Lasers in Medical Science

, Volume 28, Issue 4, pp 1183–1188

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

  • Nikolaos Malliaropoulos
  • Olga Kiritsi
  • Kostantinos Tsitas
  • Dimitris Christodoulou
  • A. Akritidou
  • Angelo Del Buono
  • Nicola Maffulli
Original Article

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.

Keywords

Menisci Tear Healing Photodynamic 

References

  1. 1.
    Raber DA, Friederich NF, Hefti F (1998) Discoid lateral meniscus in children—long-term follow up after total meniscectomy. J Bone Joint Surg Am 80:1579–1586PubMedGoogle Scholar
  2. 2.
    Lohmander LS (1998) Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum 41:687–693PubMedCrossRefGoogle Scholar
  3. 3.
    Turek SL (1984) Orthopedics: principles and their applications. JB Lippincott, PhiladelphiaGoogle Scholar
  4. 4.
    Stoller DW (1987) Meniscal tears: pathological correlation with MR imaging. Radiology 163:452Google Scholar
  5. 5.
    Tobler TH (1926) Makroskopische und histologische befund am kniegeluk meniscus in verschiedenen lebensaitern. Schweiz Med Wochenschr 56:1359Google Scholar
  6. 6.
    Roca FA, Vilalta A (1980) Lesions of the meniscus. I: macroscopic and histologic findings. Clin Orthop 146:289Google Scholar
  7. 7.
    Prade RFL, Burnett QM, Veenstra MA et al (1994) The prevalence of abnormal magnetic resonance imaging findings in asymptomatic knees. Am J Sports Med 22:739CrossRefGoogle Scholar
  8. 8.
    Smillie LS (1980) Diseases of the knee joint. Churchill-Livingstone, LondonGoogle Scholar
  9. 9.
    Mine T, Kimura M, Sakka A, Kawai S (2000) Innervation of nociceptors in the menisci of the knee joint: an immunohistochemical study. Arch Orthop Trauma Surg 120(3–4):201–204PubMedCrossRefGoogle Scholar
  10. 10.
    Gray JC (1999) Neural and vascular anatomy of the menisci of the human knee. J Orthop Sports Phys Ther 29(1):23–30PubMedGoogle Scholar
  11. 11.
    Basford RJ, Malanga AG, Krause AD, Harmsen SW (1998) A randomized controlled evaluation of low intensity laser therapy: plantar fasciitis. Arch Phys Med Rehab 79:249–254CrossRefGoogle Scholar
  12. 12.
    Cardinal E, Chhem RK, Beauregard CG et al (1996) Plantar fasciitis: sonographic evaluation. Radiology 201:257–259PubMedGoogle Scholar
  13. 13.
    Chow RT, Barnsley L (2005) Systematic review of the literature of low-level laser therapy (LLLT) in the management of neck pain. Lasers Surg Med 37:46–52PubMedCrossRefGoogle Scholar
  14. 14.
    Djavid GE, Mortazavi SMJ, Basirnia A et al (2003) A low level laser therapy in musculoskeletal pain syndromes: pain relief and disability reduction. Lasers Surg Med Suppl 15:43–43Google Scholar
  15. 15.
    Gam AN, Thorsen H, Lonnberg F (1993) The effect of low-level laser therapy on musculoskeletal pain: a meta-analysis. Pain 52:63–66PubMedCrossRefGoogle Scholar
  16. 16.
    Jacobsen FM, Couppe C, Hilden J (1997) Comments on the use of low-level laser therapy (LLLT) in painful musculo-skeletal disorders. Pain 73:110–111PubMedCrossRefGoogle Scholar
  17. 17.
    Reddy GK, Stehno-Bittel L, Enwemeka CS (1998) Laser photostimulation of collagen production in healing rabbit Achilles tendons. Lasers Surg Med 22:281–284PubMedCrossRefGoogle Scholar
  18. 18.
    Walker J (1983) Relief from chronic pain by low power laser irradiation. Neurosci Lett 43:339–344PubMedCrossRefGoogle Scholar
  19. 19.
    Downie WW, Leatham PA, Rhind VM et al (1978) Studies with pain rating scale. Am Rheum Dis 37:378–381CrossRefGoogle Scholar
  20. 20.
    Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154PubMedCrossRefGoogle Scholar
  21. 21.
    WALT (2004) Consensus agreement on the design and conduct of clinical studies with low level laser therapy and light therapy for musculoskeletal pain and disorders. http://www.walt.nu/images/stories/files/walt_standard_for_conduct_of_randomized_controlled_trials.pdf. Accessed 4 Novenber 2004
  22. 22.
    Hegedus B, Viharos L, Gervain M, Galfi M (2009) The effect of low-level laser in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial. Photomed Laser Surg 27:577–584PubMedCrossRefGoogle Scholar
