Skip to main content
Top
Published in: Lasers in Medical Science 4/2013

01-07-2013 | Original Article

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

Authors: Nikolaos Malliaropoulos, Olga Kiritsi, Kostantinos Tsitas, Dimitris Christodoulou, A. Akritidou, Angelo Del Buono, Nicola Maffulli

Published in: Lasers in Medical Science | Issue 4/2013

Login to get access

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.
Literature
1.
go back to reference Raber DA, Friederich NF, Hefti F (1998) Discoid lateral meniscus in children—long-term follow up after total meniscectomy. J Bone Joint Surg Am 80:1579–1586PubMed Raber DA, Friederich NF, Hefti F (1998) Discoid lateral meniscus in children—long-term follow up after total meniscectomy. J Bone Joint Surg Am 80:1579–1586PubMed
2.
go back to reference Lohmander LS (1998) Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum 41:687–693PubMedCrossRef Lohmander LS (1998) Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum 41:687–693PubMedCrossRef
3.
go back to reference Turek SL (1984) Orthopedics: principles and their applications. JB Lippincott, Philadelphia Turek SL (1984) Orthopedics: principles and their applications. JB Lippincott, Philadelphia
4.
go back to reference Stoller DW (1987) Meniscal tears: pathological correlation with MR imaging. Radiology 163:452 Stoller DW (1987) Meniscal tears: pathological correlation with MR imaging. Radiology 163:452
5.
go back to reference Tobler TH (1926) Makroskopische und histologische befund am kniegeluk meniscus in verschiedenen lebensaitern. Schweiz Med Wochenschr 56:1359 Tobler TH (1926) Makroskopische und histologische befund am kniegeluk meniscus in verschiedenen lebensaitern. Schweiz Med Wochenschr 56:1359
6.
go back to reference Roca FA, Vilalta A (1980) Lesions of the meniscus. I: macroscopic and histologic findings. Clin Orthop 146:289 Roca FA, Vilalta A (1980) Lesions of the meniscus. I: macroscopic and histologic findings. Clin Orthop 146:289
7.
go back to reference Prade RFL, Burnett QM, Veenstra MA et al (1994) The prevalence of abnormal magnetic resonance imaging findings in asymptomatic knees. Am J Sports Med 22:739CrossRef Prade RFL, Burnett QM, Veenstra MA et al (1994) The prevalence of abnormal magnetic resonance imaging findings in asymptomatic knees. Am J Sports Med 22:739CrossRef
8.
go back to reference Smillie LS (1980) Diseases of the knee joint. Churchill-Livingstone, London Smillie LS (1980) Diseases of the knee joint. Churchill-Livingstone, London
9.
go back to reference 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):201–204PubMedCrossRef 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):201–204PubMedCrossRef
10.
go back to reference Gray JC (1999) Neural and vascular anatomy of the menisci of the human knee. J Orthop Sports Phys Ther 29(1):23–30PubMed Gray JC (1999) Neural and vascular anatomy of the menisci of the human knee. J Orthop Sports Phys Ther 29(1):23–30PubMed
11.
go back to reference Basford RJ, Malanga AG, Krause AD, Harmsen SW (1998) A randomized controlled evaluation of low intensity laser therapy: plantar fasciitis. Arch Phys Med Rehab 79:249–254CrossRef Basford RJ, Malanga AG, Krause AD, Harmsen SW (1998) A randomized controlled evaluation of low intensity laser therapy: plantar fasciitis. Arch Phys Med Rehab 79:249–254CrossRef
12.
go back to reference Cardinal E, Chhem RK, Beauregard CG et al (1996) Plantar fasciitis: sonographic evaluation. Radiology 201:257–259PubMed Cardinal E, Chhem RK, Beauregard CG et al (1996) Plantar fasciitis: sonographic evaluation. Radiology 201:257–259PubMed
13.
go back to reference 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 37:46–52PubMedCrossRef 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 37:46–52PubMedCrossRef
14.
go back to reference 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 15:43–43 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 15:43–43
15.
go back to reference Gam AN, Thorsen H, Lonnberg F (1993) The effect of low-level laser therapy on musculoskeletal pain: a meta-analysis. Pain 52:63–66PubMedCrossRef Gam AN, Thorsen H, Lonnberg F (1993) The effect of low-level laser therapy on musculoskeletal pain: a meta-analysis. Pain 52:63–66PubMedCrossRef
16.
go back to reference Jacobsen FM, Couppe C, Hilden J (1997) Comments on the use of low-level laser therapy (LLLT) in painful musculo-skeletal disorders. Pain 73:110–111PubMedCrossRef Jacobsen FM, Couppe C, Hilden J (1997) Comments on the use of low-level laser therapy (LLLT) in painful musculo-skeletal disorders. Pain 73:110–111PubMedCrossRef
17.
go back to reference Reddy GK, Stehno-Bittel L, Enwemeka CS (1998) Laser photostimulation of collagen production in healing rabbit Achilles tendons. Lasers Surg Med 22:281–284PubMedCrossRef Reddy GK, Stehno-Bittel L, Enwemeka CS (1998) Laser photostimulation of collagen production in healing rabbit Achilles tendons. Lasers Surg Med 22:281–284PubMedCrossRef
18.
