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Low Level Laser Therapy in Knee Osteoarthritis: A Narrative Review

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Abstract

Knee osteoarthritis (KOA) is the most common musculoskeletal disorder, especially in middle up to old age. KOA also results in many complications like changes in gait. Nowadays, changes in lifestyle and the reduced physical activity make people more vulnerable to KOA. Therefore, considering the increasing prevalence of KOA in many societies and the costs imposed on the afflicted people and their governments, providing conservative management approaches with a view to saving time and money is important. There are an assortment of conservative strategies in the management of KOA including low level laser therapy (LLLT). Since the introduction of lasers in the medical field in 1960, various types of lasers with widespread administration programs are used for medical conditions from cosmetics to surgery. However, there are conflicting findings on the application of lasers in osteoarthritis. To discuss the basis of the highest level of evidence, only systematic reviews with or without meta-analyses published up to January 2019 were included in the present work. In this regard, Scopus, PEDro, Medline, ISI Web of Science, Cochrane, PubMed, Irandoc, Iran Medex, Magiran, and SID were searched to retrieve articles in English or Persian. A total of 22 systematic reviews and meta-analyses were found, 14 of which were included in this study. The accepted articles were published between 1991 and up to 2019. The purpose of this narrative review was to investigate the effect of LLLT on pain and function in subjects with KOA. The result of the present review may help clinicians in making evidence-based decisions on optimal care in relation to administering LLLT.

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References

  1. Salehi-Abari I. 2016 ACR revised criteria for early diagnosis of knee osteoarthritis. Autoimmune Dis Ther. 2016;3(1):1–5.

    Google Scholar 

  2. Lidgren L. The bone and joint decade 2000–2010. Public Health. 2003;81(9):81–2.

    Google Scholar 

  3. Kim HA, Kim S, Seo YI, et al. The epidemiology of total knee replacement in South Korea: national registry data. Rheumatology. 2008;47(1):88–91.

    PubMed  Google Scholar 

  4. Culvenor AG, Qiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2019;53(20):1268–78.

    PubMed  Google Scholar 

  5. Yoo JJ, Kim DH, Kim HA. Risk factors for progression of radiographic knee osteoarthritis in elderly community residents in Korea. BMC Musculoskelet Disord. 2018;19(1):80–6.

    PubMed  PubMed Central  Google Scholar 

  6. Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum. 1986;29(8):1039–49.

    CAS  PubMed  Google Scholar 

  7. Huang W, Zhou Y. Effects of education on cognition at older ages: evidence from China’s Great Famine. Soc Sci Med. 2013;98:54–62.

    PubMed  Google Scholar 

  8. Panah SH, Baharlouie H, Rezaeian ZS, Hawker G. Cross-cultural adaptation and validation of the Persian version of the intermittent and constant osteoarthritis pain measure for the knee. Iran J Nurs Midwifery Res. 2016;21(4):417–23.

    PubMed  PubMed Central  Google Scholar 

  9. Hawker GA, Davis AM, French MR, et al. Development and preliminary psychometric testing of a new OA pain measure—an OARSI/OMERACT initiative. Osteoarthr Cartil. 2008;16(4):409–14.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Fattahi L, Rezaeian ZS. The immediate effects of conventional physical therapy on the knee joint load in subjects with moderate knee osteoarthritis; a preliminary single blinded randomized control trial. J Rehabil Sci Res. 2016;2(4):71–9.

    Google Scholar 

  11. Shafizadegan Z, Karimi MT, Shafizadegan F, Rezaeian ZS. Evaluation of ground reaction forces in patients with various severities of knee osteoarthritis. J Mech Med Biol. 2016;16(02):1650003.

    Google Scholar 

  12. Hafer JF, Kent JA, Boyer KA. Physical activity and age-related biomechanical risk factors for knee osteoarthritis. Gait Posture. 2019;70:24–9.

    PubMed  Google Scholar 

  13. Ro DH, Lee J, Lee J, Park JY, Han HS, Lee MC. Effects of knee osteoarthritis on hip and ankle gait mechanics. Adv Orthop. 2019;2019(2019):1–6.

