Avaliação dos efeitos da Terapia laser de baixa intensidade associada ou não ao treinamento resistido no tratamento da osteoartrite de joelho

Abstract

The aim of the thesis was to present the effects of LLLT, physical exercise and their association on joint cartilage catabolism in the knees of rats submitted to an experimental model of osteoarthritis induced by anterior cruciate ligament (TLCA) transection. For this, a brief systematic review was initially performed where interventions in experimental and clinical studies with animals were considered. The search was performed in the Medline, PubMed, Scopus, Cochrane databases and by active search in a list of bibliographic references of the articles selected until October 2016. The research was carried out according to the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta- Analyzes). We searched the databases with the following terminologies for animal studies: laser therapy and exercise and knee osteoarthritis and animal model. The analyzes of the content of the selected clinical trials demonstrated that LLLT associated therapeutical exercises that can be used to improve pain and quality of life are: resistance exercises and resistance exercises associated with stretching. However, these are not methodologically sufficient to demonstrate improved functionality presenting moderate quality for animal studies and high quality for clinical studies. As the clinical studies included in this systematic review have a high methodological quality, it can be concluded that the therapeutic exercises used by the studies improved pain and functionality in knee OA. However, we suggest experimental studies with animals that may present higher methodological quality to explain the mechanisms of action of therapeutic resources. For this, the second study, investigated the effects of the protocol of resistance exercises and LLLT (associated or not) on the metabolism of cartilage in an experimental model of OA in the knee. Forty male Wistar rats were randomly divided into 4 groups: OA control (OAC); OA and LLLT (OAL); OA and Exercise (OAE); OA and Exercise and Laser (OAEL). The resisted exercise program started 2 weeks after the ACL injury, and were performed three times a week for 8 weeks, totaling 24 sessions consisting of climbing exercises with weights attached to their tails and laser irradiation (two- The results showed that all treated groups had the capacity to modulate some of the aspects related to the degenerative process due to ligament transection, but the association of resistance exercise with LLLT significantly decreased the density of chondrocytes (With or without LLLT) modulated the immunoexpression of IL-1β, caspase-3 and MMP-13. These results suggest that resisted exercises modulate the changes The present work evidences the great need of experimental studies that may explain the clinical mechanisms that favor the use of these resources. In the treatment of patients with OA in the knee.