Duygu YAMAN GRAM, Kardelen CEYDELİOĞLU, Gültekin ATALAN, Gökçen PERK

Comparison of low-level laser and dimethyl sulfoxide applications for the treatment of tendon injury in rabbits

The aim of this study was to investigate and compare the effects of low-level laser therapy (LLLT) and dimethyl sulfoxide (DMSO) on tendon healing in rabbits. A total of 30 adult healthy New Zealand rabbits were used for this study. The rabbits were randomly allocated into 3 groups containing an equal animal number. The experimental tenotomy of the Achilles tendons was created on longitudinal aspect with 10 mm in length. During the postoperative 21-day of period, rabbits in Group I were exposed to laser beam at a rate of 10.8 J/cm2 in 5 cm2 area for 4 min. In the same period, 30% DMSO solution was applied externally to the injured tendon region for Group II. Saline solution was applied to the injured tendons area for Group III. Daily clinical examinations of each rabbit were recorded during the treatment period. At the end of the 21-day treatment period, all rabbits were euthanized and their tendons were examined macroscopically. Histopathological examination of the tendons was then carried out. Immature and mature connective tissue cells had an equal number of distribution in Group I; mild immature connective tissue cells and mostly mature connective tissue cells were observed in Group II, and partially longitudinal, scattered, and irregularly arranged, immature connective tissue cells (fibroblasts) were observed in Group III. As a result, satisfactory findings were obtained from LLLT and DMSO applications for the treatment of tendon injuries taking into consideration the histopathological and clinical findings. Moreover, DMSO provided a better recovery when these two applications were compared. However, it was suggested that combined application of DMSO and LLLT might have a strong positive effect on the healing process.