    Google Scholar 

  14. Adams T, Band-Entrup D, Kuhn S, et al. Physical therapy management of knee osteoarthritis in the middle-aged athlete. Sports Med Arthrosc Rev. 2013;21(1):2–10.

    PubMed  Google Scholar 

  15. Scanzello CR, Goldring SR. The role of synovitis in osteoarthritis pathogenesis. Bone. 2012;51(2):249–57.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Yamaura M, Yao M, Yaroslavsky I, Cohen R, Smotrich M, Kochevar IE. Low level light effects on inflammatory cytokine production by rheumatoid arthritis synoviocytes. Lasers Surg Med. 2009;41(4):282–90.

    PubMed  Google Scholar 

  17. Assis L, Almeida T, Milares LP, et al. Musculoskeletal atrophy in an experimental model of knee osteoarthritis: the effects of exercise training and low-level laser therapy. Am J Phys Med Rehabil. 2015;94(8):609–16.

    PubMed  Google Scholar 

  18. Assis L, Tim C, Martignago C, Goncalves SR, Renno ACM. Effectiveness of photobiomodulation therapy and aerobic exercise training on articular cartilage in an experimental model of osteoarthritis in rats. Int Soc Opt Photonic. 2018;3:213–9. https://doi.org/10.1117/12.2291227.

    Article  Google Scholar 

  19. Milares LP, Assis L, Siqueira A, et al. Effectiveness of an aquatic exercise program and low-level laser therapy on articular cartilage in an experimental model of osteoarthritis in rats. Connect Tissue Res. 2016;57(5):398–407.

    CAS  PubMed  Google Scholar 

  20. Oliveira P, Santos AA, Rodrigues T, et al. Effects of phototherapy on cartilage structure and inflammatory markers in an experimental model of osteoarthritis. J Biomed Opt. 2013;18(12):128004–10.

    PubMed  Google Scholar 

  21. Tomazoni SS, Leal-Junior ECP, Pallotta RC, Teixeira S, de Almeida P, Lopes-Martins RAB. Effects of photobiomodulation therapy, pharmacological therapy, and physical exercise as single and/or combined treatment on the inflammatory response induced by experimental osteoarthritis. Lasers Med Sci. 2017;32(1):101–8.

    PubMed  Google Scholar 

  22. Alfredo PP, Casarotto RA, Marques AP, et al. Long-term results of a randomized, controlled, double-blind study of low-level laser therapy before exercises in knee osteoarthritis: laser and exercises in knee osteoarthritis. Clin Rehabil. 2018;32(2):173–8.

    PubMed  Google Scholar 

  23. Ali Q, Paneh A, Banoo A, Saami S. Low energy laser effects in relieving pain in patients with knee osteoarthritis. Int J Med Public Health. 2018;2(1):6–10.

    Google Scholar 

  24. Alqualo-Costa R, Thome GR, Perracini MR, Liebano RE. Low-level laser therapy and interferential current in patients with knee osteoarthritis: a randomized controlled trial protocol. Pain Manag. 2018;8(3):157–66.

    PubMed  Google Scholar 

  25. de Matos Brunelli Braghin R, Libardi EC, Junqueira C, et al. The effect of low-level laser therapy and physical exercise on pain, stiffness, function, and spatiotemporal gait variables in subjects with bilateral knee osteoarthritis: a blind randomized clinical trial. Disabil Rehabil. 2019;41(26):3165–72.

  26. de Paula Gomes CA, Leal Junior EC, Dibai-Filho AV, et al. Incorporation of photobiomodulation therapy into a therapeutic exercise program for knee osteoarthritis: a placebo-controlled, randomized, clinical trial. Lasers Surg Med. 2018;50(8):819–28.

    PubMed  Google Scholar 

  27. Paolillo FR, Paolillo AR, Joao JP, et al. Ultrasound plus low-level laser therapy for knee osteoarthritis rehabilitation: a randomized, placebo-controlled trial. Rheumatol Int. 2018;38(5):785–93.

    PubMed  Google Scholar 

  28. Rastgar Koutenaei F, Mosallanezhad Z, Naghikhani M, Biglarian A, Nouroozi M, Ghodrati M. The effect of low level laser therapy on pain and range of motion of patients with knee osteoarthritis. Phys Ther. 2017;7(1):13–8.

