Low-level laser therapy prevents degenerative morphological changes in an experimental model of anterior cruciate ligament transection in rats

Low-level laser therapy attenuates arthrogenic contracture induced by anterior cruciate ligament reconstruction surgery in rats

Therapeutic approaches to treat joint contracture after anterior cruciate ligament (ACL) reconstruction have not been established. Arthrofibrosis accompanied by joint inflammation following ACL reconstruction is a major cause of arthrogenic contracture. In this study, we examined whether anti-inflammatory treatment using low-level laser therapy (LLLT) can prevent ACL reconstruction-induced arthrogenic contracture. Rats underwent ACL transection and reconstruction surgery in their right knees. Unoperated left knees were used as controls. After surgery, rats were reared with or without daily LLLT (wavelength: 830 nm; power output: 150 mW; power density: 5 W/cm2; for 120 s/day). We assessed the passive extension range of motion (ROM) after myotomy at one and two weeks post-surgery; the reduction in ROM represents the severity of arthrogenic contracture. ROM was markedly decreased by ACL reconstruction at both time points; however, LLLT partially attenuated the decrease in ROM. One week after ACL reconstruction, the gene expression of the proinflammatory cytokine interleukin-1beta in the joint capsule was significantly upregulated, and this upregulation was significantly attenuated by LLLT. Fibrotic changes in the joint capsule, including upregulation of collagen type I and III genes, shortening of the synovium, and thickening were caused by ACL reconstruction and seen at both time points. LLLT attenuated these fibrotic changes as well. Our results indicate that LLLT after ACL reconstruction could attenuate the formation of arthrogenic contracture through inhibition of inflammation and fibrosis in the joint capsule. Thus, LLLT may become a novel therapeutic approach for ACL reconstruction-induced joint contracture.

In Vitro and In Vivo Effects of Light Therapy on Cartilage Regeneration for Knee Osteoarthritis: A Systematic Review

OBJECTIVE

To analyze the effects of light therapy (LT) on cartilage repair for knee osteoarthritis (OA) treatment.

DESIGN

The PubMed, Embase, Scopus, and Web of Science databases were searched up to August 31, 2020 to identify in vitro and in vivo studies that analyzed the effects of LT on knee cartilage for OA treatment. The study and sample characteristics, LT intervention parameters and posttreatment outcomes were analyzed. Risk of bias was assessed using the Risk of Bias Assessment for Non-randomized Studies (RoBANS) tool.

RESULTS

Three in vitro and 30 in vivo studies were included. Most studies were judged as high risk of performance and detection bias. Biochemical outcomes were analyzed for both in vitro and in vivo studies, and histological and behavioral outcomes were analyzed for in vivo studies. LT reduced extracellular matrix (ECM) degradation, inflammation, and OA progression, promoting ECM synthesis. LT improved pain-like behavior in animal models, having no apparent effect on gait performance. There were conflicting findings of some of the biochemical, histological, and behavioral outcomes.

CONCLUSION

The included studies presented different strategies and LT parameters. LT resulted in positive effects on cartilage repair and may be an adequate therapy for OA treatment.

Effects of photobiomodulation therapy in chondrocyte response by in vitro experiments and experimental model of osteoarthritis in the knee of rats

The purpose of this study is to evaluate the effects of photobiomodulation (PBM) therapy in chondrocyte response by in vitro experiments and cartilage repair using an experimental model of osteoarthritis (OA) in the knee of rats. The in vitro experiment was performed with chondrocyte cells, and they were divided into two groups: non-irradiated and irradiated with PBM (808 nm; 0.8 J or 1.4 J). Then, cell proliferation was evaluated after 1, 3, and 5 days. The experimental model of osteoarthritis (OA) was performed in the knee of 64 Wistar rats, and they were assorted into control group (CG), PBM (808 nm; 1.4 J). The results of in vitro showed that PBM 1.4 J increased cell proliferation, on days 1 and 5. However, after 3 days was demonstrated a significant increase in cell proliferation in PBM 0.8 J. The in vivo experiment results demonstrated, on histological analysis, that PBM presented less intense signs of tissue degradation with an initial surface discontinuity at the superficial zone and disorganization of the chondrocytes in the cartilage region when compared to CG, after 4 and 8 weeks. These findings were confirmed by immunohistochemistry and qRT-PCR analysis which showed that PBM increased IL-4, IL-10, COL-2, Aggrecan, and TGF-β which are anabolic factors and acts on extracellular matrix. Also, PBM reduces the IL1-β, an inflammatory marker that operates as a catabolic factor on articular cartilage. In conclusion, these results suggest that PBM may have led to a return to tissue homeostasis, promoting chondroprotective effects and stimulating the components of the articular tissue.

