Ligament injury is one of the most prevalent musculoskeletal disorders that may lead to disability or disease, such as osteoarthritis. Conservative interventions which accelerate or augment ligament healing are needed to enhance therapeutic outcomes. The purpose of this research agenda was to investigate the tissue level effects of a type of manual therapy, cross fiber massage (CFM), in particular instrument-assisted CFM (IACFM), on ligament healing.
Bilateral knee medial collateral ligament (MCL) injuries were created using an established rodent model where one MCL received IACFM treatment and the other untreated MCL served as a within subjects control. The short and long term effects of IACFM on the biomechanical and histological properties of repairing ligaments were investigated. Tensile mechanical testing was performed to determine ligament mechanical properties. Ligament histology was examined under light microscopy and scanning electron microscopy. IACFM was found to accelerate early ligament healing (4 weeks post-injury), possibly via favorable effects on collagen formation and organization, but minimal improvement was demonstrated in later healing (12 weeks post-injury).
Regional blood flow and angiogenesis were investigated as possible mechanisms underlying the accelerated healing found in IACFM-treated ligaments. Laser Doppler perfusion imaging was used to investigate vascular function. Microcomputed tomography was used to determine vascular structural parameters. Compared to untreated contralateral injured controls, IACFM-treated injured knees demonstrated a delayed increase in blood flow and altered microvascular structure, possibly suggesting angiogenesis.
Mechanotransduction is a proposed mechanism for the beneficial effects of CFM in that application of a mechanical force was found to enhance biomechanical and histological properties as well as vascular function and structure acutely in healing ligaments. Although this thesis focused on IACFM treatment of injured knee ligaments, it is plausible for concepts to apply to other manual modalities that offer conservative alternatives to invasive procedures or pharmaceuticals in the treatment of soft tissue injuries.
|2006||Provenzano PP, Vanderby R Jr. Collagen fibril morphology and organization: implications for force transmission in ligament and tendon. Matrix Biol. March 2006;25(2):71-84.|
|1987||Woo SL-Y, Inoue M, McGurk-Burleson E, Gomez MA. Treatment of the medial collateral ligament injury, II: structure and function of canine knees in response to differing treatment regimens. Am J Sports Med. January–February 1987;15(1):22-29.|
|1982||Woo SL-Y, Gomez MA, Woo Y-K, Akeson WH. Mechanical properties of tendons and ligaments, II: the relationships of immobilization and exercise on tissue remodeling. Biorheology. 1982;19(3):397-408.|
|2002||Provenzano PP, Heisey D, Hayashi K, Lakes R, Vanderby R Jr. Subfailure damage in ligament: a structural and cellular evaluation. J Appl Physiol. January 2002;92(1):362-371.|
|1994||Turner CH, Forwood MR, Otter MW. Mechanotransduction in bone: do bone cells act as sensors of fluid flow? FASEB J. August 1994;8(11):875-878.|
|1974||Noyes FR, Torvik PJ, Hyde WB, DeLucas JL. Biomechanics of ligament failure, II: an analysis of immobilization, exercise, and reconditioning effects in primates. J Bone Joint Surg. October 1974;56A(7):1406-1418.|
|2000||Woo SL-Y, Debski RE, Zeminski J, Abramowitch SD, Chan Saw SS, Fenwick JA. Injury and repair of ligaments and tendons. Annu Rev Biomed Eng. 2000;2:83-118.|
|1991||Weiss JA, Woo SL-Y, Ohland KJ, Horibe S, Newton PO. Evaluation of a new injury model to study medial collateral ligament healing: primary repair versus nonoperative treatment. J Orthop Res. July 1991;9(4):516-528.|
|2006||Tyler TF, McHugh MP, Mirabella MR, Mullaney MJ, Nicholas SJ. Risk factors for noncontact ankle sprains in high school football players: the role of previous ankle sprains and body mass index. Am J Sports Med. 2006;34(3):471-475.|
|2001||Cukierman E, Pankov R, Stevens DR, Yamada KM. Taking cell-matrix adhesions to the third dimension. Science. November 23, 2001;294(5547):1708-1712.|
|1995||Duncan RL, Turner CH. Mechanotransduction and the functional response of bone to mechanical strain. Calcif Tiss Int. December 1995;57(5):344-358.|
|1986||Woo SL-Y, Orlando CA, Camp JF, Akeson WH. Effects of postmortem storage by freezing on ligament tensile behavior. J Biomech. 1986;19(5):399-404.|
|2003||Amblard D, Lafage-Proust M-H, Laib A, Thomas T, Rüegsegger P, Alexandre C, Vico L. Tail suspension induces bone loss in skeletally mature mice in the C57BL/6J strain but not in the C3H/HeJ strain. J Bone Miner Res. March 2003;18(3):561-569.|
|2007||Duvall CL, Taylor WR, Weiss D, Wojtowicz AM, Guldberg RE. Impaired angiogenesis, early callus formation, and late stage remodeling in fracture healing of osteopontin‐deficient mice. J Bone Miner Res. February 2007;22(2):286-297.|
|2004||Duvall CL, Taylor WR, Weiss D, Guldberg RE. Quantitative microcomputed tomography analysis of collateral vessel development after ischemic injury. Am J Physiol Heart Circ Physiol. July 2004;287(1):H302-H310.|
|2006||Wang JH-C. Mechanobiology of tendon. J Biomech. 2006;39(9):1563-1582.|