups: the experiment group, which received low-level helium-neon laser therapy with 13J/cm(2) three times a week after immobilization of their right knees; the control group which did not receive laser therapy after immobilization of their knees; and the normal group which received neither immobilization nor laser therapy. Histological and electron microscopic examinations were performed at 4 and 7 weeks after immobilization. Depth of the chondrocyte filopodia in four-week immobilized experiment group, and depth of articular cartilage in seven-week immobilized experiment group were significantly higher than those of relevant control groups (exact Fisher test, p=0.001; student’s t-test, p=0.031, respectively). The surfaces of articular cartilages of the experiment group were relatively smooth, while those of the control group were unsmooth. It is therefore concluded that low-level helium-neon laser therapy had significantly increased the depth of the chondrocyte filopodia in four-week immobilized femoral articular cartilage and the depth of articular cartilage in seven-week immobilized knee in comparison with control immobilized articular cartilage.

Osteoarthritis Cartilage. 2006 Apr;14(4):377-83. Epub 2005 Dec 13

Effects of helium-neon laser on the mucopolysaccharide induction in experimental osteoarthritic cartilage.

Lin YS<>, Huang MH<>, Chai CY<>.

Kun Shan University, Tainan, Taiwan, ROC.

OBJECTIVE: To investigate the effects of mucopolysaccharide induction after treatment by low power laser for experimental osteoarthritis (OA). METHODS: Seventy-two rats with three different degrees of papain induced OA over right knee joints were collected for helium-neon (He-Ne) laser treatment. The severity of induced arthritis was measured by 99mTc bone scan and classified into three groups (I-III) by their radioactivity ratios (right to left knee joints). The rats in each group were further divided into study subgroups (Is, IIs, and IIIs) and control subgroups (Ic, IIc, and IIIc) randomly. The arthritic knees in study subgroups received He-Ne laser treatment, and those in controls received sham laser treatment. The changes of arthritic severity after treatment and follow-up 2 months later were measured. The histopathological changes were evaluated through light microscope after disarticulation of sections (H.E. stain), and the changes of mucopolysaccharide density in cartilage matrix were measured by Optimas scanner analyzer after Alcian blue (AB) stain. The densities of mucopolysaccharide induced after treatment in arthritic cartilage were compared and correlated with their histopathological changes. RESULTS: The density of mucopolysaccharide rose at the initial stage of induced arthritis, and decreased progressively in later stages. The densities of mucopolysaccharide in treated rats increased upon complete laser treatment more than those of the controls, which is closely related with the improvement in histopathological findings, but conversely with the changes in arthritic severity. CONCLUSION: He-Ne laser treatment will enhance the biosynthesis of arthritic cartilage, and results in the improvement of arthritic histopathological changes.

Photomed Laser Surg. 2005 Dec;23(6):556-60

Low-level laser therapy improves early healing of medical collateral ligament injuries in rats.

Bayat M<>, Delbari A<>, Almaseyeh MA<>, Sadeghi Y<>, Bayat M<>, Reziae F<>.

Cell and Molecular Biology Research Center, Medical School, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. bayat_m@cyahoo.com

OBJECTIVE: This study sought to investigate whether or not low-level laser therapy (LLLT) with a helium-neon laser increased biomechanical parameters of transected medial collateral ligament (MCL) in rats. BACKGROUND DATA: It has been reported that LLLT can enhance tendon healing. METHODS: Thirty rats received surgical transection to their right MCL, and five were assigned as the control group. After surgery, the rats were divided into three groups: group 1 (n = 10) received LLLT with 0.01 J/cm(2) energy density per day, group 2 (n = 10) received LLLT with 1.2 J/cm(2) energy density per day, and group 3 (sham = exposed group; n = 10) received daily placebo laser with shut-down laser equipment, while the control group received neither surgery nor LLLT. Biomechanical tests were performed at 12 and 21 days after surgery. The data were analyzed by one-way analysis of variance. RESULTS: The ultimate tensile strength (UTS) of group 2 on day 12 was significantly higher than that of groups 1 and 3. Furthermore, the UTS and energy absorption of the control (uninjured) group were significantly higher than those of the other groups. CONCLUSIONS: LLLT with a helium-neon laser is effective for the early improvement of the ultimate tensile strength of medial collateral ligament injuries.

Connect Tissue Res. 2005;46(3):125-30

Combined treatment of therapeutic laser and herbal application improves strength of repairing ligament.

Fung DT<>, Ng GY<>, Leung MC<>.