Photobiomodulation effect of red LED (630 nm) on the free radical levels produced by pulp cells under stress conditions

The aim of this study was to assess the ability of red light emitting diodes (LED) to modulate oxidative stress in human dental pulp fibroblasts (HDPFs) when different irradiation parameters are employed. Cells from primary teeth were seeded (100,000 cells/well) in 24-well plates in culture medium (DMEM). At 24 h after incubation, the culture medium was replaced with DMEM containing 10 μg/mL lipopolysaccharide (LPS). Thereafter, the cells were irradiated (LED 630 nm, 0.04 W/cm² and 0.08 W/cm²) at 0 J/cm² (control group), 4 J/cm², 15 J/cm², and 30 J/cm²; and their viability (MTT assay), number (Trypan Blue), synthesis of nitric oxide (NO) (Griess reagent), and reactive oxygen species (ROS) (fluorescence probe, DCFH-DA) were assessed. The Kruskal-Wallis and Mann-Whitney statistical tests using Bonferroni correction were employed (significance level of 5%). Compared to that in control fibroblasts, increased viability was observed in HDPFs exposed to LPS and irradiated with 15 J/cm² and 30 J/cm² at 0.04 W/cm² and 4 J/cm² and 15 J/cm² at 0.08 W/cm² (p < 0.05). Exposure to 4 J/cm² at 0.04 W/cm² and 15 J/cm² and 30 J/cm² at 0.08 W/cm² modulated the oxidative stress in cells relative to that observed in non-irradiated LPS-treated pulp cells (p < 0.05). It was concluded that the irradiation strategies of using red LED with radiant exposures of 15 J/cm² and 30 J/cm² at 0.04 W/cm² and 15 J/cm² at 0.08 W/cm² were the best parameters to decrease NO and ROS concentration and to stimulate viability of HDPFs exposed to LPS challenge.

Low-intensity photobiomodulation at 632.8 nm increases tgfβ3, col2a1, and sox9 gene expression in rat bone marrow mesenchymal stem cells in vitro

The high incidence of cartilage destructions, as well as the social and economic importance of this pathology attracted great interest to the problem. At the present time, some data are available about the 632.8 nm low-intensity laser photobiomodulation positive effect on the cartilage tissue proliferation. The effect of this wavelength laser irradiation on the mesenchimal stem cell (MSC) differentiation in the chondrogenic direction was studied. The main aim of this work was to assess the low-intensity photobiomodulation effect on chondrogenesis. In this experiment, the cell model was used to compare the photobiomodulation and cytokine Tgfβ3 (transforming growth factor β 3) effects. Bone marrow MSCs were isolated from Wistar rats and cultured for the third passage. Chondrogenic effects of low-intensity He-Ne laser photobiomodulation and cytokine Tgfβ3 (10 ng/μL) were analyzed and compared after 21 days. The radiation source was the standard LGN-208 helium-neon (He-Ne) laser (632.8 nm, 1.7 mWt). Irradiation was performed cyclically for 15 min with 45-min pauses. The increase of the responsible for chondrogenesis (col2a1, tgfβ3, and sox9) main gene expression under the photobiomodulation at 632.8 nm was evaluated in comparison with Tgfβ3 effect. The tgfβ3, col2a1, and sox9 gene expression increase was obtained in two experimental groups: using the laser photobiomodulation and cytokine Tgfβ3 effect. Gene expression levels of tgfβ3, col2a1, and sox9 were measured using real-time polymerase chain reaction (RT-PCR) according to the -ΔΔCt method. It was found that the responsible for chondrogenesis genes expression (tgfβ3, col2a1, sox9) increased under the action of specific laser photobiomodulation during the observation period (from 0 to 21 days). The chondrogenic differentiation effect under the laser irradiation is less significant than Tgfβ3 cytokine effect.

Photobiomodulation Therapy (Light-Emitting Diode 630 nm) Favored the Oxidative Stress and the Preservation of Articular Cartilage in an Induced Knee Osteoarthritis Model

