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A utilização do ultra som com a finalidade de acelerar o reparo tecidual é muito freqüente na prática clínica, embora as bases científicas para sua utilização não estejam bem estabelecidas. Este estudo analisou os efeitos do ultra som na cicatrização de tendões flexores de coelhos após tenorrafia. Foram utilizados 30 coelhos da raça Nova Zelândia, com peso médio de 2,7 Kg, divididos em dois grupos de 15 animais submetidos a tenotomia e tenorrafia com sutura tipo Kessler do tendão flexor profundo do terceiro dedo da pata dianteira direita. Após 24 horas foi iniciado em um dos grupos tratamento com ultra som, sendo o outro grupo utilizado para controle. A freqüência utilizada foi a de 3 MHz e a intensidade de 0,8 W/centímetro quadrado (SATA), por contato direto durante 7 dias consecutivos. Cada grupo foi dividido em subgrupos com 5 animais cada, e estes sacrificados em períodos distintos (8, 15 e 30 graus PO), e o tendão operado, dissecado e submetido à análise histológica pela microscopia de luz, analisando a reação inflamatória, grau de necrose, proliferação de fibroblastos, deposição de colágeno e formação de granuloma. Os resultados mostraram que o ultra som interferiu com o processo de reparo tecidual após a tenorrafia dos tendões flexores de coelhos / The use of ultrasound aiming to accelerate tissue healing is very frequent in clinical pratice, although the scientific basis to its use are not well established. This study analized the effects of ultrasound on the healing of rabbit’s flexor tendons after repair. It was used 30 New Zealand rabbits, with an average weight of 2.7 Kg, divided in two groups of 15 animal. They were submetted to tenotomy and repair with Kessler’s suture on deep flexor tendon of the middle right front claw. After 24 hour one of the groups started the ultrasound treatment, and the other was de control group. The ultrasound frequency used was 3 MHz and the intensity was 0.8 W/square cemtimeter (SATA), by direct contact during 7 consecutive days. Each group was divided in subgroups with 5 animals each, and these were killed in distincts periods (PO 8, 15 and 30), and the operated tendon was dissected and submitted to histologic analises by light microscopy, anlaysing the inflammatory reaction, necrosis degree, fibroblasts proliferation, colagen synthesis and granulom formation. The result showed that ultrasound interfere on the tissue healing process after repair on the rabbit’s flexor tendons

<p>Tendon healing is a slow process and the tendon may not regain its initial mechanical properties after rupture. Mechanical stimuli have shown to have positive effect on tendon healing. This study is the first to investigate the effect of vibration stimuli on healing tendons. Vibration was also compared to treadmill running, which has previously been used for mechanical stimuli.63 female Sprauge-Dawley rats were used. A 3 mm segment was removed from the Achilles tendon and the tendon was left to heal. The animals were subjected to 15 min of daily exercise, vibration or treadmill running or acted as controls without exercise. The study was divided into three experiments. Experiment 1; the animals had full time cage activity and was randomized into running, vibration and control group. Experiment 2; the animals were unloaded and randomized into vibration, running and control group. There was also a control group with full time cage activity in experiment 2. Experiment 3; the animals were unloaded and randomized into vibration and placebo group. 14 days after surgery the animals were killed and mechanical testing of the Achilles tendons was performed. The results showed no significant difference between the groups in experiment 1. Experiment 2 showed that controls with full time cage activity had higher peak load, stiffness and cross sectional area than unloaded running, vibration and control groups. In experiment 3, there was no significant difference between vibration and placebo group. In conclusion, this study shows that vibration, as applied here, does not affect tendon healing.</p>

Tendon healing is a slow process and the tendon may not regain its initial mechanical properties after rupture. Mechanical stimuli have shown to have positive effect on tendon healing. This study is the first to investigate the effect of vibration stimuli on healing tendons. Vibration was also compared to treadmill running, which has previously been used for mechanical stimuli.63 female Sprauge-Dawley rats were used. A 3 mm segment was removed from the Achilles tendon and the tendon was left to heal. The animals were subjected to 15 min of daily exercise, vibration or treadmill running or acted as controls without exercise. The study was divided into three experiments. Experiment 1; the animals had full time cage activity and was randomized into running, vibration and control group. Experiment 2; the animals were unloaded and randomized into vibration, running and control group. There was also a control group with full time cage activity in experiment 2. Experiment 3; the animals were unloaded and randomized into vibration and placebo group. 14 days after surgery the animals were killed and mechanical testing of the Achilles tendons was performed. The results showed no significant difference between the groups in experiment 1. Experiment 2 showed that controls with full time cage activity had higher peak load, stiffness and cross sectional area than unloaded running, vibration and control groups. In experiment 3, there was no significant difference between vibration and placebo group. In conclusion, this study shows that vibration, as applied here, does not affect tendon healing.