PDF

___

1. Gültekin M. Evcil Memeli Hayvanların Karşılaştırmalı Myolagia’sı (Aktif Hareket Sistemi). Ankara, Türkiye: A Ü Basımevi; 1977 (in Turkish).
2. Dyson SJ. Tendon and ligament injuries. Part I. Equine Practice 1994; 10 (2): 273-487.
3. Seyrek İntaş D, Çelimli N. Atların tendinitislerinde iyileşme ve güncel sağaltım yöntemleri. In: 1st National Equine Symposium, Konya, Turkey; 1999. pp. 251-267 (in Turkish).
4. Silbersiepe E, Berge E, Müller H. Krankheiten an fesselgelenk und fessel. Lehrbuch der Speziellen Chirurgie für Tierärzte und Studierende, Stuttgart: Ferdinand Enke Verlag; 1986 (in German).
5. Li M, Zhu Y, Pei Q, Deng Y, Ni T. The 532 nm laser treatment promotes the proliferation of tendon-derived stem cells and up-regulates Nr4a1 to stimulate tenogenic differentiation. Shanghai Jiao Tong University, Shanghai, China, 2021. doi: 10.21203/rs.3.rs-960303/v2
6. Lin CC, Wu PT, Chang CW, Lin RW, Wang GJ et al. A singlepulsed electromagnetic field enhances collagen synthesis in tendon cells. Medical Engineering & Physics 2020; 77: 130-136. doi: 10.1016/j.medengphy.2019.12.001
7. Lui PPY. Mesenchymal stem cell-derived extracellular vesicles for the promotion of tendon repair-an update of literature. Stem cell reviews and reports 2021; 17 (2): 379-389. doi: 10.1007/ s12015-020-10023-8
8. Tsai WC, Tang, ST, Liang, FC. Effect of therapeutic ultrasound on tendons. American Journal of Physical Medicine & Rehabilitation 2011; 90 (12): 1068-1073. doi: 10.1097/ PHM.0b013e31821a70be
9. Yu H, Cheng J, Shi W, Ren B, Zhao F et al. Bone marrow mesenchymal stem cell-derived exosomes promote tendon regeneration by facilitating the proliferation and migration of endogenous tendon stem/progenitor cells. Acta Biomaterialia 2020; 106: 328-341. doi: 10.1016/j.actbio.2020.01.051
10. Karu T. Photobiological fundamentals of low powered laser therapy. IEEE Journal of Quantum Electronics 1987; 23 (10): 1703-1717. doi: 10.1109/JQE.1987.1073236
11. Laakso EL, Cramond T, Richardson C, Gallian JP. Plasma ACTH and ß endorphin levels in response to low level laser therapy for myofascial trigger points. Laser Therapy 1994; 6 (3): 133-141. doi: 10.5978/islsm.94-OR-07
12. Moshkovska T, Mayberry J. It is time to test low level laser therapy in Great Britain. Postgraduate Medical Journal 2005; 81 (957): 436-441. doi: 10.1136/pgmj.2004.027755
13. Parker S. Low level laser use in dentistry. British Dental Journal 2007; 202 (3): 131-138. doi: 10.1038/bdj.2007.75
14. Posten W, Wrone DA, Dover JS, Arndt KA, Silapunt S et al. Low-level laser therapy for wound healing: mechanism and efficacy. Dermatologic Surgery 2005; 31 (3): 334-340. doi: 10.1111/j.1524-4725.2005.31086
15. Bjordal JM, Couppé C, Ljunggren AE. Low level laser therapy for tendinopathy. Evidence of a dose–response pattern. Physical Therapy Reviews 2001; 6 (2): 91-99. doi: 10.1179/ ptr.2001.6.2.91
16. Dever M. What’s in a laser beam for pain therapy? Pain 1990; 43 (2): 139. doi: 10.1016/0304-3959(90)91065-Q
17. Lögdberg-Andersson M, Mützell S, Hazel A. Low level laser therapy (LLLT) of tendinitis and myofascial pains a randomized, double-blind controlled study. Laser Therapy 2004; 14 (2): 79-84. doi: 10.5978/islsm.14.0_79
18. Moritz U, Sjolund B. Kan laser lindra smarta’? Fa kontrollerade studier och osakra resultat. Lakartidningen 1990; 87(26-27): 2261-4 (in Swedish).
19. Denegar CR, Saliba E, Saliba S. Therapeutic Modalities for Musculoskeletal Injuries. 4th ed. Human Kinetics; 2015.
20. Ganidağlı E, Güzel R. Arşiv Kaynak Tarama Dergisi 2013; 22 (2): 170-183.
21. Kalyon TA. Ultrason. In: Tuna N (editor). Elektroterapi. İstanbul, Türkiye: Nobel Tıp Kitabevi; 2001. pp. 129-41 (in Turkish).
22. Kokubu S, Inaki R, Hoshi K, Hikita A. Adipose-derived stem cells improve tendon repair and prevent ectopic ossification in tendinopathy by inhibiting inflammation and inducing neovascularization in the early stage of tendon healing. Regenerative Therapy 2020; 14: 103-110. doi: 10.1016/j.reth.2019.12.003
23. Ricco’ S, Renzi S, Del Bue M, Conti V, Merli E et al. Allogeneic adipose tissue-derived mesenchymal stem cells in combination with platelet rich plasma are safe and effective in the therapy of superficial digital flexor tendonitis in the horse. International Journal of Immunopathology and Pharmacology 2013; 26 (1) (Suppl.): 61-68. doi.org/10.1177%2F03946320130260S108
24. Cihan M, Özaydın İ. Koyunlarda fibrin adeziv (tisseel) ile deneysel tenografi. Kafkas Üniversitesi Veteriner Fakültesi Dergisi 1999; 5: 103-112 (in Turkish).
25. Allahverdi A, Sharifi D, Takhtfooladi MA, Hesaraki S, Khansari M et al. Evaluation of low-level laser therapy, plateletrich plasma, and their combination on the healing of Achilles tendon in rabbits. Lasers in Medical Science 2015; 30 (4): 1305- 1313. doi: 10.1007/s10103-015-1733-6
26. Bjordal JM, Lopes-Martins RAB, Iversen VV. A randomised, placebo controlled trial of low level laser therapy for activated Achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations. British Journal of Sports Medicine 2006; 40: 76-80. doi: 10.1136/ bjsm.2005.020842
27. Demir H, Menku P, Kirnap M, Calis M, Ikizceli I. Comparison of the effects of laser, ultrasound, and combined laser + ultrasound treatments in experimental tendon healing. Lasers in Surgery and Medicine: The Official Journal of the American Society for Laser Medicine and Surgery 2004; 35 (1): 84-89. doi: 10.1002/lsm.20046
28. Nascimento LDS, Nascimento KFS, Pessoa DR, Nicolau RA. Effects of therapy with light emitting diode (led) in the calcaneal tendon lesions of rats: a literature review. The Scientific World Journal 2019. doi: org/10.1155/2019/6043019
29. Çetiner S, Kahraman SA, Yücetaş S. Evaluation of lowlevel laser therapy in the treatment in the treatment of temporomandibular disorders. Photomedicine and Laser Surgery 2006; 24: 637-641. doi: 10.1089/pho.2006.24.637
30. Tumilty SI, Munn J, McDonough S, Hurley DA, Basford JR et al. Low level laser treatment of tendinopathy: a systematic review with meta-analysis. Photomedicine Laser Surgery 2010; 28 (1): 3-16. doi: 10.1089/pho.2008.2470
31. Reddy GK, Stehno-Bittel L, Enwemeka CS. Laser photostimulation of collagen production in healing rabbit Achilles tendons. Lasers in Surgery and Medicine: The Official Journal of the American Society for Laser Medicine and Surgery 1998; 22 (5): 281-287. doi: 10.1002/(sici)1096- 9101(1998)22:5<281::aid-lsm4>3.0.co;2-l