Objective: To evaluate the effects of photobiomodulation (PBM) therapy on oxidative stress and histological aspects of knee osteoarthritis (OA) induced by sodium monoiodoacetate in Wistar rats. Background: OA is a chronic degenerative disease. In addition to the inflammatory role, other factors, such as redox balance, appear to contribute to changes in the articular cartilage, the main articular structure affected. PBM therapy using light-emitting diode (LED) has been proposed to treat the disease by favoring anti-inflammatory effects and modulating markers of oxidative stress, acting on the degenerative process of cartilage. Methods: Twenty-seven male rats were separated into three groups: control (CG), OA (OAG), and LED treatment (LEDG). In the LED group, PBM (LED 630 nm, 300 mW, 9 J/cm², 0.3 W/cm², 30 sec) was applied, starting 24 h after induction, three times per week, for 8 weeks. Cartilage thickness, number of chondrocytes, enzymatic antioxidant defenses [superoxide dismutase (SOD) and catalase (CAT)], oxidative damage [thiobarbituric acid reactive substances (TBARS)], and nonenzymatic defense (ferric reducing antioxidant power) were analyzed. Results: The LEDG had higher average cartilage thickness compared with the OAG and had similar thickness to the CG. Also, the number of chondrocytes was similar to the CG. In the oxidative stress analysis, the LEDG presented antioxidant enzymatic activity (SOD and CAT) higher than the CG, and presented concentration of TBARS lower than the CG and OAG groups. Conclusions: PBM therapy was effective in recovering oxidative stress and preserving the articular cartilage aspects in a knee OA animal model.

Effectiveness of Led Photobiomodulation Therapy on Treatment With Knee Osteoarthritis: A Rat Study

OBJECTIVE

The present study aimed to evaluate the effectiveness of photobiomodulation therapy by light-emitting diode on osteoarthritis treatment in the knees of rats.

DESIGN

Twenty male Wistar rats were randomly assigned into two experimental groups: OAC: animals subjected to induction of osteoarthritis, without therapeutic intervention and the group OAL: animals subjected to induction of osteoarthritis treated with light-emitting diode photobiomodulation therapy (850 nm, 200 mW, 6 J).

RESULTS

The results of gait analysis showed no statistical difference between the groups. The histological findings showed that the OAL group presented abnormal chondrocyte orientation, yet with less irregularities along fibrillation and the joint tissue. Thus, it presented a lower degenerative process when evaluated by the Osteoarthritis Research Society International. Likewise, in the immunohistochemical analysis, the OAL group showed higher collagen 2 and transforming growth factor β immunoexpression when compared with the OAC group.

CONCLUSIONS

Given the above, it is possible to suggest that the photobiomodulation therapy by light-emitting diode had positive effects on the expression of extracellular matrix proteins responsible for synthesis of articular tissue.

Evaluation of metalloproteinases-2, -9, and -13 post photobiomodulation in mice talocrural joint

The extracellular matrix (ECM) is the main constituent of connective tissue with structural and regulatory functions, stimulating cell differentiation and proliferation. Moreover, ECM is a dynamic structure in the constant remodeling process, which is controlled by a balance between metalloproteinases (MMPs) and their inhibitors (TIMPs). Photobiomodulation (PBM) is widely described in the literature and applied in clinical practices, although its effects on ECM have not yet been elucidated. Therefore, it was evaluated if PBM could alter ECM components, such as MMP-2, -9, -13, and TIMP-2 from mice talocrural joints. Mice were divided into 3 groups (n = 6): control, PBM 3 J cm^-2, and PBM 30 J cm^-2. A low-level laser (830 nm, 10 mW, 0.05 irradiated area, energy densities 3 J cm^-2 and 30 J cm^-2, the irradiation time of 15 and 150 s, respectively, continuous wave) was applied on the joint for 4 consecutive days. mRNA levels of metalloproteinases genes (MMP-2, MMP-9, and MMP-13), their regulator (TIMP-2), and protein expressions of MMP-13 and TIMP-2 were quantified. PBM can alter only mRNA relative levels of MMP-2 at 30 J cm^-2 (p < 0.05), while MMP-9, MMP-13, and TIMP-2 mRNA relative levels did not demonstrate statistical differences for any of the groups (p > 0.05). Regarding protein expressions, MMP-13 demonstrated positive-labeled cells, only in articular cartilage, although the cell quantification did not demonstrate statistical differences when compared with the control group (p > 0.05). TIMP-2 did not present positive-labeled cells for any tissues evaluated. Our results indicate that PBM can alter MMP-2 mRNA relative level but cannot alter MMP-9, MMP-13, and TIMP mRNA relative levels. Moreover, both MMP-13 and TIMP-2 proteins were also unaltered after PBM.

Photobiomodulation Therapy in Veterinary Medicine: A Review

Laser therapy, or photobiomodulation, has rapidly grown in popularity in human and veterinary medicine. With a number of proposed indications and broad, sometimes anecdotal, use in practice, research interest has expanded aimed at providing scientific support. Recent studies have shown that laser therapy alters the inflammatory and immune response as well as promotes healing for a variety of tissue types. This review will cover the history of the modality, basic principles, proposed mechanisms of action, evidence-based clinical indications, and will guide the practitioner through its application in practice.

