The effect of intermittent hyperbaric oxygen on short term recovery from grade II medial collateral ligament injuries.
Soolsma, S.J. (English Abstract Available)
Abstract: Objective: To examine the hypothesis that intermittent exposure to hyperbaric oxygen (HBO) will increase the rate of recovery from a grade II medial collateral complex injury.
Design: A double blinded controlled study of a treatment group and control group of patients who experience an initial clinical assessment, a magnetic resonance imaging scan of the knee (MRI), two weeks of either HBO or sham treatment, a second MRI post-treatment and six weekly follow up visits after the injury.
Setting: Allan McGavin Sports Medicine Clinic, University of British Columbia, Vancouver, BC., Canada. Patients: Nineteen patients entered; 14 completed the clinical assessment portion, 9 of the fourteen completed pre and post treatment MRIs.
Interventions: Treatment group: ten HBO treatments consisted of 2 atmospheres absolute (ATA) for one hour with 100 percent oxygen (O2) in ten out of fourteen days in the first two weeks of recovery.
Control group: ten HBO treatments consisted of 1.2 ATA with air for one hour in ten out of fourteen days in the first two weeks of recovery
Main Outcome Measures: MRI pre-post treatment volumetric analysis; weekly assessments and comparisons of the injured and uninjured knee of: 1) a subjective questionnaire, 2) pain, 3) thigh girth, 4) knee girth, 5) range of motion, 6) maximum flexion, 7) one legged jump test. During the last three weeks a comparison of times straight running to a figure of eight course was made.
Results: Significant findings were found during the treatment period (the first two weeks) specifically. A more rapid decrease in the volume of edema in patients treatment with HBO as measured by MRI was observed. Patients treated with HBO also experienced less muscle wasting, greater range of motion and maximum flexion improvements. Comparisons of the running tests suggest a greater mobility during the 4th, 5th and 6th week of recovery. Analysis of variables measured throughout all the trials did not show any significance. Length of the study may have contributed to their insignificance.
Conclusions: Early intervention with HBO after a sports injury is beneficial in increasing the rate of recovery. Possible mechanisms are discussed.
LIGAMENTS; MEDIAL collateral ligament; WOUNDS & injuries; HYPERBARIC oxygenation
Reduction of sports injury morbidity with hyperbaric oxygen treatment.
Borromeo, C.N. (English Abstract Available) Abstract: The purpose of this study was to investigate the effect Hyperbaric Oxygen (HBO) treatment with standard rehabilitation and Sham HBO treatment with standard rehabilitation had on acute ankle sprains. Thirty subjects with acute ankle sprains were randomly assigned to HBO or Sham HBO treatment groups. The HBO treatment group received 3 HBO treatments in seven days with 100 percent oxygen at 2 Atmospheres/Absolute (ATA) pressure (n is 15). The Sham HBO treatment group received 3 Sham HBO treatments in seven days with medical air at 1.2 ATA (n is 15). Treatments were 90, 60, and 60 minutes for sessions 1, 2, and 3, respectively. All subjects were evaluated by an orthopaedic surgeon 72 hours post injury. The following dependent variables were used to assess the effect HBO treatment had on acute ankle sprains: perceived pain; edema; active and passive ranges of motion for dorsiflexion, plantar flexion, inversion, and eversion; function; and recovery time of the injured ankle. One, 2×1 ANOVA and eleven, 2x3x2 ANOVAs with repeated measures at the p less than .05 alpha level were used to analyze the 12 dependent variables with regard to acute ankle sprains. The F values for group indicated no significant differences between the HBO and Sham HBO treatment groups regardless of session and test. The F values for session indicated significant main effects regardless of test and group in all dependent variables except recovery time. The F values for test indicated significant main effects regardless of session and group in all dependent variables except active ankle plantar flexion, active ankle eversion, passive ankle plantar flexion, and recovery time. The results indicated improvements in perceived pain, edema, active and passive range of motion (dorsiflexion, plantar flexion, inversion, and eversion), function, and recovery time with regard to acute ankle sprains for both HBO and Sham HBO treatment groups. Additionally, significant interactions were revealed between sessions and tests for both groups regarding perceived pain, active and passive ankle dorsiflexion, and function. Subsequent tests for simple effects (Hotelling’s t-squared statistic (TSQ) at the p less than .05 alpha level and pairwise t-tests with the p level adjusted via the Bonferroni technique to determine where significant differences occurred were performed. The results indicated a decrease in perceived pain and an increase in active ankle dorsiflexion from pretest to posttest for the Sham HBO group only, and increases in passive dorsiflexion and function from session to session and pretest to posttest for both groups. In conclusion, HBO treatment had no significant effect on the reduction of morbidity of the acute ankle sprains. The natural healing process and standard rehabilitation may have improved the recovery of the ankle sprains regardless of treatment group. Although not significant and after removal of recovery time data of one outlier, the HBO treatment group recovered 5.14 days sooner than the Sham HBO treatment group.
ANKLE — Wounds & injuries; ANKLE; WOUNDS & injuries; REHABILITATION; HYPERBARIC oxygenation; COMPARATIVE studies
Effect of hyperbaric oxygen on type procollagen gene expression in the early phase of ligament healing.
Mashitori, H.; Sakai, H.; Ohtake, H., Japanese Journal of Clinical Sports Medicine 2002, Vol. 10 Issue 1, p90 (English Abstract Available) Abstract: The study examines type I procollagen gene expression in experimentally lacerated ligament by in situ hybridization histochemistry to determine the administration of hyperbaric oxygen to promote the early phase of ligament healing. In each of 30 Sprague-Dawley rats, a 2mm segment of the medial collateral ligament mid-substance, centered over the knee joint line, was removed to leave a gap between the opposing ends of the ligament. A total of 15 rats were exposed to hyperbaric oxygen at 2.5 ATA for 2 hours for 5 days a week, beginning the day of surgery (Group H), whereas the remaining 15 control rats were exposed only to room air(Group C). The animals were sacrificed at 3,7,14 days postoperatively, and the medial collateral ligaments were harvested. In situ hybridization histochemistry was performed with [<sup>35</sup>S] UTP-labeled RNA probe corresponding to a<sub>1</sub> (I)procollagen mRNA. All the healing ligaments showed an increased expression of type I procollagen gene especially in the scar tissue created between both ends of the ligament. At 7 or 14 days postoperatively, the level of gene expression was higher than that at 3 days in both groups, but in Group H, much more increase in gene expression was observed at 7 days compared to Group C. These results suggest that the administration of hyperbaric oxygen promotes the ligament healing process. ABSTRACT FROM AUTHOR
HYPERBARIC oxygenation; LIGAMENTS — Wounds & injuries; OXYGEN therapy; SPORTS medicine; SPORTS injuries; GENE expression