Histomorphometric analysis of the Achilles tendon of Wistar rats treated with laser therapy and eccentric exercise
Authors: Souza Maria V. de , Moreira José do C.L. , Silva Micheline O. da , Crepaldi Júlio , Silva Carlos Henrique Osório , Garcia Silvana L.R. , Natali Antônio José 
Published: July 2016

Abstract: Low-level laser therapy is recommended for the treatment of tendinopathies despite the contradictory results related to the ideal dose of energy, wavelength and time of application. This study aimed to assess the effects of laser therapy and eccentric exercise on tendinopathy of the Achilles tendon of Wistar rats. Forty-eight adult male rats were randomly distributed into four groups (L= laser; E= eccentric exercise; LE = laser and eccentric exercise; and R= rest). Laser therapy (904nm/3J/cm2) and/or eccentric exercise (downhill walking; 15o incline treadmill; 12m/min; 50min/day) was started 24h after induction of unilateral tendinopathy and remained for 20 days. At 3, 7, 14 and 21 days after lesion induction, three rats from each group were euthanized and the tendons were collected for histological and morphometric analyses. There was no difference among groups or among times for the characteristics hemorrhage (p=0.4154), fibrinous adhesion formation (p=0.0712), and organization of collagen fibers (p=0.2583) and of the connective tissue (p=0.1046). For these groups, regardless of the time, eccentric exercise led to epitenon thickening (p=0.0204), which was lower in the group treated with laser therapy. Histological analysis revealed differences (p=0.0032) in the number of inflammatory cells over time. They were more numerous in the group that only exercised. This result was confirmed by morphometric analysis, which showed a significant interaction (groups x time) for this characteristic. Eccentric exercise increased (p=0.0014) the inflammatory infiltrate over time (3 and 21 days). However, association with laser therapy reduced inflammatory reaction. On the other hand, the combination of the treatments increased angiogenesis in morphometric (p=0.0000) and histological (p=0.0006) analyses compared with the other groups, while the isolated application of low-level laser reduced this characteristic over time. Animals maintained at rest presented the lowest amount (p=0.0000) of fibroblasts, according to the morphometric analysis. However, histological evaluation showed a significant group x time interaction (p=0.0024). Greater amounts of fibroblasts were observed in groups E, L and LE on the 7th, 14th and 21st days, respectively. The animals that received laser therapy and were exercised showed a greater (p=0.0000) amount of collagen fibers over time. Laser therapy at a dose of 3J and at a wavelength of 904nm, starting 24h after surgical induction of tendinopathy in Wistar rats, is suitable for angiogenesis and prevention of tendon thickening, which can be associated with the intensity of inflammatory process. When associated with eccentric exercise, the therapy has the advantage of increasing the amount of collagen fibers, reducing fibrinous adhesions and inflammatory infiltrate, despite prolonging angiogenesis. Therefore, eccentric exercise performed concomitantly with laser therapy improves the histological properties of the injured tendon.