go back to reference Walker J (1983) Relief from chronic pain by low power laser irradiation. Neurosci Lett 43:339–344PubMedCrossRef Walker J (1983) Relief from chronic pain by low power laser irradiation. Neurosci Lett 43:339–344PubMedCrossRef
19.
go back to reference Downie WW, Leatham PA, Rhind VM et al (1978) Studies with pain rating scale. Am Rheum Dis 37:378–381CrossRef Downie WW, Leatham PA, Rhind VM et al (1978) Studies with pain rating scale. Am Rheum Dis 37:378–381CrossRef
20.
go back to reference Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154PubMedCrossRef Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154PubMedCrossRef
22.
go back to reference 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 27:577–584PubMedCrossRef 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 27:577–584PubMedCrossRef
23.
go back to reference 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 25:275–281PubMedCrossRef 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 25:275–281PubMedCrossRef
24.
go back to reference 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 11:1142–1150PubMedCrossRef 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 11:1142–1150PubMedCrossRef
25.
go back to reference 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 4:291–295PubMedCrossRef 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 4:291–295PubMedCrossRef
26.
go back to reference 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):77 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):77
27.
go back to reference 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 18:47–50PubMedCrossRef 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 18:47–50PubMedCrossRef
28.
go back to reference Enwemeka CS (1991) Connective tissue plasticity: ultrastructural, biomechanical and morphometric effects of physical factors on intact and regenerating tendons. J Orthop Sports Phys Ther 14:198–212PubMed Enwemeka CS (1991) Connective tissue plasticity: ultrastructural, biomechanical and morphometric effects of physical factors on intact and regenerating tendons. J Orthop Sports Phys Ther 14:198–212PubMed
29.
go back to reference 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 16:368–379PubMedCrossRef 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 16:368–379PubMedCrossRef
30.
go back to reference 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 9:50–58PubMedCrossRef 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 9:50–58PubMedCrossRef
31.
go back to reference Yu W, Naimm JO, Lanzafame RJ (1997) Effects of photostimulation on wound healing in diabetic mice. Lasers Surg Med 20:56–63PubMedCrossRef Yu W, Naimm JO, Lanzafame RJ (1997) Effects of photostimulation on wound healing in diabetic mice. Lasers Surg Med 20:56–63PubMedCrossRef
32.
go back to reference 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 12:528–537PubMedCrossRef 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 12:528–537PubMedCrossRef
33.
go back to reference McCarty EC, Marx RG, DeHaven KE (2002) Meniscus repair: considerations in treatment and update of clinical results. Clin Orthop Rel Res 402:122–134CrossRef McCarty EC, Marx RG, DeHaven KE (2002) Meniscus repair: considerations in treatment and update of clinical results. Clin Orthop Rel Res 402:122–134CrossRef
34.
go back to reference Lee JM, Fu FH (2000) The meniscus: basic science and clinical applications. Oper Tech Orthop 10:162–168CrossRef Lee JM, Fu FH (2000) The meniscus: basic science and clinical applications. Oper Tech Orthop 10:162–168CrossRef
35.
go back to reference Senan V, Sucheendran J, Prasad KH, Balagopal K (2011) Histological features of meniscal injury. Kerala J Orthop 24:30–36 Senan V, Sucheendran J, Prasad KH, Balagopal K (2011) Histological features of meniscal injury. Kerala J Orthop 24:30–36
36.
go back to reference 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 5:444–448CrossRef 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 5:444–448CrossRef
37.
go back to reference Lievens P (1988) The influence of laser treatment on the lymphatic system and on wound healing. Laser 1(2):6–12 Lievens P (1988) The influence of laser treatment on the lymphatic system and on wound healing. Laser 1(2):6–12
38.
go back to reference Tam G (1999) Low power laser therapy and analgesic action. J Clin Laser Med Surg 17:29–33PubMed Tam G (1999) Low power laser therapy and analgesic action. J Clin Laser Med Surg 17:29–33PubMed
Metadata
Title
Low-level laser therapy in meniscal pathology: a double-blinded placebo-controlled trial
Authors
Nikolaos Malliaropoulos
Olga Kiritsi
Kostantinos Tsitas
Dimitris Christodoulou
A. Akritidou
Angelo Del Buono
Nicola Maffulli
Publication date
01-07-2013
Publisher
Springer London
Published in
Lasers in Medical Science / Issue 4/2013
Print ISSN: 0268-8921
Electronic ISSN: 1435-604X
DOI
https://doi.org/10.1007/s10103-012-1219-8

Other articles of this Issue 4/2013

Lasers in Medical Science 4/2013 Go to the issue