Placebo-controlled randomized clinical trial of the effect two different low-level laser therapies (LLLT)—intraoral and extraoral—on trismus and facial swelling following surgical extraction of the lower third molar

The purpose of this study is to compare the effects of extraoral and intraoral low-level laser therapies (LLLT) on postoperative trismus and oedema following the removal of mandibular third molars. Forty-eight patients who were to undergo surgical removal of their lower third molars were studied. Patients were randomly allocated to one of three groups: extraoral LLLT, intraoral LLLT, or placebo. In the study, a Ga-Al-As diode laser device with a continuous wavelength of 808 nm was used, and the laser therapy was applied by using a 1 × 3-cm handpiece. The flat-top laser beam profile was used in this therapy. For both of the LLLT groups, laser energy was applied at 100 mW (0.1 W) for a total of 120 s (0.1 W × 120 s = 12 J). Patients in the extraoral-LLLT group (n = 16) received 12-J (4 J/cm²) low-level laser irradiation, and the laser was applied at the insertion point of the masseter muscle immediately after the operation. Patients in the intraoral-LLLT group (n = 16) received 12-J (4 J/cm²) low-level laser irradiation intraorally at the operation site 1 cm from the target tissue. In the placebo group (n = 16), the handpiece was inserted intraorally at the operation site and then was touched extraorally to the masseter muscle for 1 min at each site (120 s total), but the laser was not activated. The size of the interincisal opening and facial swelling were evaluated on the second and seventh postoperative days. At the second postoperative day, trismus (29.0 ± 7.6 mm [p = 0.010]) and swelling (105.3 ± 5.0 mm [p = 0.047]) in the extraoral-LLLT group were significantly less than in the placebo group (trismus: 21.1 ± 7.6 mm, swelling: 109.1 ± 4.4 mm). Trismus (39.6 ± 9.0 mm [p = 0.002]) in the extraoral-LLLT group at the seventh postoperative day was also significantly less than in the placebo group (29.0 ± 6.2 mm). However, at the seventh postoperative day in the intraoral-LLLT group, only trismus (35.6 ± 8.5 [p = 0.002]) was significantly less than in the placebo group (29.0 ± 6.2 mm). This study demonstrates that extraoral LLLT is more effective than intraoral LLLT for the reduction of postoperative trismus and swelling after extraction of the lower third molar.     

Tissue engineered intrasynovial tendons: in vivo graft survival and tensile strength

Rabbit flexor tendons can be harvested, acellularized, and used as scaffolds for reseeding of flexor tendon constructs. The purpose of this study was to compare the biomechanical characteristics of seeded and unseeded flexor tendon constructs to autologous grafts in vivo in the rabbit model. The experimental groups were created using acellularized rabbit tendon scaffolds: scaffolds with no cells, and scaffolds re-seeded with either tenocytes or adipoderived stem cells. Autologous flexor tendon grafts were used as controls. All constructs bridged a zone II defect in the rabbit and were explanted at 2, 4, 10, or 20 weeks. These tendons were then tested for ultimate tensile strength (UTS) or processed for histology. The experimental groups exhibited UTS comparable to autologous grafts up to 4 weeks, and were significantly weaker at 10 weeks (p < 0.000–0.024). At 20 weeks, UTS was significantly improved (p = 0.013) in tenocyte-seeded constructs compared with 10 weeks. There was no significant difference in UTS between seeded or unseeded constructs at 2, 4, and 20 weeks. In all groups, there were more cells at the repair ends, and the cells penetrated to the core of the grafts over time. The goal of this technology is the development of tissue engineered tendon grafts for clinical use. This study provides proof of the concept that tissue-engineered flexor tendons—both acellularized and reseeded—can survive and incorporate over time. Further work will focus on bioreactor preconditioning of reseeded constructs to increase ultimate tensile strength.     