  23. 23.
    Kiritsi O, Tsitas K, Malliaropoulos N, Mikroulis G (2010) Ultrasonographic evaluation of plantar fasciitis after low-level laser therapy: results of a double-blind, randomized, placebo-controlled trial. Lasers Med Sci 25:275–281PubMedCrossRefGoogle Scholar
  24. 24.
    Abergel RP, Meeker CA, Lam TS, Dwyer RM, Lesavoy MA, Uitto J (1984) Control of connective tissue metabolism by lasers: recent developments and future prospects. J Am Acad Dermatol 11:1142–1150PubMedCrossRefGoogle Scholar
  25. 25.
    Abergel RP, Dwyer RM, Meeker CA, Lask G, Kelly A, Uitto J (1984) Laser treatment of keloids: a clinical trial and in vitro study with Nd:YAG laser. Lasers Surg Med 4:291–295PubMedCrossRefGoogle Scholar
  26. 26.
    Lam TS, Abergel RP, Castel JC, Dwyer RM, Uitto J (1986) Laser stimulation of collagen synthesis in human skin fibroblast cultures. Laser Life Sci 1(61):77Google Scholar
  27. 27.
    Lyons RF, Abergel RP, White RA, Dwyer RM, Castel JC, Uitto J (1987) Biostimulation of wound healing in vivo by a helium: neon laser. Ann Plast Surg 18:47–50PubMedCrossRefGoogle Scholar
  28. 28.
    Enwemeka CS (1991) Connective tissue plasticity: ultrastructural, biomechanical and morphometric effects of physical factors on intact and regenerating tendons. J Orthop Sports Phys Ther 14:198–212PubMedGoogle Scholar
  29. 29.
    Romanos GE, Pelekanos S, Strub JR (1995) Effects of Nd: YAG laser on wound healing processes: clinical and immunohistochemical findings in rat skin. Lasers Surg Med 16:368–379PubMedCrossRefGoogle Scholar
  30. 30.
    Braverman B, McCarthy RJ, Ivankovich AD, Forde DE, Overfield M, Bapka MS (1989) Effect of He:Ne and infrared laser irradiation on wound healing in rabbits. Lasers Surg Med 9:50–58PubMedCrossRefGoogle Scholar
  31. 31.
    Yu W, Naimm JO, Lanzafame RJ (1997) Effects of photostimulation on wound healing in diabetic mice. Lasers Surg Med 20:56–63PubMedCrossRefGoogle Scholar
  32. 32.
    van Breugel HHFI, Bar PRD (1992) Power density and exposure time of He-Ne laser irradiation are more important than total energy dose in photo-biomodulation of human fibroblasts in vitro. Lasers Surg Med 12:528–537PubMedCrossRefGoogle Scholar
  33. 33.
    McCarty EC, Marx RG, DeHaven KE (2002) Meniscus repair: considerations in treatment and update of clinical results. Clin Orthop Rel Res 402:122–134CrossRefGoogle Scholar
  34. 34.
    Lee JM, Fu FH (2000) The meniscus: basic science and clinical applications. Oper Tech Orthop 10:162–168CrossRefGoogle Scholar
  35. 35.
    Senan V, Sucheendran J, Prasad KH, Balagopal K (2011) Histological features of meniscal injury. Kerala J Orthop 24:30–36Google Scholar
  36. 36.
    Longo L, Evangelista S, Tinacci G, Sesti AG (1987) Effects of diodes laser silver arsenide aluminium (GaAlAs) 904 nm on healing of experimental wounds. Laser Surg Med 5:444–448CrossRefGoogle Scholar
  37. 37.
    Lievens P (1988) The influence of laser treatment on the lymphatic system and on wound healing. Laser 1(2):6–12Google Scholar
  38. 38.
    Tam G (1999) Low power laser therapy and analgesic action. J Clin Laser Med Surg 17:29–33PubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2012

Authors and Affiliations

  • Nikolaos Malliaropoulos
    • 1
    • 2
  • Olga Kiritsi
    • 1
    • 3
  • Kostantinos Tsitas
    • 1
  • Dimitris Christodoulou
    • 1
    • 2
  • A. Akritidou
    • 2
  • Angelo Del Buono
    • 4
  • Nicola Maffulli
    • 5
  1. 1.National Track & Field Centre, Sports Injury ClinicSports Medicine Clinic of S.E.G.A.S.ThessalonikiGreece
  2. 2.Thessaloniki Sports Medicine ClinicThessalonikiGreece
  3. 3.James Paget University Hospital, NHS Foundaton TrustGreat YarmouthUK
  4. 4.Department of Orthopaedic and Trauma SurgeryCampus Biomedico University of RomeRomeItaly
  5. 5.Barts and the London School of Medicine and Dentistry Institute of Health Sciences Education Centre for Sports and Exercise Medicine Mile End HospitalLondonUK

Personalised recommendations