Title : Optimizing the regenerative effects on equine tendons and ligaments using a multi-frequency laser device as a standalone therapy: A methodological approach
Abstract:
In recent decades, extensive research has explored the effects of laser light on cells, resulting in well-documented photo-bio-modulation. The significant potential of laser light for tissue regeneration has been effectively applied to treat soft tissue injuries. Our developed methodology employs a multifrequency laser for transcutaneous application under precise skin thermal control to address tendon and ligament injuries in sports horses.The methodology was first validated through a clinical study (Pluim et al., 2018) and standardized experimental studies utilising diagnostic imaging (Pluim et al., 2020) and at the ultrastructural level (Pluim et al., 2022). In this retrospective clinical study, over 150 tendon and ligament lesions were treated between January 2021 and June 2023, using high-power multifrequency laser therapy under thermal control with individually customised parameters. The horses' ages ranged from 5 to 14 years old, with the majority competing in high-level show-jumping competitions. The 12-month follow-up was conducted through clinical examinations and analysis of competition entry records. Laser protocols included a combination of 3 to 4 wavelengths spanning from 450 to 980 nanometers. Commonly utilised laser wavelength combinations were 450, 660, 808 nanometers and 650, 808, 905 nanometers. Laser emissions were adjusted to continuous or interrupted-continuous modes (pulse duration > 100 ms) to enhance the photo-bio-modulation effect, with each micro-session lasting 10 to 40 seconds. Each treatment involved 3 to 20 micro-sessions. The horses underwent treatment for a period of 10 to 30 days, receiving a total of 8 to 20 sessions. The number of treatments increased depending on whether the lesion being treated was more acute or chronic. Total power density ranged from 2.5 to 6 Watt/cm2 at the skin surface, tailored based on skin photo-type. The thermal control system was regulated to temperatures ranging from 37 to 42 degrees, based on the pathology's phase (acute vs. chronic), considering inflammation levels and fluid presence confirmed through clinical and power doppler examinations. Power and energy settings were adapted according to injury site (depth from the skin), desired therapeutic effect, and lesion size. Parameters were dynamically adjusted as the pathology progressed, with feedback from the thermal control system guiding protocol adaptation. During treatment, blue and red light laser sources operated at power densities below 0.5 Watt/cm2, while infrared sources ranged from 1 to 3 Watts/cm2. Follow-up assessments demonstrated a notable reduction in rehabilitation time (6 to 8 weeks for controlled exercise) compared to traditional orthobiologic therapies. Re-injury rates varied from 5% to 12% based on lesion characteristics. Full recovery to pre-injury performance levels ranged from 4 to 5 months. This methodology presents itself as an independent regenerative approach for treating tendon and ligament injuries. By harnessing the benefits of both low and high-powered laser light, it shows promising outcomes in sport horses and holds potential for adaptation in human applications with appropriate modifications.
