Evaluation of low-level laser therapy, platelet-rich plasma, and their combination on the healing of Achilles tendon in rabbits.
Allahverdi A, Sharifi D, Takhtfooladi MA, Hesaraki S, Khansari M, and Dorbeh SS. Lasers Med Sci. 2015. [Epub Ahead of Print].
Take Home Message: Both platelet-rich plasma and low-level laser therapies are effective treatments for Achilles tendon injury. In the present study however, combining PRP and LLLT demonstrated an increase in healed tendon strength and histological function in a rabbit model.
Tendon injury is common among those who participate in sports. While many treatments such as platelet-rich plasma (PRP) and low-level laser therapies (LLLT) exist, no research has been completed on the effectiveness of combining therapies. If combining therapies together yields better tissue healing results, clinicians may utilize this gold standard to expedite return to play. Therefore, Allahverdi and colleagues completed an animal study to investigate if combining LLLT and PRP are more effective than LLLT or PRP alone. Seventy-two male New Zealand white rabbits were equally divided into 4 treatment groups (control, PRP only, LLLT only, and LLLT+PRP). All rabbits underwent surgical Achilles tendon weakening (10 full-thickness incisions mid-way between calcaneal insertion and musculotendinous junction) before undergoing the specified treatment for 15 days. Rabbits treated with PRP were injected with autologous PRP with platelet concentration 400% of the peripheral blood count at 1, 8, and 15 days post injury. The rabbits in the LLLT group were treated for 15 consecutive days post-injury. The 18 rabbits in the combination group received both treatments described above. After 30 days the rabbits were sacrificed and tendons were harvested for examination. Histological examinations focused on the presence of inflammation, arrangement of collagen fibers, and adhesion formation. Biomechanical testing assessed breaking strength and tensile strength of the healed tendon as compared with the contralateral tendon. Biomechanical testing and histological assessment revealed better outcomes in all of the treated groups compared with the control group. Furthermore, the combination group had better results than either single treatment groups.
Overall, the combination of PRP and LLLT lead to superior treatment outcomes than either PRP or LLLT alone. This data should be especially interesting for those clinicians who have access to PRP and LLLT. By combining these 2 treatment options outcomes can be improved. It should also be noted that both PRP and LLLT lead to significantly better outcomes than the control group, which would support the use of either treatment individually. It will be interesting to see if these results can be replicated in humans. This study can also offer clinicians some additional clinical insight. The current study demonstrated that combining therapies might help shorten recovery timelines and yield better overall outcomes. Clinicians should always consider if combinations of treatments may lead to improved results or merely take more time. Clinical trials often assess one treatment option at a time and similarly clinicians often focus on the gold-standard treatment for a particular injury rather than seeking efficient and effective combinations of treatments.
Questions for Discussion: What combination treatments have you found to be particularly useful for tendon injuries? How do you choose and assess treatment combinations in your clinical practice?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
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Allahverdi A, Sharifi D, Takhtfooladi MA, Hesaraki S, Khansari M, & Dorbeh SS (2015). Evaluation of low-level laser therapy, platelet-rich plasma, and their combination on the healing of Achilles tendon in rabbits. Lasers in Medical Science, 30 (4), 1305-13 PMID: 25759233