    Google Scholar 

  29. Beckerman H, de Bie RA, Bouter LM, De Cuyper HJ, Oostendorp RA. The efficacy of laser therapy for musculoskeletal and skin disorders: a criteria-based meta-analysis of randomized clinical trials. Phys Ther. 1992;72(7):483–91.

    CAS  PubMed  Google Scholar 

  30. Bjordal JM, Couppe C, Chow RT, Tuner J, Ljunggren EA. A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. J Physiother. 2003;49(2):107–16.

    Google Scholar 

  31. Brosseau L, Robinson V, Wells GA, et al. Low level laser therapy (classes I, II and III) for treating osteoarthritis. Cochrane Database Syst Rev. 2004;3:1–59.

    CAS  Google Scholar 

  32. de Bie RA, Verhagen AP, Lenssen AF, et al. Efficacy of 904 nm laser therapy in the management of musculoskeletal disorders: a systematic review. Phys Ther Rev. 1998;3(2):59–72.

    Google Scholar 

  33. Ferreira RM, Duarte JA, Goncalves RS. Non-pharmacological and non-surgical interventions to manage patients with knee osteoarthritis: an umbrella review. Acta Reumatol Port. 2018;43(3):182–200.

    PubMed  Google Scholar 

  34. Ferronato L, Cunha HM, Machado PM, Souza GDSD, Limana MD, Avelar NCPD. Physical modalities on the functional performance in knee osteoarthritis: a systematic review. Fisioter Mov. 2017;30(3):607–23.

    Google Scholar 

  35. Larmer PJ, Reay ND, Aubert ER, Kersten P. Systematic review of guidelines for the physical management of osteoarthritis. Arch Phys Med Rehabil. 2014;95(2):375–89.

    PubMed  Google Scholar 

  36. Bjordal JM, Johnson MI, Lopes-Martins RA, Bogen BÈ, Chow R, Ljunggren AE. Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials. BMC Musculoskelet Disord. 2007;8(1):1–14.

    Google Scholar 

  37. Clijsen R, Brunner A, Barbero M, Clarys P, Taeymans J. Effects of low-level laser therapy on pain in patients with musculoskeletal disorders: a systematic review and meta-analysis. Eur J Phys Rehabil Med. 2017;53(4):603–10.

    PubMed  Google Scholar 

  38. Gam AN, Thorsen H, Lonnberg F. The effect of low-level laser therapy on musculoskeletal pain: a meta-analysis. Pain. 1993;52(1):63–6.

    CAS  PubMed  Google Scholar 

  39. Huang Z, Ma J, Shen B, et al. Effectiveness of low-level laser therapy in patients with knee osteoarthritis: a systematic review and meta-analysis. Osteoarthr Cartil. 2015;23(9):1437–44.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Jang H, Lee H. Meta-analysis of pain relief effects by laser irradiation on joint areas. Photomed Laser Surg. 2012;30(8):405–17.

    PubMed  PubMed Central  Google Scholar 

  41. Rayegani SM, Raeissadat SA, Heidari S, Moradi-Joo M. Safety and effectiveness of low-level laser therapy in patients with knee osteoarthritis: a systematic review and meta-analysis. J Lasers Med Sci. 2017;8(3):S12–9.

    PubMed  PubMed Central  Google Scholar 

  42. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil. 2019;27(11):1578–89.

    CAS  PubMed  Google Scholar 

  43. Brosseau L, Taki J, Desjardins B, et al. The Ottawa Panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs. Clin Rehabil. 2017;31(5):596–611.

    PubMed  Google Scholar 

  44. McAlindon TE, Bannuru R, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22(3):363–88.

    CAS  PubMed  Google Scholar 

  45. Helianthi DR, Simadibrata C, Srilestari A, Wahyudi ER, Hidayat R. Pain reduction after laser acupuncture treatment in geriatric patients with knee osteoarthritis: a randomized controlled trial. Acta Med Indones. 2016;48(2):114–21.

    PubMed  Google Scholar 

  46. Hsieh RL, Lo MT, Liao WC, Lee WC. Short-term effects of 890-nanometer radiation on pain, physical activity, and postural stability in patients with knee osteoarthritis: a double-blind, randomized, placebo-controlled study. Arch Phys Med Rehabil. 2012;93(5):757–64.

