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First published on February 13, 2006, doi:10.1177/0363546505286139
This version was published on July 1, 2006
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The American Journal of Sports Medicine 34:1094-1102 (2006)
© 2006 American Orthopaedic Society for Sports Medicine

Low-Intensity Pulsed Ultrasound Accelerates and a Nonsteroidal Anti-inflammatory Drug Delays Knee Ligament Healing

Stuart J. Warden, BPhysio (Hons), PhD*, Keith G. Avin, MS, Erin M. Beck, PTA, Marie E. DeWolf, ATC, Molly A. Hagemeier and Kristin M. Martin

From the Department of Physical Therapy, Indiana University, Indianapolis, Indiana

* Address correspondence to Stuart J. Warden, BPhysio (Hons), PhD, Department of Physical Therapy, Indiana University, 1140 W. Michigan Street, CF-326, Indianapolis, IN 46202 (e-mail: stwarden{at}iupui.edu).

Background: Low-intensity pulsed ultrasound and nonsteroidal anti-inflammatory drugs are used to treat ligament injuries; however, their individual and combined effects are not established.

Hypotheses: Low-intensity pulsed ultrasound accelerates ligament healing, a nonsteroidal anti-inflammatory drug delays healing, and the nonsteroidal anti-inflammatory drug inhibits the beneficial effect of low-intensity pulsed ultrasound.

Study Design: Controlled laboratory study.

Methods: Sixty adult rats underwent bilateral transection of their knee medial collateral ligaments. Animals were divided into 2 drug groups and treated 5 d/wk with celecoxib (5 mg/kg) mixed in a vehicle solution (NSAID group) or vehicle alone (VEH group). One to 3 hours after drug administration, all animals were treated with unilateral active low-intensity pulsed ultrasound and contralateral inactive low-intensity pulsed ultrasound. Equal numbers of animals from each drug group were mechanically tested at 2 weeks (n = 14/group), 4 weeks (n = 8/group), and 12 weeks (n = 8/group) after injury.

Results: Ultrasound and drug intervention did not interact to influence ligament mechanical properties at any time point. After 2 weeks of intervention, ligaments treated with active low-intensity pulsed ultrasound were 34.2% stronger, 27.0% stiffer, and could absorb 54.4% more energy before failure than could ligaments treated with inactive low-intensity pulsed ultrasound, whereas ligaments from the NSAID group could absorb 33.3% less energy than could ligaments from the VEH group. There were no ultrasound or drug effects after 4 and 12 weeks of intervention.

Conclusions: Low-intensity pulsed ultrasound accelerated but did not improve ligament healing, whereas the nonsteroidal anti-inflammatory drug delayed but did not impair healing. When used in combination, the beneficial low-intensity pulsed ultrasound effect was cancelled by the detrimental nonsteroidal anti-inflammatory drug effect.

Clinical Relevance: Low-intensity pulsed ultrasound after ligament injury may facilitate earlier return to activity, whereas non-steroidal anti-inflammatory drugs may elevate early reinjury risk.

Key Words: biomechanics • ligament healing • medial collateral ligament (MCL) • therapeutic ultrasound




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