Effectiveness of an aquatic exercise program and low-level laser therapy on articular cartilage in an experimental model of osteoarthritis in rats

OBJECTIVE

The aim of this study was to evaluate the effects of an aquatic exercise program and low-level laser therapy (LLLT) (associated or not) on degenerative modifications and inflammatory mediators on the articular cartilage using an experimental model of knee OA.

METHOD

Forty male Wistar rats were divided into 4 groups: knee OA - without treatment (OA); OA plus exercise program group (OAE); OA plus LLLT (OAL); OA plus exercise program associated with LLLT (OAEL). Trained rats performed a water-jumping program carrying a load equivalent to 50-80 % of their body mass strapped to their chest. The laser irradiation was used either as the only method or after the exercise training had been performed, at 2 points contact mode (medial and lateral side of the left joint). The treatments started 4 weeks after the surgery, 3 days/week for 8 weeks.

RESULTS

The results revealed that all treated groups (irradiated or not) exhibited a better pattern of tissue organization, with less fibrillation and irregularities along the articular surface and improved chondrocytes organization. Also, a lower cellular density and structural damage (OARSI score) and higher thickness values were observed in all treated groups. Additionally, OAE and OAEL showed a reduced expression in IL-1β and caspase-3 as compared with OA. Furthermore, a statistically lower MMP-13 expression was only observed in OAEL as compared with OA.

CONCLUSION

These results suggest that aquatic exercise program and LLLT were effective in preventing cartilage degeneration. Also, physical exercise program presented anti-inflammatory effects in the knees in OA rats.

Aerobic exercise training and low-level laser therapy modulate inflammatory response and degenerative process in an experimental model of knee osteoarthritis in rats

OBJECTIVE

The aim of this study was to evaluate the effects of an aerobic exercise training and low-level laser therapy (LLLT) (associated or not) on degenerative modifications and inflammatory mediators on the articular cartilage using an experimental model of knee OA.

MATERIAL AND METHODS

Fifty male Wistar rats were randomly divided into five groups: control group (CG); knee OA control group (OAC); OA plus exercise training group (OAT); OA plus LLLT group (OAL); OA plus exercise training associated with LLLT group (OATL). The exercise training (treadmill; 16 m/min; 50 min/day) and the laser irradiation (two points-medial and lateral side of the left joint; 24 sessions) started 4 weeks after the surgery, 3 days/week for 8 weeks.

RESULTS

The results showed that all treated groups showed (irradiated or not) a better pattern of tissue organization, with less fibrillation and irregularities along the articular surface and chondrocytes organization, a lower degenerative process measured by OARSI score and higher thickness values. Additionally, all treated group showed a reduced expression in IL-1β, caspase-3 and MMP-13 compared to OAC. Moreover, a lower caspase-3 expression was observed in OATL compared to OAL and OAT.

CONCLUSION

These results suggest that exercise training and LLLT were effective in preventing cartilage degeneration and modulating inflammatory process induced by knee OA.

Effectiveness of low-level laser therapy in patients with knee osteoarthritis: a systematic review and meta-analysis

OBJECTIVE

To investigate the efficacy of low-level laser therapy (LLLT) treatment of knee osteoarthritis (KOA) by a systematic literature search with meta-analyses on selected studies.

DESIGN

MEDLINE, EMBASE, ISI Web of Science and Cochrane Library were systematically searched from January 2000 to November 2014. Included studies were randomized controlled trials (RCTs) written in English that compared LLLT (at least eight treatment sessions) with sham laser in KOA patients. The efficacy effective size was estimated by the standardized mean difference (SMD). Standard fixed or random-effects meta-analysis was used, and inconsistency was evaluated by the I-squared index (I(2)).

RESULTS

Of 612 studies, nine RCTs (seven double-blind, two single-blind, totaling 518 patients) met the criteria for inclusion. Based on seven studies, the SMD in visual analog scale (VAS) pain score right after therapy (RAT) (within 2 weeks after the therapy) was not significantly different between LLLT and control (SMD = -0.28 [95% CI = -0.66, 0.10], I(2) = 66%). No significant difference was identified in studies conforming to the World Association of Laser Therapy (WALT) recommendations (four studies) or on the basis of OA severity. There was no significant difference in the delayed response (12 weeks after end of therapy) between LLLT and control in VAS pain (five studies). Similarly, there was no evidence of LLLT effectiveness based on Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain, stiffness or function outcomes (five and three studies had outcome data right after and 12 weeks after therapy respectively).

CONCLUSION

Our findings indicate that the best available current evidence does not support the effectiveness of LLLT as a therapy for patients with KOA.