    PubMed  Google Scholar 

  47. Puett DW, Griffin MR. Published trials of nonmedicinal and noninvasive therapies for hip and knee osteoarthritis. Ann Intern Med. 1994;121(2):133–40.

    CAS  PubMed  Google Scholar 

  48. Ucurum SG, Kayali Y. The relationship between pain, muscle strength and lower extremity function in patients with knee osteoarthritis. J Basic Clin Health Sci. 2020;4(1):72–6.

    Google Scholar 

  49. Xie Y, Yu Y, Wang JX, et al. Health-related quality of life and its influencing factors in Chinese with knee osteoarthritis. Qual Life Res. 2020. https://doi.org/10.1007/s11136-020-02502-9.

  50. Schram B, Orr R, Pope R, Canetti E, Knapik J. Risk factors for development of lower limb osteoarthritis in physically demanding occupations: a narrative umbrella review. J Occup Health. 2020;62(1):1–13.

    Google Scholar 

  51. Griffin TM, Guilak F. The role of mechanical loading in the onset and progression of osteoarthritis. Exerc Sport Sci Rev. 2005;33(4):195–200.

    PubMed  Google Scholar 

  52. Messier SP, Beavers DP, Mihalko SL, et al. The effects of intensive dietary weight loss and exercise on gait in overweight and obese adults with knee osteoarthritis. The Intensive Diet and Exercise for Arthritis (IDEA) trial. J Biomech. 2020;98:109477.

    PubMed  Google Scholar 

  53. Messier SP, Resnik AE, Beavers DP, et al. Intentional weight loss in overweight and obese patients with knee osteoarthritis: is more better? Arthritis Care Res. 2018;70(11):1569–75.

    Google Scholar 

  54. Assari S, Bazargan M, Chalian M. The unequal effect of income on risk of overweight/obesity of whites and blacks with knee osteoarthritis: the osteoarthritis initiative. J Racial Ethn Health Disparities. 2020. https://doi.org/10.1007/s40615-020-00719-5.

  55. Ÿiestad BE, Juhl CB, Eitzen I, Thorlund JB. Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis. A systematic review and meta-analysis. Osteoarthr Cartil. 2015;23(2):171–7.

    Google Scholar 

  56. Iijima H, Yorozu A, Suzuki Y, Eguchi R, Aoyama T, Takahashi M. Hip abductor muscle weakness and slowed turning motion in people with knee osteoarthritis. J Biomech. 2020;101:1–22.

    Google Scholar 

  57. Cotler HB, Chow RT, Hamblin MR, Carroll J. The use of low level laser therapy (LLLT) for musculoskeletal pain. MOJ Orthop Rheumatol. 2015;2(5):1–16.

    Google Scholar 

  58. Gur A, Cosut A, Jale Sarac A, Cevik R, Nas K, Uyar A. Efficacy of different therapy regimes of low-power laser in painful osteoarthritis of the knee: a double-blind and randomized-controlled trial. Lasers Surg Med. 2003;33(5):330–8.

    PubMed  Google Scholar 

  59. Kheshie AR, Alayat MSM, Ali MME. High-intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Laser Med Sci. 2014;29(4):1371–6.

    Google Scholar 

  60. Ohshiro T. Auto-simultaneous laser treatment: a new effect-based classification. Laser Ther. 2005;14(1):11–7.

    Google Scholar 

  61. Cross F. Book review: Low level laser treatment: a new practical introduction. Ohshiro T, Calderhead RG. 1988. Chichester: Wiley. Br J Surg. 1989;76(4):424.

  62. Ohshiro T. New classification for single-system light treatment. Laser Ther. 2011;20(1):11–5.

    PubMed  PubMed Central  Google Scholar 

  63. Ohshiro T. A new effect-based classification of laser applications in surgery and medicine. Laser Ther. 1996;8(4):233–9.

    Google Scholar 

  64. Alayat MSM, Aly THA, Elsayed AEM, Fadil ASM. Efficacy of pulsed Nd: YAG laser in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Lasers Med Sci. 2017;32(3):503–11.

