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

Using auriculotherapy for osteoarthritic knee among elders: a double-blinded randomised feasibility study

Background

Osteoarthritic knee (OA knee) is a common condition in the elderly. Exploration of non-invasive complementary therapies for OA knee is warranted given the limitations of pharmacologic therapies. Auriculotherapy (AT) is a therapeutic method in which specific points on the auricle are stimulated to treat various disorders of the body, and the therapeutic value and synergistic effect of laser auriculotherapy (LAT) when combined with magneto-auriculotherapy (MAT) merits further investigation.

Methods

This study adopted a double-blinded four-arm randomized placebo design. The aims of study are (1) to assess the feasibility of AT among elders with OA knee in a future large-scale study, including the use of blinding in subjects and evaluators, acceptance of treatment protocol, and estimating the effect size and attrition rate; and (2) to evaluate the preliminary effect of AT in elders with OA knee. Subjects were randomly divided into four groups with different modes of AT with/without placebo objects. A total of 43 subjects completed the 6-week intervention and post-assessment. Assessments included a numerical rating scale of pain (NRS), the timed-up-and-go test (TUGT), and standard goniometer measurements during knee flexion and extension, Kruskal–Wallis test was used to evaluate differences among groups, and Wilcoxon sign-ranked test for examining within-group comparison.

Results

Preliminary results indicated the absence of differences in the NRS, TUGT, and active/passive knee flexion and extension at baseline, as well as post-therapy, between the four groups. Even though the differences of these parameters between groups were not significant, the relative differences of NRS and TUGT in subjects who received combined MAT plus LAT were higher than those treated with MAT or LAT alone, or the placebo group. Four of the six parameters demonstrated significant within group differences in subjects who received MAT and/or LAT, whereas no significant differences were found in the placebo group.

Conclusion

This study demonstrates that the AT protocol adopted in this study for elders with OA knee is feasible and could be applied in future larger-scale study. Larger sample size should be considered in a future trial to determine the causal relationship between treatment and effect.

Trial Registration

ClinicalTrials.gov: NCT02352636. Registered on 23 January 2015.

Ultrasound phonophoresis of panax notoginseng improves the strength of repairing ligament: a rat model

This study examined the phonophoretic effect of a therapeutic ultrasound coupled with a Panax notoginseng (PN) gel and compared it with a therapeutic ultrasound alone for medial collateral ligament repair in rats. Twenty mature male Sprague-Dawley rats receiving surgical transection to the left medial collateral ligament (MCL) were divided randomly into three groups: ultrasound (US, n = 7), ultrasound with PN coupling gel (PNUS, n = 7) and control (n = 6). The treatments started on day 3 after surgery for six days per week over a two-week period. The US group received 4 min of pulsed ultrasound (1 MHz) at the intensity of 0.5W/cm(2) with a normal ultrasonic coupling gel. The PNUS group received the same ultrasound treatment, but with a coupling gel that contained PN extract. The control group received a placebo ultrasound treatment similar to the other two groups. On day 17, the ligaments were mechanically tested for load-relaxation, stiffness and ultimate tensile strength (UTS). Values of the left side were normalized against that of the right side of each animal for analysis. Results revealed significantly higher normalized stiffness (p = 0.009) and UTS (p = 0.022) in the PNUS group than the other two groups, but insignificant difference in load-relaxation among all groups. This study reveals a positive ultrasonic phonophoretic effect of Panax notoginseng extract for improving the strength of ligament repair than ultrasound therapy alone.

Combining therapeutic laser and herbal remedy for treating ligament injury: an ultrastructural morphological study

OBJECTIVE

We examined the ultrastructural morphology (number of collagen fibrils, mean and mass-averaged diameter) of isolated and combined treatments of a therapeutic laser and herbs for medial collateral ligament (MCL) injury in rats.

MATERIALS AND METHODS

Twenty-eight rats, divided into seven groups: laser (L), herb (H), laser + herb (LH), laser control (LC), herb control (HC), laser sham (LS) and herb sham (HS), were studied. Right MCL of groups L, H, LH, LC and HC were transected, while that of LS and HS remained intact. Group L received 9 treatment sessions of GaAlAs laser with a dosage of 3.5 Jcm(-2); group H received herbal plaster treatment; groups LH had combined treatments of laser and herb; group LC had placebo laser; group LS had no treatment; groups HC and HS received only bandage without herb. All MCLs were analyzed using transmission electron microscopy at 3 weeks.

RESULTS

Differences (p < 0.05) existed in mean fibril diameters among groups. Core mass-averaged diameters of groups L and H were larger than the control groups (LC and HC). Fibril diameter of group LH (combined treatment) was even larger and approaching that of the intact MCL.

CONCLUSION

Combined therapeutic laser and herbal treatment hastened collagen fibril maturation in MCL repair.

Effect of Low-Level Laser Therapy on Healing of Medial Collateral Ligament Injuries in Rats: An Ultrastructural Study

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.