A utilização do ultra som com a finalidade de acelerar o reparo tecidual é muito freqüente na prática clínica, embora as bases científicas para sua utilização não estejam bem estabelecidas. Este estudo analisou os efeitos do ultra som na cicatrização de tendões flexores de coelhos após tenorrafia. Foram utilizados 30 coelhos da raça Nova Zelândia, com peso médio de 2,7 Kg, divididos em dois grupos de 15 animais submetidos a tenotomia e tenorrafia com sutura tipo Kessler do tendão flexor profundo do terceiro dedo da pata dianteira direita. Após 24 horas foi iniciado em um dos grupos tratamento com ultra som, sendo o outro grupo utilizado para controle. A freqüência utilizada foi a de 3 MHz e a intensidade de 0,8 W/centímetro quadrado (SATA), por contato direto durante 7 dias consecutivos. Cada grupo foi dividido em subgrupos com 5 animais cada, e estes sacrificados em períodos distintos (8, 15 e 30 graus PO), e o tendão operado, dissecado e submetido à análise histológica pela microscopia de luz, analisando a reação inflamatória, grau de necrose, proliferação de fibroblastos, deposição de colágeno e formação de granuloma. Os resultados mostraram que o ultra som interferiu com o processo de reparo tecidual após a tenorrafia dos tendões flexores de coelhos / The use of ultrasound aiming to accelerate tissue healing is very frequent in clinical pratice, although the scientific basis to its use are not well established. This study analized the effects of ultrasound on the healing of rabbit’s flexor tendons after repair. It was used 30 New Zealand rabbits, with an average weight of 2.7 Kg, divided in two groups of 15 animal. They were submetted to tenotomy and repair with Kessler’s suture on deep flexor tendon of the middle right front claw. After 24 hour one of the groups started the ultrasound treatment, and the other was de control group. The ultrasound frequency used was 3 MHz and the intensity was 0.8 W/square cemtimeter (SATA), by direct contact during 7 consecutive days. Each group was divided in subgroups with 5 animals each, and these were killed in distincts periods (PO 8, 15 and 30), and the operated tendon was dissected and submitted to histologic analises by light microscopy, anlaysing the inflammatory reaction, necrosis degree, fibroblasts proliferation, colagen synthesis and granulom formation. The result showed that ultrasound interfere on the tissue healing process after repair on the rabbit’s flexor tendons

Um dos recursos mais utilizados no processo de reparo de lesões tendíneas é o laser que demonstrou ter resultados satisfatórios quando se buscam efeitos antiinflamatório e cicatrizante. No entanto, por requerer uma tecnologia de alto custo, um outro tipo de fototerapia vem sendo buscado, como o diodo emissor de luz, LED. Porém, o número de pesquisas realizadas para a determinação segura de seus efeitos terapêuticos ainda é muito pequeno, inviabilizando uma proposta de protocolo para adoção do LED. Um outro recurso também utilizado durante a reabilitação de lesões tendíneas, é o ultra-som pulsado de baixa intensidade (LIPUS). Trabalhos realizados até o momento mostram alterações satisfatórias quanto à deposição e alinhamento das fibras de colágeno. Este estudo objetiva testar comparativamente a eficácia da aplicação de LEDs 630 nm e 830 nm em relação à terapia laser de baixa intensidade (LILT), com laser de 685 nm e 830 nm, e à terapia com LIPUS em tendão calcâneo parcialmente lesado. Foram utilizados 56 ratos Wistar, submetidos à lesão mecânica parcial do tendão calcâneo. A análise da evolução do processo foi realizada através da microscopia de polarização. Os resultados mostraram uma real eficácia dos tratamentos com LEDs e lasers, e uma ineficácia do tratamento à base de US. Nosso estudo sugere que uma boa organização e um bom alinhamento das fibras de colágeno são conseguidos no processo de reparo de lesões tendíneas através de aplicações à base de LED 880 nm e laser 630 nm, os quais se mostraram mais eficazes. No entanto, outras pesquisas na área se fazem necessárias para uma determinação segura e eficaz dos protocolos de tratamento utilizando essa modalidade de fototerapia. / Laser is one of the most effective resources of treatment for tendinous injury when anti-inflammatory and cicatrizing effects are wanted. However, it is considered an expensive treatment and so, an alternative and cheaper light therapy as effective as it has been searched and the light emitting diodes, LEDs, are a promising candidate for it. Results from the studies already done have been useful to predict the possible effects of LED on the injured tissues, but are not enough to establish a treatment protocol