Effectiveness of Low-level Laser Therapy
Condition: Rotator Cuff Tears; Rehabilitation; Rotator Cuff Injuries
MeSH terms: Rotator Cuff Injuries
Study type: Interventional

Summary: 
      During rotator cuff tear healing stages, there are complex interactions between a variety of
      tissue growth factors and cells, ultimately resulting in tissue that is markedly different
      from that of normal, uninjured tendon. Hence, there is a strong drive to investigate the role
      of potential therapies in the form of biological augments that may restore the pathologic
      tissue to a near normal physiological state. In this context, low-level laser therapy (LLLT)
      may be an effective choice in the treatment of nonoperative small and medium-sized rotator
      cuff tears (RCT). To the best of our knowledge, there is no randomized controlled study
      investigating the effects of the LLLT in patients with a arthroscopic rotator cuff repair
      (ARCR). Therefore, the aim of the current study is to investigate all the possible effects of
      the LLLT in terms of functional status, pain-free mobility, and quality-of-life.
    

Detailed description: 
      Recently, there is a increasing evidence that the addition of low-level laser therapy (LLLT)
      to treatment program of shoulder problems plays an important role in stimulation of healing,
      augmenting tissue repair, relief of pain and inflammation, and restoration of function. LLLT,
      phototherapy or photobiomodulation refers to the use of photons at a non-thermal irradiance
      to alter biological activity. The basic biological mechanism behind the effects of LLLT is
      thought to be through absorption of red and near infrared light by mitochondrial
      chromophores, in particular cytochrome c oxidase (CCO) which is contained in the respiratory
      chain located within the mitochondria, and perhaps also by photoacceptors in the plasma
      membrane of cells. It is hypothesized that this absorption of light energy may cause
      photodissociation of inhibitory nitric oxide from CCO9 leading to enhancement of enzyme
      activity, electron transport, mitochondrial respiration and adenosine triphosphate (ATP)
      production. In turn, LLLT alters the cellular redox state which induces the activation of
      numerous intracellular signaling pathways, and alters the affinity of transcription factors
      concerned with cell proliferation, survival, tissue repair and regeneration.

      During rotator cuff tear healing stages, there are complex interactions between a variety of
      tissue growth factors and cells, ultimately resulting in tissue that is markedly different
      from that of normal, uninjured tendon. Hence, there is a strong drive to investigate the role
      of potential therapies in the form of biological augments that may restore the pathologic
      tissue to a near normal physiological state. In this context, LLLT may be an effective choice
      in the treatment of nonoperative small and medium-sized rotator cuff tears (RCT). o the best
      of our knowledge, there is no randomized controlled study investigating the effects of the
      LLLT in patients with a arthroscopic rotator cuff repair (ARCR). Therefore, the aim of the
      current study is to investigate all the possible effects of the LLLT in terms of functional
      status, pain-free mobility, and quality-of-life.
    

Intervention name(s): In addition to the conservative treatment, Low-level laser therapy; In addition to the conservative treatment, Low-level laser therapy (turned off); Conservative treatment solely
Intervention type(s): Other; Other; Other
Intervention description(s): For Experimental Group A Gallium-aluminum-arsenide (Ga-Al-As) diode laser instrument (Roland Serie, Elettronica Pagani, Paderno, Italy, Mod IR 27/1) will be used (wavelength 904 nm, 5500 Hz frequency, 27 W maximum power output per pulse, 13.2 mW average power, 0.8-cm2 spot size, 1.6 J of total energy will be delivered per point at each session at a power density of 16.5 mW/cm2, and the cumulative energy per point for all sessions was 16 J).
Ga-Al-As laser therapy will be applied to experimental group patients two times per week for 6 weeks in 10-min sessions. LLLT will be applied over the tuberculum majus and minus, the anterior and posterior faces of the capsule, and the subacromial regions. Each point will be treated for 120 sec. The head of the instrument will be held perpendicular to the body surface and in skin contact without pressure.; For Placebo Group In the placebo group, laser instrument will be applied in the same way but the device will be turned off during treatment sessions. Patients and physiotherapist will be asked to use protective eyeglasses during therapy for safety.; For Control Group All patients using an immobilization bandage up to post-operative 6th week will receive the standardized 6-week supervised rehabilitation program advocated by the same physiotherapist (CK), 7 years of experience in the clinical treatment of rotator cuff tear, after the baseline assessment. Composed of 30 treatment sessions (five days/week) of 45 to 60 minutes, the rehabilitation program will be provided individually to all participants. Physiotherapy sessions will be devoted to strength, mobilizations, stretching, perturbation, and sensorimotor training using motor control exercises, hence, to restore adequate shoulder neuromuscular control. The treatment program will also be included patient education.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Laser Therapy; Low-Level; Biostimulation; Phototherapy; Rotator Cuff Injuries; Rotator Cuff Tears