An in-vivo experimental evaluation of He–Ne laser photostimulation in healing Achilles tendons

There is no method of treatment that has been proven to accelerate the rate of tendon healing or to improve the quality of the regenerating tendon. Low level laser photostimulation has gained a considerable attention for enhancing tissue repair in a wide spectrum of applications. However, there is controversy regarding the effectiveness of laser photostimulation for improvement of the healing process of surgically repaired tendons. Accordingly, the present study was conducted to evaluate the role of helium–neon (He–Ne) laser photostimulation on the process of healing of surgically repaired Achilles tendons. Thirty unilateral Achilles tendons of 30 Raex rabbits were transected and immediately repaired. Operated Achilles tendons were randomly divided into two equal groups. Tendons at group A were subjected to He–Ne laser (632.8 nm) photostimulation, while tendons at group B served as a control group. Two weeks later, the repaired Achilles tendons were histopathologically and biomechanically evaluated. The histopathological findings suggest the favorable qualitative pattern of the newly synthesized collagen of the regenerating tendons after He–Ne laser photostimulation. The biomechanical results support the same favorable findings from the functional point of view as denoted by the better biomechanical properties of the regenerating tendons after He–Ne laser photostimulation with statistical significance (p ≤ 0.01) at most of the biomechanical parameters. He–Ne laser photostimulation reported a great value after surgical repair of ruptured and injured tendons for a better functional outcome. It could be applied safely and effectively in humans, especially with respect to the proposed long-term clinical outcome.     

Effects of low-level laser therapy on expression of TNF-α and TGF-β in skeletal muscle during the repair process

The aim of the present study was to determine the effect of low-level laser therapy (LLLT) on the expression of TNF-α and TGF-β in the tibialis anterior muscle of rats following cryoinjury. Muscle regeneration involves cell proliferation, migration and differentiation and is regulated by growth factors and cytokines. A growing body of evidence suggests that LLLT promotes skeletal muscle regeneration by reducing the duration of acute inflammation and accelerating tissue repair. Adult male Wistar rats (n = 35) were randomly divided into three groups: control group (no lesion, untreated, n = 5), cryoinjury without LLLT group (n = 15), and cryoinjury with LLLT group (n = 15). The injured region was irradiated three times a week using an AlGaInP laser (660 nm; beam spot 0.04 cm², output power 20 mW, power density 500 mW/cm², energy density 5 J/cm², exposure time 10 s). Muscle remodeling was evaluated at 1, 7 and 14 days (long-term) following injury. The muscles were removed and total RNA was isolated using TRIzol reagent and cDNA synthesis. Real-time polymerase chain reactions were performed using TNF-α and TGF-β primers; GAPDH was used to normalize the data. LLLT caused a decrease in TNF-α mRNA expression at 1 and 7 days following injury and in TGF-β mRNA expression at 7 days following cryoinjury in comparison to the control group. LLLT modulated cytokine expression during short-term muscle remodeling, inducing a decrease in TNF-α and TGF-β.     

Effect of low-level laser therapy on healing of tenotomized Achilles tendon in streptozotocin-induced diabetic rats

Diabetes mellitus (DM) is associated with musculoskeletal damage. Investigations have indicated that healing of the surgically tenotomized Achilles tendon was considerably augmented following low-level laser therapy (LLLT) in non-diabetic, healthy animals. The aim of the present study was to evaluate the effect of LLLT on the Achilles tendon healing in streptozotocin-induced diabetic (STZ-D) rats via a biomechanical evaluating method. Thirty-three rats were divided into non-diabetic (n?=?18) and diabetic (n?=?15) groups. DM was induced in the rats by injections of STZ. The right Achilles tendons of all rats were tenotomized 1 month after STZ injections. The two experimental groups (n?=?6 for each group) of non-diabetic rats were irradiated with a helium–neon (He–Ne) laser at 2.9 and 11.5 J/cm² for ten consecutive days. The two experimental groups of diabetic rats (n?=?5 for each group) were irradiated with a He–Ne laser at 2.9 and 4.3 J/cm² for ten consecutive days. The tendons were submitted to a tensiometric test. Significant improvements in the maximum stress (MS) values (Newton per square millimeter) were found following LLLT at 2.9 J/cm² in both the non-diabetic (p?=?0.031) and diabetic (p?=?0.019) experimental groups when compared with their control groups. LLLT at 2.9 J/cm² to the tenotomized Achilles tendons in the non-diabetic and diabetic rats significantly increased the strength and MS of repairing Achilles tendons in our study.     

