Effect of hyperbaric oxygen therapy on patellar tendinopathy in a rabbit model.
BACKGROUND
Hyperbaric oxygen therapy is a method for augmenting oxygen availability to tissues. This study investigated the effect of hyperbaric oxygen therapy on the collagenase-induced tendinopathy in the rabbit patellar tendon.


METHODS
In this study, 13 rabbits were treated by ultrasound-guided injection of 0.025 mL collagenase into the patellar tendon at the right knee, with the left knee serving as a control condition. The rabbits were randomly divided into two groups. After tendinopathy had been confirmed by histologic examination 3 weeks after treatment, hyperbaric oxygen therapy was initiated for group 1. The hyperbaric oxygen therapy involved 30 daily sessions of 2.5 ATA for 120 minutes starting 6 weeks after treatment. The rabbits in group 2 were put in normobaric room air. Both groups were killed 10 weeks after treatment. Histologic examinations as well as mechanical and biochemical tests were performed after the animals were killed.


RESULTS
The ultimate tensile load in the tendon that had hyperbaric oxygen therapy was 34.8% greater than that in the control tendon 10 weeks after treatment (p < 0.05). Hydroxyproline concentrations increased 82.2% simultaneously in the tendons that had hyperbaric oxygen therapy, as compared with the concentrations in the control tendons (p < 0.05). However, no statistical difference was found between the two groups in terms of pyridinoline concentration at the 10th week (p > 0.05). The histologic examination demonstrated an increase in blastlike tenocytes in group 1, with more mature phenotype, more organized collagen matrix, absence of myxoid degeneration, and increased vascularity at the 10th week, as compared with the control knee.


CONCLUSIONS
The results validate the effectiveness of hyperbaric oxygen therapy in the treatment of tendinopathy. Hyperbaric oxygen therapy may increase collagen synthesis and collagen cross-link formation during the early healing process.
Hsu
Robert Wen-Wei
RW
Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia-Yi, Chia-Yi, Taiwan. wwh@cgmh.org.tw
Hsu
Wei-Hsiu
WH
Tai
Ching-Lung
CL
Lee
Kam-Fai
KF
D000596:Amino Acids / Q000032:analysis; D000818:Animals; D002851:Chromatography, High Pressure Liquid; D017364:Collagenases / Q000008:administration & dosage / Q000009:adverse effects*; D006931:Hyperbaric Oxygenation; D008297:Male; D023421:Models, Animal; D017847:Patellar Ligament / Q000187:drug effects / Q000473:pathology*; D011817:Rabbits; D011897:Random Allocation; D052256:Tendinopathy / Q000139:chemically induced / Q000628:therapy; D013708:Tendon Injuries / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D014463:Ultrasonography; D014945:Wound Healing / Q000502:physiology
D000596:Amino Acids; C015484:pyridinoline; D017364:Collagenases