that guarantees its recommendation as a substitute therapeutic tool for tendinous injury treatment. Another promising resource for tendinous injury healing is the ultra-sound of low intensity (LIPUS). Studies done until the present moment have shown satisfactory results when deposition and alignments of collagens fibers are wanted. The aim of this study was to compare the effects of laser, light emitting diodes (LEDs) and ultra-sound of low intensity on the treatment of Achilles tendon of albino rats, Wistar lineage, exposed to mechanical trauma. The experimental model consisted of a partial mechanical lesion of the right Achilles tendon of 56 rats, which were divided in 6 groups, 5 with 10 animals and one, the control group, with 6. One hour after the lesion, the injured animals received the respective applications of laser, LED or US, and the same procedure was repeated each 24 h. The healing process and the deposition were evaluated by analyze of the alignment of collagens fibers through polarization microscopy. The results showed a real efficiency of treatments based on LEDs and lasers, but the treatment based on US was inefficient. Applications of laser at 830 and LED 880 nm were more efficient when the aim is a good organization and alignment of the collagen fibers on tendon healing. However more research is needed for a safety and more efficient determination of a protocol.

Foi realizado um estudo experimental dos efeitos do ultra-som terapêutico sobre a resistência à tração de tendões flexores em cicatrização, usando o tendão flexor dos dedos de coelho como modelo. Foram utilizados 25 coelhos fêmea, da raça Nova Zelândia, adultos jovens de 3 Kg de peso corporal médio. Todos os animais foram operados sob anestesia geral para terem o tendão flexor profundo do terceiro dedo da pata dianteira direita seccionado e imediatamente reparado com a técnica de Kessler. As patas operadas eram imobilizadas com uma órtese de material termoplástico durante todo o período do experimento (4 semanas) e os animais foram distribuídos em dois grupos ( A e B) de acordo com o tratamento pós-operatório. No grupo A (13 animais) todos os animais receberam uma aplicação diária de 6 minutos de duração de ultra-som pulsado (1:5), regulado para uma freqüência de 3 MHz e intensidade de 0,8 W/cm², por sete dias consecutivos começando do primeiro dia. O grupo B (12 animais) era apenas de controle. Quatro semanas mais tarde, os animais eram mortas e todo o tendão operado era ressecado, incluindo a junção miotendínea e o segmento distal, e submetidos aos testes de resistência à tração na máquina universal de ensaios. Gráficos das cargas versus a deformação foram obtidos, permitindo a análise dos parâmetros carga e deformação máximas, carga e deformação no limite de proporcionalidade e rigidez. Os resultados mostraram que não houve diferenças significantes entre os grupos A e B, levando à conclusão de que o ultra-som terapêutico não tem influência no curso do processo de cicatrização dos tendões, particularmente no que se refere à resistência mecânica. / An experimental study of the effects of the therapeutic ultrasound on the resistance to traction of healing flexor tendons carried out using the rabbit flexor tendon as model. Twenty five young adult female New Zeland rabbits of average 3 Kg body weight were used. All the animals were operated under general anesthetics to have the profundus flexor tendon of the third finger of the right forepaw divided and immediately repaired with Kessler technique. The operated on paw was immobilized with an orthesis made of thermoplastic material for the entire length of the experiment (four weeks) and the animals were divided in two groups (A and B), according to the postoperative treatment. In group A (13 animals) all animals received one 6 minutes daily application of pulsed ultrasound (1:5), set for 3 MHz frequence and 0,8 W/cm² intensity, for seven consecutive days beginning on the first postoperative day. Group B (12 animals) was for control only. Four weeks later, the animals were killed, the entire operated tendons were resected including the myotendinous junction and the distal segment and submitted to the test of resistance to traction in a universal testing machine. Load versus deformation graphs were obtained allowing for the analysis of the parameters maximum load and deformation, load and deformation in the limit of proportionality, and stiffness. The results showed that there was no significant difference between groups A and B, leading to the conclusion that therapeutic ultrasound does not influence the course of the tendon healing process, as refers to mechanical resistance.