Low-level laser therapy (LLLT) prevents oxidative stress and reduces fibrosis in rat traumatized Achilles tendon

BACKGROUND AND OBJECTIVES: The present study investigated the effects of low-level laser therapy (LLLT) on oxidative stress and fibrosis in an experimental model of Achilles tendon injury induced by a single impact trauma. STUDY DESIGN/MATERIALS AND METHODS: Male Wistar rats were randomly divided into four groups (n = 8): control, trauma, trauma+LLLT for 14 days, and trauma+LLLT for 21 days. Achilles tendon traumatism was produced by dropping down a load with an impact kinetic energy of 0.544 J. A low level Ga-As laser was applied with a 904 nm wavelength, 45 mW average power, 5 J/cm(2) dosage, for 35 seconds duration, continuously. Studies were carried out at day 21. RESULTS: Histology showed a loss of normal architecture, with inflammatory reaction, angiogenesis, vasodilatation, and extracellular matrix formation after trauma. This was accompanied by a significant increase in collagen concentration when compared the control group. Oxidative stress, measured by the concentration of thiobarbituric acid reactive substances and hydroperoxyde-initiated chemiluminiscence, was also significantly increased in the trauma group. Administration of LLLT for 14 or 21 days markedly alleviated histological abnormalities reduced collagen concentration and prevented oxidative stress. Superoxide dismutase activity was significantly increased by LLLT treatment over control values. CONCLUSION: LLLT by Ga-As laser reduces histological abnormalities, collagen concentration, and oxidative stress in an experimental model of Achilles tendon injury. Reduction of fibrosis could be mediated by the beneficial effects on the oxidant/antioxidant balance.     

Effect of 830 nm low-level laser therapy in exercise-induced skeletal muscle fatigue in humans

This study aimed to investigate the effect of 830 nm low-level laser therapy (LLLT) on skeletal muscle fatigue. Ten healthy male professional volleyball players entered a crossover randomized double-blinded placebo-controlled trial. Active LLLT (830 nm wavelength, 100 mW output, spot size 0.0028 cm², 200 s total irradiation time) or an identical placebo LLLT was delivered to four points on the biceps humeri muscle immediately before exercises. All subjects performed voluntary biceps humeri contractions with a load of 75% of the maximum voluntary contraction (MVC) force until exhaustion. After active LLLT the mean number of repetitions was significantly higher than after placebo irradiation [mean difference 4.5, standard deviation (SD) ± 6.0, P = 0.042], the blood lactate levels increased after exercises, but there was no significant difference between the treatments. We concluded that 830 nm LLLT can delay the onset of skeletal muscle fatigue in high-intensity exercises, in spite of increased blood lactate levels.     

Experimental treatment of tendon injury with heparin

The effect of heparin on the progress of healing in the injured tendon was examined after a standard injury had been created in the Achilles tendons of New Zealand White rabbits. Half of the rabbits were then treated by the intratendinous injection of heparin. The diameters of the injured right hind and the uninjured left hind Achilles tendon and overlying skin were measured using vernier calipers before injury and at one month after injury. At this time histological analysis was carried out on all Achilles tendons and tendon dry weight, collagen concentration and DNA concentration were measured. Orientation of collagen fibres was more pronounced in treated than untreated tendons while cellularity and blood vessel density were less pronounced. Analysis by Students t-test demonstrated a statistically significant difference between treated and untreated tendons in terms of leg diameter (p less than 0.005), dry weight (p less than 0.01) and DNA concentration (p less than 0.01).     