Orthopaedic Rehabilitation Research and Microscopy Laboratory, Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China.

The present study investigated the effects of combined therapeutic laser and herbal medication protocols on injured medial collateral ligaments (MCLs) of rat knees. Fully 36 rats were evenly divided into 9 groups. Right MCLs of groups 1 to 6 and 8 were transected, while that of groups 7 and 9 remained intact. After surgery, group 1 was treated with 1 session of high-dosed laser; group 2 with 9 sessions of low-dosed laser; group 3 with an herbal plaster; groups 4 and 5 received combined treatments of groups 1 and ss and 2, and 3 respectively; groups 6 and 7 received only bandaging; groups 8 and 9 received placebo laser and no treatment, respectively. All MCLs were subjected to biomechanical testing at 3 weeks postsurgery. Results revealed significant differences among groups in ultimate tensile strength (UTS) and stiffness (p < 0.01). Combination of multiple low-dosed laser treatment with herbal treatment (group 5) resulted in higher UTS than either no treatment (groups 6 and 8), single high-dosed laser treatment (group 1), multiple low-dosed laser treatment (group 2), or herbal treatment (group 2) alone. We concluded that combined applications of laser and herb can enhance further biomechanical properties of repairing rat MCLs than separate applications at 3 weeks postinjury.

Photochem Photobiol. 2005 Feb 1; [Epub ahead of print]

In vivo Study of the Inflammatory Modulating Effects of Low Level Laser Therapy on iNOS Expression Using Bioluminescence Imaging.

Moriyama Y<>, Moriyama EH<>, Blackmore K<>, Akens MK<>, Lilge L<>.

Ontario Cancer Institute Princess Margaret Hospital.

This study was designed to demonstrate that bioluminescence imaging (BLI) can be used as a new tool to evaluate the effects of low level laser therapy (LLLT) during in vivo inflammatory process. Here, the efficacy of LLLT in modulating inducible nitric oxide synthase (iNOS) expression using different therapeutic wavelengths was determined using transgenic animals with the luciferase gene under control of the iNOS gene expression. Thirty transgenic mice (FVB/N-Tg(iNOS-luc)Xen) were allocated randomly to one of four experimental groups treated with different wavelengths (lambda=635, 785, 808 and 905nm) or a control group (non-treated). Inflammation was induced by intra-articular injection of Zymosan A in both knee joints. Laser treatment (25mW.cm(-2), 200 s, 5 J.cm(-2)) was applied to the knees 15 minutes (or min) after inflammation induction. Measurements of iNOS expression were performed at various times (0, 3, 5, 7, 9 and 24h) by measuring the bioluminescence signal using a highly sensitive charge-coupled device (CCD) camera. The results showed a significant increase in BLI signals after irradiation with 635nm laser when compared to both the non-irradiated animals and the other LLLT treated groups indicating wavelength-dependence of LLLT effects on iNOS expression during the inflammatory process. Histological analysis was also performed and demonstrated the presence of fewer inflammatory cells in the synovial joints of mice irradiated with 635nm compared to non-irradiated knee joints. BLI demonstrated an action spectrum of iNOS gene expression following LLLT in vivo.

Lasers Surg Med. 2004;34(3):285-9.

Comparison of single and multiple applications of GaAlAs laser on rat medial collateral ligament repair.

Ng GY<>, Fung DT<>, Leung MC<>, Guo X<>.

Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong. rsgng@polyu.edu.hk

Abstract

BACKGROUND AND OBJECTIVES: To examine single versus multiple applications of the gallium aluminum arsenide (GaAlAs) laser on the healing of surgically injured medial collateral ligaments (MCLs) in rats.

STUDY DESIGN/MATERIALS AND METHODS: Sixteen rats were studied, with 12 receiving surgical transection to their right MCL and 4 receiving a sham injury. Group 1 (n = 4) received a single dose of GaAlAs laser therapy (wavelength 660 nm, average power 8.8 mW, pulse 10 kHz, dosage 31.6 J/cm(2)) directly to their MCL during surgery. Group 2 (n = 4) received 9 doses of GaAlAs laser therapy applied transcutaneously on alternate days (wavelength 660 nm, average power 8.8 mW, pulse 10 kHz, dosage 3.5 J/cm(2)). The controls (Group 3, n = 4) received one session of placebo laser at the time of surgery, with the laser equipment shut down, while the sham injured Group 4 (n = 4) received no treatment. Biomechanical tests for structural stiffness, ultimate tensile strength (UTS), and load-relaxation were done at 3 weeks after injury. The stiffness and UTS data were normalized by expressing as a percentage of the left side of each animal before statistical analysis.