Foi realizado um estudo experimental dos efeitos do ultra-som terapêutico sobre a resistência à tração de tendões flexores em cicatrização, usando o tendão flexor dos dedos de coelho como modelo. Foram utilizados 25 coelhos fêmea, da raça Nova Zelândia, adultos jovens de 3 Kg de peso corporal médio. Todos os animais foram operados sob anestesia geral para terem o tendão flexor profundo do terceiro dedo da pata dianteira direita seccionado e imediatamente reparado com a técnica de Kessler. As patas operadas eram imobilizadas com uma órtese de material termoplástico durante todo o período do experimento (4 semanas) e os animais foram distribuídos em dois grupos ( A e B) de acordo com o tratamento pós-operatório. No grupo A (13 animais) todos os animais receberam uma aplicação diária de 6 minutos de duração de ultra-som pulsado (1:5), regulado para uma freqüência de 3 MHz e intensidade de 0,8 W/cm², por sete dias consecutivos começando do primeiro dia. O grupo B (12 animais) era apenas de controle. Quatro semanas mais tarde, os animais eram mortas e todo o tendão operado era ressecado, incluindo a junção miotendínea e o segmento distal, e submetidos aos testes de resistência à tração na máquina universal de ensaios. Gráficos das cargas versus a deformação foram obtidos, permitindo a análise dos parâmetros carga e deformação máximas, carga e deformação no limite de proporcionalidade e rigidez. Os resultados mostraram que não houve diferenças significantes entre os grupos A e B, levando à conclusão de que o ultra-som terapêutico não tem influência no curso do processo de cicatrização dos tendões, particularmente no que se refere à resistência mecânica. / An experimental study of the effects of the therapeutic ultrasound on the resistance to traction of healing flexor tendons carried out using the rabbit flexor tendon as model. Twenty five young adult female New Zeland rabbits of average 3 Kg body weight were used. All the animals were operated under general anesthetics to have the profundus flexor tendon of the third finger of the right forepaw divided and immediately repaired with Kessler technique. The operated on paw was immobilized with an orthesis made of thermoplastic material for the entire length of the experiment (four weeks) and the animals were divided in two groups (A and B), according to the postoperative treatment. In group A (13 animals) all animals received one 6 minutes daily application of pulsed ultrasound (1:5), set for 3 MHz frequence and 0,8 W/cm² intensity, for seven consecutive days beginning on the first postoperative day. Group B (12 animals) was for control only. Four weeks later, the animals were killed, the entire operated tendons were resected including the myotendinous junction and the distal segment and submitted to the test of resistance to traction in a universal testing machine. Load versus deformation graphs were obtained allowing for the analysis of the parameters maximum load and deformation, load and deformation in the limit of proportionality, and stiffness. The results showed that there was no significant difference between groups A and B, leading to the conclusion that therapeutic ultrasound does not influence the course of the tendon healing process, as refers to mechanical resistance.