Ultrasonographic evaluation of plantar fasciitis after low-level laser therapy: results of a double-blind, randomized, placebo-controlled trial

The aim of this study was to investigate the effect of low-level laser therapy (LLLT) on plantar fasciitis documented by the ultrasonographic appearance of the aponeurosis and by patients’ pain scores. Thirty individuals with diagnosis of unilateral plantar fasciitis were enrolled in a randomized, double-blind, placebo-controlled trial, but 25 participants completed the therapeutic protocol. The contralateral asymptomatic fascia was used as control. After enrolment, symptomatic individuals were randomly assigned to receive LLLT, or identical placebo, for 6 weeks. Ultrasonography was performed at baseline and after completion of therapy. The subjective subcalcaneal pain was recorded at baseline and after treatment on a visual analogue scale (VAS). After LLLT, plantar fascia thickness in both groups showed significant change over the experimental period and there was a difference (before treatment and after treatment) in plantar fascia thickness between the two groups. However, plantar fascia thickness was insignificant (mean 3.627 ± 0.977 mm) when compared with that in the placebo group (mean 4.380 ± 1.0042 mm). Pain estimation on the visual analogue scale had improved significantly in all test situations (after night rest, daily activities) after LLLT when compared with that of the placebo group. (P = 0.006 and P = 0.01, respectively). Additionally, when the difference in pain scores was compared between the two groups, the change was statistically significant (after night rest P = 0.000; daily activities P = 0.001). In summary, while ultrasound imaging is able to depict the morphologic changes related to plantar fasciitis, 904 nm gallium–arsenide (GaAs) infrared laser may contribute to healing and pain reduction in plantar fasciitis.     

The effects of low-level light emitting diode on the repair process of Achilles tendon therapy in rats

Thirty Wistar rats (350 ± 20 g) were subjected to total Achilles tendon tenotomy of the right fore limb. They were submitted to a daily dose of 20 J/cm² light emitting diode (LED) (640 ± 20 nm) therapy. The LED was applied punctually and transcutaneously to the lesioned region. The animals were separated into six groups, C1 and L1, C2 and L2, C3 and L3. The C groups were used for control and the L groups, treated for 7, 14 and 21 consecutive days, respectively. The animals were killed on the 7th, 14th and 21st days after surgery. After the animals had been killed, their tendons were extracted and dissected, fixed in formaldehyde at 10%, and sent for histological analysis by light microscopy in which the repair process was analysed. This study demonstrated that LED interfered in the repair process of the tendon tissue, reducing the number of fibroblasts in the initial periods and improving the quality of the repair in all periods studied.     

Low-level laser therapy (LLLT) attenuates RhoA mRNA expression in the rat bronchi smooth muscle exposed to tumor necrosis factor-α

Low-level laser therapy (LLLT) has been found to produce anti-inflammatory effects in a variety of disorders. Bronchial smooth muscle (BSM) hyperreactivity is associated with increased Ca⁺² sensitivity and increased RhoA mRNA expression. In the current study, we investigated if LLLT could reduce BSM contraction force and RhoA mRNA expression in tumor necrosis factor-α (TNF-α)-induced BSM hyperreactivity. In the study, 112 male Wistar rats were divided randomly into 16 groups, and BSM was harvested and suspended in TNF-α baths for 6 and 24 h, respectively. Irradiation with LLLT was performed with a wavelength of 660 nm for 42 s with a dose of 1.3 J/cm². This LLLT dose was administered once in the 6-h group and twice in the 24-h group. LLLT significantly decreased contraction force in BSM at 6 h (TNF-α + LLLT: 11.65 ± 1.10 g/100 mg of tissue) (F = 3115) and at 24 h (TNF-α + LLLT: 14.15 ± 1.1 g/100 mg of tissue) (F = 3245, p < 0.05) after TNF-α, respectively, when compared to vehicle-bathed groups (control). LLLT also significantly decreased the expression of RhoA mRNA in BSM segments at 6 h (1.22 ± 0.20) (F = 2820, p < 0.05) and 24 h (2.13 ± 0.20) (F = 3324, p < 0.05) when compared to BSM segments incubated with TNF-α without LLLT irradiation. We conclude that LLLT administered with this protocol, reduces RhoA mRNA expression and BSM contraction force in TNF-α-induced BSM hyperreactivity.     