    PubMed  Google Scholar 

  65. World Association of LASER Therapy. Recommended treatment doses for low level laser therapy: laser class 3B, 780–860nm GaAlAs lasers. WALT, San Francisco. Updated 21 May 2020. https://www.waltza.co.za/wp-content/uploads/2012/08/Dose_table_780-860nm_for_Low_Level_Laser_Therapy_WALT-2010.pdf. Accessed 23 May 2020.

  66. World Association of LASER Therapy. Recommended treatment doses for low level laser therapy: laser class 3B, 904 nm GaAs lasers. WALT, San Francisco. Updated 21 May 2020. https://www.waltza.co.za/wp-content/uploads/2012/08/Dose_table_904nm_for_Low_Level_Laser_Therapy_WALT-2010.pdf. Accessed 23 May 2020.

  67. Osteoarthritis Research Society International. Physician summary—non surgical management of knee osteoarthritis. Osteoarthritis Research Society International, New Jersey. Updated 24 March 2014. https://www.oarsi.org/sites/default/files/library/2014/pdf/physiciansumfinal.pdf. Accessed 23 May 2020.

  68. Assis L, Milares LP, Almeida T, et al. Aerobic exercise training and low-level laser therapy modulate inflammatory response and degenerative process in an experimental model of knee osteoarthritis in rats. Osteoarthr Cartil. 2016;24(1):169–77.

    CAS  PubMed  Google Scholar 

  69. McConnell S, Kolopack P, Davis AM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Care Res. 2001;45(5):453–61.

    CAS  Google Scholar 

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Acknowledgements

The authors appreciate scientific support by Dr. Alireza Rahimi for improving the search strategy and his intellectual contribution in revising the paper.

Funding

This study has been funded by Isfahan University of Medical Sciences as a part of a thesis for a Master’s Degree in Physical Therapy by SG (Registration code: 298102). The sponsor played no role in data collection, analysis of the data, and drafting the manuscript. No Rapid Service Fee was received by the journal for the publication of this article.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authorship Contributions

Conception and design: ZSR, JM, and SG. Funding and obtaining financial support: ZSR. Administrative, technical or logistic support: ZSR. Provision of the study materials or patients: ZSR, JM, and SG. Data collection: SG. Drafting the manuscript: SG, ZSR, and JM. Critical revising of the article for important intellectual content: ZSR, JM, and SG. Final approval of the article: ZSR, JM, and SG. Integration of the study protocol from design to dissemination: ZSR, JM, and SG.

Disclosures

Soheila Ganjeh, Zahra Sadat Rezaeian, and Javid Mostamand have nothing to disclose.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. The study is a part of a project ethically approved by Isfahan University of Medical Sciences (Ethics Code: https://ethics.research.ac.ir/ProposalCertificateEn.php?id=93701&Print=true&NoPrintHeader=true&NoPrintFooter=true&NoPrintPageBorder=true&LetterPrint=true). The full text of all the articles cited in the present study were accurately retrieved and analyzed. In case of limited access to full texts, the first or corresponding author of the article or the editor of the publishing journal was contacted.

Data Availability

This study was a preliminary study to assess the need for and feasibility of a comprehensive umbrella review on the effectiveness of LLLT in KOA. The main protocol is under review at Prospero and data will be available upon registration. Data presented in this paper are accurate and match the data presented in the original works. The present study included or analyzed no quantitative data. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Authors and Affiliations

  1. Musculoskeletal Research Center, and Student Research Committee of Rehabilitation Students (Treata), Rehabilitation Sciences Research Institute, Department of Physical Therapy, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

    Soheila Ganjeh

  2. Musculoskeletal Research Center, Rehabilitation Sciences Research Institute, Department of Physical Therapy, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

    Zahra Sadat Rezaeian & Javid Mostamand

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  1. Soheila Ganjeh
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Correspondence to Javid Mostamand.

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Ganjeh, S., Rezaeian, Z.S. & Mostamand, J. Low Level Laser Therapy in Knee Osteoarthritis: A Narrative Review. Adv Ther 37, 3433–3449 (2020). https://doi.org/10.1007/s12325-020-01415-w

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