Um dos recursos mais utilizados no processo de reparo de lesões tendíneas é o laser que demonstrou ter resultados satisfatórios quando se buscam efeitos antiinflamatório e cicatrizante. No entanto, por requerer uma tecnologia de alto custo, um outro tipo de fototerapia vem sendo buscado, como o diodo emissor de luz, LED. Porém, o número de pesquisas realizadas para a determinação segura de seus efeitos terapêuticos ainda é muito pequeno, inviabilizando uma proposta de protocolo para adoção do LED. Um outro recurso também utilizado durante a reabilitação de lesões tendíneas, é o ultra-som pulsado de baixa intensidade (LIPUS). Trabalhos realizados até o momento mostram alterações satisfatórias quanto à deposição e alinhamento das fibras de colágeno. Este estudo objetiva testar comparativamente a eficácia da aplicação de LEDs 630 nm e 830 nm em relação à terapia laser de baixa intensidade (LILT), com laser de 685 nm e 830 nm, e à terapia com LIPUS em tendão calcâneo parcialmente lesado. Foram utilizados 56 ratos Wistar, submetidos à lesão mecânica parcial do tendão calcâneo. A análise da evolução do processo foi realizada através da microscopia de polarização. Os resultados mostraram uma real eficácia dos tratamentos com LEDs e lasers, e uma ineficácia do tratamento à base de US. Nosso estudo sugere que uma boa organização e um bom alinhamento das fibras de colágeno são conseguidos no processo de reparo de lesões tendíneas através de aplicações à base de LED 880 nm e laser 630 nm, os quais se mostraram mais eficazes. No entanto, outras pesquisas na área se fazem necessárias para uma determinação segura e eficaz dos protocolos de tratamento utilizando essa modalidade de fototerapia. / Laser is one of the most effective resources of treatment for tendinous injury when anti-inflammatory and cicatrizing effects are wanted. However, it is considered an expensive treatment and so, an alternative and cheaper light therapy as effective as it has been searched and the light emitting diodes, LEDs, are a promising candidate for it. Results from the studies already done have been useful to predict the possible effects of LED on the injured tissues, but are not enough to establish a treatment protocol that guarantees its recommendation as a substitute therapeutic tool for tendinous injury treatment. Another promising resource for tendinous injury healing is the ultra-sound of low intensity (LIPUS). Studies done until the present moment have shown satisfactory results when deposition and alignments of collagens fibers are wanted. The aim of this study was to compare the effects of laser, light emitting diodes (LEDs) and ultra-sound of low intensity on the treatment of Achilles tendon of albino rats, Wistar lineage, exposed to mechanical trauma. The experimental model consisted of a partial mechanical lesion of the right Achilles tendon of 56 rats, which were divided in 6 groups, 5 with 10 animals and one, the control group, with 6. One hour after the lesion, the injured animals received the respective applications of laser, LED or US, and the same procedure was repeated each 24 h. The healing process and the deposition were evaluated by analyze of the alignment of collagens fibers through polarization microscopy. The results showed a real efficiency of treatments based on LEDs and lasers, but the treatment based on US was inefficient. Applications of laser at 830 and LED 880 nm were more efficient when the aim is a good organization and alignment of the collagen fibers on tendon healing. However more research is needed for a safety and more efficient determination of a protocol.

Nitric oxide is a small free radical generated by family of enzymes, the nitric oxide synthases. In a series of experiments performed over the last 15 years we showed that nitric oxide is induced by all three isoforms of nitric oxide synthase during tendon healing and that it plays a crucial beneficial role in restoring tendon function. In normal tendon we found very little nitric oxide synthase activity while in injured rat and human tendons nitric oxide synthase activity was expressed in healing fibroblasts in a temporal fashion. In healing rat Achilles tendon fibroblasts the first isoform to be expressed was endothelial nitric oxide synthase (eNOS), followed by inducible nitric oxide synthase (iNOS), and then brain or neuronal nitric oxide synthase (bNOS). Systemic inhibition of nitric oxide synthase activity decreased the cross sectional area and mechanical properties of the healing rodent Achilles tendons. Addition of nitric oxide via NO-flurbiprofen or NO-paracetamol enhanced rat Achilles tendon healing. Addition of nitric oxide to cultured human tendon cells via chemical means and via adenoviral transfection enhanced collagen synthesis, suggesting that one mechanism for the beneficial of nitric oxide on tendon healing might be via matrix synthesis. The final part of the work involved three randomized, double-blind clinical trials which evaluated the efficacy of nitric oxide donation via a patch in the management of the tendinopathy. In all three clinical trials there was a significant positive beneficial effect of nitric oxide donation to the clinical symptoms and function of patients with Achilles tendinopathy, tennis elbow and Achilles tendonitis.