Effect of laser therapy (660 nm) on recovery of the sciatic nerve in rats after injury through neurotmesis followed by epineural anastomosis

The aim of this study was to analyze the influence of aluminum gallium arsenide (AlGaAs) laser (660 nm) on the myelin sheath and functional recovery of the sciatic nerve in rats. The sciatic nerves of 12 Wistar rats were subjected to injury through neurotmesis and epineural anastomosis, and the animals were divided into two groups: group 1 was the control and group 2, underwent low-level laser therapy (LLLT). After the injury, AlGaAs laser at 660 nm, 4 J/cm², 26.3 mW and beam area of 0.63 cm² was administered to three equidistant points on the injury for 20 consecutive days. In the control group the mean area of the myelin impairment was 0.51 (± 0.11) on day 21 after the operation, whereas this value was 1.31 (± 0.22) in the LLLT group. Student’s t-test revealed a P value = 0.0229 for the mean area values of the myelin sheath between the LLLT and control groups. Comparison of the sciatic functional index (SFI) showed that there was no significant difference between the pre-lesion value in the laser therapy group and the control group. The use of AlGaAs laser (660 nm) provided significant changes to the morphometrically assessed area of the myelin sheath, but it did not culminate in positive results for functional recovery in the sciatic nerve of the rats after injury through neurotmesis.     

Low‐level laser therapy in collagenase‐induced Achilles tendinitis in rats: Analyses of biochemical and biomechanical aspects

NSAIDs are widely prescribed and used over the years to treat tendon injuries despite its well‐known long‐term side effects. In the last years several animal and human trials have shown that low‐level laser therapy (LLLT) presents modulatory effects on inflammatory markers, however the mechanisms involved are not fully understood. The aim of this study was to evaluate the short‐term effects of LLLT or sodium diclofenac treatments on biochemical markers and biomechanical properties of inflamed Achilles tendons. Wistar rats Achilles tendons (n = 6/group) were injected with saline (control) or collagenase at peritendinous area of Achilles tendons. After 1 h animals were treated with two different doses of LLLT (810 nm, 1 and 3 J) at the sites of the injections, or with intramuscular sodium diclofenac. Regarding biochemical analyses, LLLT significantly decreased (p < 0.05) COX‐2, TNF‐α, MMP‐3, MMP‐9, and MMP‐13 gene expression, as well as prostaglandin E₂ (PGE₂) production when compared to collagenase group. Interestingly, diclofenac treatment only decreased PGE₂ levels. Biomechanical properties were preserved in the laser‐treated groups when compared to collagenase and diclofenac groups. We conclude that LLLT was able to reduce tendon inflammation and to preserve tendon resistance and elasticity. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:1945–1951, 2012     

Comparison between laser therapy and non-surgical therapy for periodontitis in rats treated with dexamethasone

The aim of this study was to compare low-level laser therapy (LLLT) as adjuvant treatment for induced periodontitis with scaling and root planing (SRP) in dexamethasone-treated rats. One-hundred twenty rats were divided into groups: D group (n = 60), treated with dexamethasone; ND group (n = 60) treated with saline solution. In both groups, periodontal disease was induced by ligature at the left first mandibular molar. After 7 days, the ligature was removed and all animals were subjected to SRP and were divided according to the following treatments: SRP, irrigation with saline solution (SS); SRP + LLLT, SS and laser irradiation (660 nm; 24 J; 0.428 W/cm²). Ten animals in each treatment were killed after 7 days, 15 days and 30 days. The radiographic and histometric values were statistically analyzed. In all groups radiographic and histometric analysis showed less bone loss (P < 0.05) in animals treated with SRP + LLLT in all experimental periods. SRP + LLLT was an effective adjuvant conventional treatment for periodontitis in rats treated with dexamethasone.     

Influence of low-level laser therapy on wound healing in nicotine-treated animals

