Sports Medicine Research: In the Lab & In the Field: Can Laser Therapy be used to Treat Meniscal Injuries? (Sports Med Res)


Wednesday, December 12, 2012

Can Laser Therapy be used to Treat Meniscal Injuries?

Can Laser Therapy be used to Treat Meniscal Injuries?

Low-Level Laser Therapy in Meniscal Pathology: a Double-Blinded Placebo-Controlled Trial

Malliaropoulos N, Kiritsi O, Tsitas K, Christodoulou D, Akritidou A, Del Bueno A, &
Maffulli N. Lasers in Medicine and Science. Epub ahead of print October 24, 2012. DOI:10.1007/s10103-012-1219-8

A meniscal injury is the most common cause of symptomatic knee pain.  Due to the inability of the meniscus to heal, current management of these injuries involves symptomatic management, and surgery as needed. Low-level laser therapy (LLLT) for soft tissue injuries has become increasingly apparent in recent years, with claims of reduction in pain, inflammation, as well as accelerated healing time.  It is currently being used for these possible benefits; however, its effectiveness for treating meniscal tears is still unknown.  Therefore, the purpose of this double-blind placebo-controlled study was to assess the effectiveness of LLLT in 64 patients with symptomatic medial meniscus injuries.  Half of the patients were randomized to receive LLLT and the other half was randomized to receive sham treatment.  The results were compared between the two groups using a visual analog scale (VAS) for knee pain, Lysholm Knee Scoring System (knee pain and function), and swelling of the knee.  The LLLT group demonstrated significant improvements from baseline at all time points (i.e., 4 weeks, 6 months, 1 year post treatment).  Furthermore, at 4 weeks post treatment, the VAS and Lysholm scores were significantly improved in the LLLT when compared to the sham group.

LLLT demonstrated effectiveness in a population with symptomatic meniscal pathology.  It still remains unclear as to mechanistically why LLLT may have had superior outcomes.  Some theories include an analgesic effect of LLLT which could have been caused by improved healing and decreased pain-receptor stimulation.  Depth of penetration of any laser therapy is limited (~ 5mm) due to superficial tissues absorbing the energy.  It would have been interesting if this study had taken a follow-up MRI to determine if there had been any structural changes that occurred within the involved knees.  This would appropriately address whether or not healing is actually occurring, or if the LLLT slows ensuing degenerative changes that may be occurring in the sham group.  Also, if LLLT has the ability to decrease inflammation, this would be reinforced if the authors of the study assessed biochemical markers of the involved joint.  The findings of this study are certainly exciting as to the future possibilities, but there still remains much to be answered.  The authors looked at a very specific set of inclusion criteria for meniscal injury; I wonder what the applicability may be across other types of meniscal or even other knee pathologies.  I also wonder if these patients went on to have surgery or if this prevented the need for surgical intervention.  And lastly, what are the long-term effects of this on degenerative changes of the knee.  Clinically, I am not sure how many athletic training programs have lasers.  Does anyone have any experiences using one?  What kind of outcomes have people seen?

Written by: Nicole Cattano 
Reviewed by: Stephen Thomas

Related Posts:
Malliaropoulos N, Kiritsi O, Tsitas K, Christodoulou D, Akritidou A, Del Buono A, & Maffulli N (2012). Low-level laser therapy in meniscal pathology: a double-blinded placebo-controlled trial. Lasers in Medical Science PMID: 23093133


Kelly Golob DC said...

Interesting article, I have had success with LLLT in treating meniscus injuries (preventing surgery in a patient who had tried everything else) and accelerating fracture healing (displaced Boxer's fracture that was able to get her cast off in less than 4 weeks). Here are some articles I have written on my blog about other studies of LLLT for neck pain, and bone healing.

Comment via Google+ - Douglas Johnson said...

I've used LLLT extensively over the past 10 years... You ask some very good questions in your post. So far, I don't believe there have been follow up imaging of the knees to validate "tissue" repair following LLLT application. This would be interest, however, without good funding, it would be outside the scope of most university settings to perform.

The mechanisms of light/tissue interaction are at best "fuzzy". We have bits and pieces, but there is clearly no big pictures, and as we study the topic more, we find there are more pathways involved than previously thought.

My experience with any anatomical deficit, laser therapy may improve symptoms but cannot completely "heal" an injury that requires surgical correction. It may just delay it to another time.

As to your question of laser accessibility at collegiate level, this is certainly improving. Most ATs have access to the equipment, either through direct purchase or donation to the school.

Nicole Cattano said...

Thank you for your comments. I am fascinated by your previous experiences utilizing LLLT. It seems like a very interesting and complicated potential pathophysiologic mechanism in which it improves patient outcomes, and possibly slowing down or reverting damaged tissues. The boxer's fracture seems very interesting to me Kelly. It makes sense to me since it is superficial, I become less clear when this therapy works in deeper tissues. Does the energy actually get that deep?

Patient outcomes drive a lot of what we do. But my curiosity is peaked by Douglas's points. If surgery can, in fact, be delayed to another it purely symptom management or are we structurally slowing or modifying the injury process? This has potentially large implications in how we manage orthopedic injuries. Thanks for sharing!

Anonymous said...

I personally had a full thickness degenerative tear of the medial meniscus 5 years ago. Surgical repair was denied to me as it was not expected to produce a favourable outcome in my case. The surgeon's advice was "see me when you're ready for a joint replacement, I was 42 at the time. I used LLLT daily and consumed 12g of N-Acetyl D Glucosamine daily. After six months of this regimen I have been symptom free with full function including running, deep squatting, squash and any other abuse I throw at it. I've never had a follow up MRI to see what it looks like.

Stephanie Michel said...

I like the idea of using LLLT for the treatment of the pain of meniscal injuries. However, if the meniscus is never getting fixed, down the road, won't there be more degeneration of the cartilage? Isn't the LLLT only a temporary fix for the symptoms associated with meniscal issues?

Nicole Cattano said...

Anonymous, I am glad that you have had such great outcomes utilizing LLLT as a concommittant therapy to your supplementation regime.

While the use of LLLT has demonstrated effective symptom management in the clinical and research environments, it still remains unclear as to WHY the therapy provides symptom management. Is it nuerological, biochemical, or perhaps psychological?

So Stephanie, to your point, we do not know what the modality is doing from a pathophysiologic standpoint. Therefore, we do not know if there will be more degradation or not. LLLT may actually be slowing the OA progression down, ultimately resolving further degradation.

Definitely a sign that more needs to be looked into for this modality.

Sneha said...
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