RESULTS: The load-relaxation data did not show any differences between the groups (P = 0.18). The normalized stiffness levels of Groups 2 (81.08+/-11.28%) and 4 (92.66+/-13.19%) were significantly higher (P = 0.025) than that of the control Group 3 (58.99+/-15.91%). The normalized UTS of Groups 2 (81.38+/-5.68%) and 4 (90.18+/-8.82%) were also significantly higher (P = 0.012) than that of the control (64.49+/-9.26%). Although, Group 1 had higher mean stiffness and UTS values than the control, no statistically significant difference was found between these two groups.

CONCLUSIONS: Multiple laser therapy improves the normalized strength and stiffness of repairing rat MCLs at 3 weeks after injury. The multiple treatments seem to be superior to a single treatment when the cumulative dosages are comparable between the two modes of application.

Lasers Surg Med. 2003;32(4):286-93.

Effects of a therapeutic laser on the ultrastructural morphology of repairing medial collateral ligament in a rat model.

Fung DT<>, Ng GY<>, Leung MC<>, Tay DK<>.

Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.

Abstract

BACKGROUND AND OBJECTIVES: Low energy laser therapy has been shown to enhance mechanical strength of healing medial collateral ligament (MCL) in rats. The present study investigated its effects on the ultrastructural morphology and collagen fibril profile of healing MCL in rats.

STUDY DESIGN/MATERIALS AND METHODS: Thirty-two mature male Sprague-Dawley (SD) rats were used. Twenty-four underwent surgical transection to their right MCLs and eight received only skin wound. Immediately after surgery, eight of the MCL transected rats were treated with a single dose of laser therapy at 63.2 J cm(-2), eight were treated with a single dose of laser therapy at 31.6 J cm(-2), the rest had no treatment and served as control. At 3 and 6 weeks after surgery, the MCLs were harvested and examined with electron microscopy for collagen fibril size, distribution, and alignment.

RESULTS: Significant differences (P < 0.001) were found in fibril diameters from the same anatomical site and time period among different groups. The mass-averaged diameters of the laser-treated (64.99-186.29 nm) and sham (64.74-204.34 nm) groups were larger than the control group (58.66-85.89 nm). The collagen fibrils occupied 42.55-59.78, 42.63-53.94, and 36.92-71.64% of the total cross-sectional areas in the laser-treated, control and sham groups, respectively. Mode obliquity was 0.53-0.84 among the three groups.

CONCLUSIONS: Single application of low energy laser therapy increases the collagen fibril size of healing MCLs in rats.

Aust J Physiother. 2003;49(2):107-16.

A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders.

Bjordal JM<>, Couppé C<>, Chow RT<>, Tunér J<>, Ljunggren EA<>.

Section of Physiotherapy Science, University of Bergen, Bergen, 5020, Norway. jmb@hib.no

Abstract

We investigated if low level laser therapy (LLLT) of the joint capsule can reduce pain in chronic joint disorders. A literature search identified 88 randomised controlled trials, of which 20 trials included patients with chronic joint disorders. Six trials were excluded for not irradiating the joint capsule. Three trials used doses lower than a dose range nominated a priori for reducing inflammation in the joint capsule. These trials found no significant difference between active and placebo treatments. The remaining 11 trials including 565 patients were of acceptable methodological quality with an average PEDro score of 6.9 (range 5-9). In these trials, LLLT within the suggested dose range was administered to the knee, temporomandibular or zygapophyseal joints. The results showed a mean weighted difference in change of pain on VAS of 29.8 mm (95% CI, 18.9 to 40.7) in favour of the active LLLT groups. Global health status improved for more patients in the active LLLT groups ( relative risk of 0.52; 95% CI 0.36 to 0.76). Low level laser therapy with the suggested dose range significantly reduces pain and improves health status in chronic joint disorders, but the heterogeneity in patient samples, treatment procedures and trial design calls for cautious interpretation of the results.

Clin J Sport Med. 2001 Apr;11(2):103-10.

A systematic review of physical interventions for patellofemoral pain syndrome.

Crossley K<>, Bennell K<>, Green S<>, McConnell J<>.