Low-level laser therapy (LLLT) has been shown to have several biological effects that favor the healing process, and nicotine has been shown to delay the healing process. In this study we investigated the healing of open wounds created on the back of rats treated with nicotine with or without LLLT. Of 115 animals, 59 received subcutaneous injections of saline solution, and the others received subcutaneous injections of nicotine (3 mg/kg body weight), twice a day throughout the study period. After 30 days, skin wounds were created on the back of the animals. The animals receiving saline injections were divided into two groups: group 1 (G1, n = 29), in which the wounds were left untreated, and group 2 (G2, n = 30), in which the wounds were treated with LLLT (GaAlAs, 660 nm, 30 mW, 5.57 J/cm² per point, 0.39 J, 13 s per point, 0.42 W/cm²). The animals receiving nicotine injections were also divided into two groups: group 3 (G3, n = 29), in which the wounds were left untreated, and group 4 (G4, n = 27), in which the wounds were treated with LLLT. The animals were killed 3, 7 or 14 days after surgery. Wound healing was evaluated histologically both qualitatively and semiquantitatively. Wounds of G2 showed a delay in epithelial migration and connective tissue organization compared to those of G1. Wounds of G2 showed faster healing than those of G1; similarly, wounds of G4 showed more advanced healing than those of G3. LLLT acted as a biostimulatory coadjuvant agent balancing the undesirable effects of nicotine on wound tissue healing.     

Quantification of fibrosis and mast cells in the tissue response of endodontic sealer irradiated by low-level laser therapy

Low-level laser therapy (LLLT) accelerates tissue repair. Mast cells induce the proliferation of fibroblasts and the development of local fibrosis. The objective of this study was to quantify fibrosis rate and mast cells in connective tissue after endodontic sealer zinc oxide and eugenol (ZOE) was implanted and submitted to LLLT, immediately after implant and again 24 h later. Sixty mice were distributed into three groups: GI, GII, and GIII (n = 20). In GI, the tubes filled with Endofill were implanted in the animals and were not irradiated with LLLT. In GII, the tubes containing Endofill were implanted in the animals and then irradiated with red LLLT (InGaAIP) 685-nm wavelength, D = 72 J/Cm², E = 2 J, T = 58 s, P = 35 mW, and in GIII, the tubes with Endofill were implanted and irradiated with infrared LLLT (AsGaAl) 830-nm wavelength, D = 70 J/Cm², E = 2 J, T = 40 s, P = 50 mW. After 7 days and 30 days, the animals were killed. A series of 6-μm-thick sections were obtained and stained with Toluidine Blue and Picrosirius and analyzed under a standard light microscope using a polarized light filter for the quantification of fibrosis. The statistics were qualitative and quantitative with a significance of 5%. The irradiation with LLLT did not offer improvement in the fibrosis rate, however, it provided a significant decrease in the concentration of independent mast cells for the period studied.     

Biomechanical and immunohistochemical analysis of high hydrostatic pressure-treated Achilles tendons

Background Reconstruction of bone defects caused by malignant tumors is carried out in different ways. At present, tumor-bearing bone segments are devitalized mainly by extracorporeal irradiation or autoclaving, but both methods have substantial disadvantages. In this regard, high hydrostatic pressure (HHP) treatment of the bone is a new, advancing technology that has been used in preclinical testing to inactivate normal cells and tumor cells without altering the biomechanical properties of the bone. The aim of this study was to examine the biomechanical and immunohistochemical properties of tendons after exposure to HHP and to evaluate whether preservation of the bony attachment of tendons and ligaments is possible. Methods For this, 19 paired Achilles tendons were harvested from both hindlimbs of 4-month-old pigs. After preparation, the cross-sectional area of each tendon was determined by magnetic resonance imaging (MRI). For each animal, one of the two tendons was taken at random and exposed to a pressure of 300 MPa (n = 9) or 600 MPa (n = 10). Results The contralateral tendon served as an untreated control. The biomechanical properties of the tendons remained unchanged with respect to the tested parameters: Young's modulus (MPa) and tensile strength (MPa). This finding is in line with immunohistochemical labeling results, as no difference in the labeling pattern of collagen I and versican was observed when comparing the HHP group (at 600 MPa) to the untreated control group. Conclusions We anticipate that during orthopedic surgery HHP can serve as a novel, promising methodical approach to inactivate Achilles tendon and bone cells without altering the biomechanical properties of the tendons. This should allow one to preserve the attachment of tendon and ligaments to the devitalized bone and to facilitate functional reconstruction.     

Laser therapy in the treatment of achilles tendinopathy: a pilot study

OBJECTIVE: To test the feasibility of a randomized controlled trial to assess the clinical effectiveness of low-level laser therapy (LLLT) when used in addition to eccentric exercise in the management of Achilles tendinopathy. BACKGROUND DATA: LLLT has emerged as a possible treatment modality for tendon injuries. Over the past 20 years only three human studies have investigated LLLT for Achilles tendinopathy. MATERIALS AND METHODS: Twenty patients were randomized into an active laser or placebo group; all patients, therapists, and investigators were blinded to allocation. All patients were given a 12-week eccentric exercise program and irradiated three times per week for 4 wk with either an active or placebo laser at standardized points over the affected tendons. Irradiation parameters in the active treatment group were: 810 nm, 100 mW, applied to six points on the tendon for 30 s, for a total dose of 3 J per point and 18 J per session. Outcome measures were the VISA-A questionnaire, pain, and isokinetic strength. Patients were measured before treatment and at 4 and 12 wk. Analysis of covariance was used to analyze data, using the effects of baseline measurements as a covariate. RESULTS: Within groups, there were significant improvements (p < 0.05) at 4 and 12 wk for all outcome measures, except eccentric strength for the placebo group at 4 wk (p = 0.11). Based on the results of the current study, recruitment of 20 subjects per group would be required to perform an adequately powered study based on minimally important clinical differences in VISA-A scale. CONCLUSION: This study has demonstrated the feasibility of undertaking a randomized controlled trial of LLLT for Achilles tendinopathy. Conclusions regarding effectiveness cannot be made due to the low statistical power of this pilot study.     

Rupture of the Achilles tendon--fibrin gluing or suture?]

The rise of recreational sports activities and the incidence of ruptures of the Achilles tendons has increased simultaneously. Recently the use of fibrin sealing for surgical therapy of ruptured Achilles tendons has emerged as an alternative technique. Between 1982 and 1989 62 consecutive patients were operated for unilateral Achilles tendon rupture. Following causes for ruptures are known: 36 indirect traumas in sport (74%), 9 direct blunt injuries at occupational work (18%), 3 traffic-accidents (11%) and 1 rupture after operation of a Haglund exostosis. 25 patients (56%) were treated by suture technique and 20 patients (44%) with fibrin sealant. The mean long term follow-up of 49 months is known of 49 patients. There were 3 (12%) postoperative infections in the suture group and none in the fibrin group. After suturing the Achilles tendon 3 (12%) reruptures occurred 8-10 weeks after tendon repair and 1 (5%) rerupture after fibrin sealing. All reruptures are caused by a new adequate trauma. The time of return to social and recreational activities was 9 months in the suture group and 7 months in the fibrin group. The functional and cosmetic results after use of fibrin was significant better, and the long-term results were very satisfactory. We prefer fibrin sealing for the treatment of acute ruptures of Achilles tendons.     

Pulsed ultrasound treatment accelerates the repair of Achilles tendon rupture in rats.

A rat tenotomy model was used to investigate the effect of combined conservative management and pulsed ultrasound (PUS) on the repair of tenotomized Achilles tendon. Hemitenotomy of right medial Achilles tendon was performed in 48 rats without suture, and patella tenotomy was performed to mimic immobilization and limb disuse of an injured limb. PUS and sham PUS were applied to the healing wound for the treatment group and control group for 5 min, 3 times per week for 2 or 4 weeks, respectively. Tensile tests showed that the ultimate tensile strength (UTS) and stiffness of the repaired tendon in the treatment group at 2 weeks reached 48.92+/-8.39% and 62.48+/-32.46% of the contralateral normal tendon strength, which were significantly higher than those of the control group (UTS, 30.36+/-15.46%; stiffness, 33.90+/-17.59; p<0.05). At 4 weeks, UTS increased to 77.09+/-15.31% and stiffness to 92.48+/-31.12% in the treatment group, significantly higher than those in the control group (UTS, 54.33+/-18.40%, p<0.01; stiffness, 65.02+/-25.48%, p<0.05). Light microscopy revealed more regular, denser, and better aligned collagen fibers in the healing scar of the PUS-treated healing tendons. The findings suggested that PUS were able to accelerate the healing of the ruptured tendons.