Centre for Sports Medicine Research and Education, School of Physiotherapy, University of Melbourne, Victoria, Australia. k.crossley@pgrad.unimelb.edu.au

Abstract

OBJECTIVE: Physical interventions (nonpharmacological and nonsurgical) are the mainstay of treatment for patellofemoral pain syndrome (PFPS). Physiotherapy is the most common of all physical interventions and includes specific vastus medialis obliquus or general quadriceps strengthening and/or realignment procedures (tape, brace, stretching). These treatments appear to be based on sound theoretical rationale and have attained widespread acceptance, but evidence for the efficacy of these interventions is not well established. This review will present the available evidence for physical interventions for PFPS.

DATA SOURCES: Computerized bibliographic databases (MEDLINE, Current Contents, CINAHL) were searched, including the keywords “patellofemoral,” “patella,” and “anterior knee pain,” combined with “treatment,” “rehabilitation,” and limited to clinical trials through October 2000.

STUDY SELECTION: The critical eligibility criteria used for inclusion were that the study be a controlled trial, that outcome assessments were adequately described, and that the treatment was a nonpharmacological, nonsurgical physical intervention.

RESULTS: Of the 89 potentially relevant titles, 16 studies were reviewed and none of these fulfilled all of the requirements for a randomized, controlled trial. Physiotherapy interventions were evaluated in eight trials, and the remaining eight trials examined different physical interventions. Significant reductions in PFPS symptoms were found with a corrective foot orthosis and a progressive resistance brace, but there is no evidence to support the use of patellofemoral orthoses, acupuncture, low-level laser, chiropractic patellar mobilization, or patellar taping. Overall the physiotherapy interventions had significant beneficial effects but these interventions were not compared with a placebo control. There is inconclusive evidence to support the superiority of one physiotherapy intervention compared with others.

CONCLUSIONS: The evidence to support the use of physical interventions in the management of PFPS is limited. There appears to be a consistent improvement in short-term pain and function due to physiotherapy treatment, but comparison with a placebo group is required to determine efficacy, and further trials are warranted for the other interventions.

Radiol Med (Torino). 1998 Apr;95(4):303-9.

Low-level laser therapy in osteoarticular diseases in geriatric patients

[Article in Italian]

Giavelli S<>, Fava G<>, Castronuovo G<>, Spinoglio L<>, Galanti A<>.

Dipartimento di Radiologia e Laserterapia, Istituto Gerontologico Pio Albergo Trivulzio, Milano.

INTRODUCTION: Laser light absorption through the skin causes tissue changes, targeting the nervous, the lymphatic, the circulatory and the immune systems with an antalgic, anti-inflammatory, anti-edemic effect and stimulating tissue repair. Therefore low level laser therapy is now commonly used in numerous rehabilitation centers, including the “Istituto Gerontologico Pio Albergo Trivulzio”, Milan, Italy. However, to activate the treatment program, the basic medical research results must always be considered to choose the best optical wavelength spectrum, technique and dose, for rehabilitative laser therapy. We analyzed the therapeutic effects of different wavelengths and powers in various treatment schedules. In particular, a protocol was designed to test such physical parameters as laser type, doses and individual schedule in different pathologic conditions. We report the results obtained with low level laser therapy in the rehabilitation of geriatric patients, considering the various physical and technical parameters used in our protocol. MATERIAL AND METHODS: We used the following laser equipment: an HeNe laser with 632.8 nm wavelength (Mectronic), a GaAs Laser with 904 nm wavelength (Mectronic) and a CO2 Laser with 10,600 nm wavelength (Etoile). To evaluate the patient clinical status, we use a different form for each involved joint; the laser beam is targeted on the region of interest and irradiation is carried out with the sweeping method or the points technique. Irradiation technique, doses and physical parameters (laser type, wavelength, session dose and number) are indicated on the form. The complete treatment cycle consists of 5 sessions per week–20 sessions in all. At the end of the treatment cycle, the results were scored on a 5-grade semiquantitative scale–excellent, good, fair, poor and no results. We examined 3 groups of patients affected with gonarthrosis (149 patients), lumbar arthrosis (117 patients), and algodystrophy (140 patients) respectively. RESULTS: In gonarthrosis patients, the statistical analysis of the results showed no significant differences between CO2 laser and GaAs laser treatments (p = .975), but significant differences between CO2 laser and HeNe laser treatments (p = .02) and between GaAs laser and HeNe laser treatments (p = .003). In lumbar arthrosis patients treated with GaAs or HeNe laser, significant differences were found between the two laser treatments and the combined sweeping-points techniques appeared to have a positive trend relative to the sweeping method alone, especially in sciatic suffering. In the algodystrophy syndrome, in hemiplegic patients, significant differences were found between CO2 and HeNe laser treatments (p = .026), between high and low CO2 laser doses (p = .024), and between low CO2 laser dose and high HeNe laser dose (p = .006). CONCLUSIONS: Low level laser therapy can be used to treat osteoarticular pain in geriatric patients. To optimize the results, the diagnostic picture must be correct and a treatment program defining the physical parameters used (wavelength, dose and irradiation technique) must also be designed.

J Am Geriatr Soc. 1992; 40: 23-26.

Improvement of pain and disability in elderly patients with degenerative osteoarthritis of the knee treated with narrow-band light therapy.

Stelian J, Gil I, Habot B et al.

In an Israeli study the effect of laser therapy in degenerative osteoarthritis (DOA) of the knee was investigated in a double blind study among 50 patients. One group received infrared (GaAlAs) and one red (HeNe) laser. Only the first group could be blinded, while the latter was open. Patients were treated twice daily, 15 minutes each time, for 10 days. The patients treated themselves after instruction. Total dose for each session was 10.3 J for red and 11.1 for infrared. Continuous mode was used for 7.5 minutes, pulsed for 7.5 minutes, rationale not stated. There was a significant pain reduction in the laser groups as compared to the placebo groups. There was no significant difference between the red and the infrared group. The Disability Index Questionnaire also revealed an improvement in the laser groups. All patients in the placebo group required analgesics within two months after laser therapy while the patients in the laser group were pain free ranging from 2 months to 1 year.

J Am Geriatr Soc. 1992 Jan;40(1):23-6.

Improvement of pain and disability in elderly patients with degenerative osteoarthritis of the knee treated with narrow-band light therapy.

Stelian J<>, Gil I<>, Habot B<>, Rosenthal M<>, Abramovici I<>, Kutok N<>, Khahil A<>.
Geriatric Medical Center, Shmuel Harofe Hospital, Beer Yaakov, Israel.

OBJECTIVE: To evaluate the effects of low-power light therapy on pain and disability in elderly patients with degenerative osteoarthritis of the knee. DESIGN: Partially double-blinded, fully randomized trial comparing red, infrared, and placebo light emitters. PATIENTS: Fifty patients with degenerative osteoarthritis of both knees were randomly assigned to three treatment groups: red (15 patients), infrared (18 patients), and placebo (17 patients). Infrared and placebo emitters were double-blinded. INTERVENTIONS: Self-applied treatment to both sides of the knee for 15 minutes twice a day for 10 days. MAIN OUTCOME MEASURES: Short-Form McGill Pain Questionnaire, Present Pain Intensity, and Visual Analogue Scale for pain and Disability Index Questionnaire for disability were used. We evaluated pain and disability before and on the tenth day of therapy. The period from the end of the treatment until the patient’s request to be retreated was summed up 1 year after the trial. RESULTS: Pain and disability before treatment did not show statistically significant differences between the three groups. Pain reduction in the red and infrared groups after the treatment was more than 50% in all scoring methods (P less than 0.05). There was no significant pain improvement in the placebo group. We observed significant functional improvement in red- and infrared-treated groups (p less than 0.05), but not in the placebo group. The period from the end of treatment until the patients required treatment was longer for red and infrared groups than for the placebo group (4.2 +/- 3.0, 6.1 +/- 3.2, and 0.53 +/- 0.62 months, for red, infrared, and placebo, respectively). CONCLUSIONS: Low-power light therapy is effective in relieving pain and disability in degenerative osteoarthritis of the knee.

 

 

THE EFFECT OF LOW POWER LASER THERAPY ON OSTEOARTHRITIS OF THE KNEE

Basirnia A., Sadeghipoor G., Esmaeeli Djavid G. et al.

Treatment was performed on 20 patients, aging from 42 to 60 years. All patients had received conservative treatment with poor results. Laser device used for this treatment was pulsed IR diode laser; 810 nm wavelength once per day for 5 consecutive days, followed by a 2-day interval .The total number of applications was 12 sessions. Irradiation was performed on 5 periarticular tender points, each for 2 min. The treatment outcome (pain relief and functional ability) was observed and measured according to the following methods: 1) Numerical rating scales (NRS), 2) Self assessment by the patient, 3) Index of severity for osteoarthritis of the knee (ISK), 4) Analgesic requirements. We achieved significant improvement in pain relief and quality of life in 70% of patients, comparing to their previous status (p<0.05). There was no significant change in range of motion of the knee.