Study Author

Sample Size

Gender Ratio (M/F)

Mean Age (years)

Condition

Intervention

Laser Specifications

Dosage

Comparator

Outcomes

Limitations

Akaltun et al. [13]

40

12 / 29

58.24 ± 9.73

Knee osteoarthritis

Group 1 (HILT),
Group 2 (EX)

BTL-6000 High
Intensity Laser (12 W, 1064 nm wavelength) Nd:YAG Laser

5 sessions per week for 2 weeks

Group 3 (PL + EX)

VAS, WOMAC scores, femoral cartilage thickness, and FROM improved significantly.

p<0.05

Low number of patients who were not followed up for long terms, and the exercise status of the patients was not questioned.

Alfredo et al. [14]

40

9 / 31

62.5

Knee osteoarthritis

active LLLT

gallium arsenide (60mW, 904 nm wavelenght)

3 times a week

placebo LLLT

The laser group had significant improvement in VAS & WOMAC between T1 and T2 and between T2 and T3.
There was also significant improvement in range of motion and functionality between T2 and T3.

VAS (p < 0.05) & WOMAC (p < 0.001) between T1 and T2 and between T2 and T3 (p=0.001).
ROM (p=0.01) and functionality (p= 0.001) between T2 and T3.

The small number of patients, the absence of a control group, and the absence of followup.

Alfredo et al. [15]

40 (20 vs 20)

-

-

Knee osteoarthritis

active LLLT + Ex

-

10 sessions over 3 weeks followed by 8 weeks of exercise

placebo LLLT + Ex

Daily consumption of rescue analgesics was significantly lower in the LLLT group at 6 months

p<0.05

Small sample size, short follow up.

Alfredo et al. [16]

40 (20 vs 20)

7 / 33

62.22

Knee osteoarthritis

active LLLT + Ex

gallium arsenide (60mW, 904 nm wavelenght)

3 times a week for 3 weeks, then combined LLLT + EX for 8 weeks in both groups

placebo LLLT + Ex

Reduced pain, disability, and intake of medication over a six-month period

Pain scores: 9.1 (1.3), 2.6 (2.3), 0.2 (0.9) and 0.2 (0.8) for the Laser Group
9.5 (8.0), 7.7 (5.3), 5.6 (2.4) and 7.4 (5.0) for the Placebo Group at 0,3,11 weeks and 6 months.

Disability scores: 14.9 (4.7), 7.6 (4.8), 3.9 (4.2) and 3.5 (4.1) for the Laser Group 17.8 (14.7), 15.2 (11.5), 11.6 (6.4) and 15.8 (11.9) for the Placebo Group at 0,3, 11 weeks, and 6 months.

Small sample size, absence of true placebo group

Amendolia et al. [17]

90 (45 vs 45)

53 / 37

55±11.2

Knee osteoarthritis

HPLT+GS 1500mg

GS - Dona (905nm wavelength, 4.5 W)

12 sessions, 3 per week

HPLT + Placebo

VAS, ADL, SSCT, Zohlen's sign, (RASPING), & Rabot test showed significant difference between groups at 6 months

p<0.05

-

Angelova et al. [18]

72 (37 vs 35)

-

65

Chronic Knee osteoarthritis

HILT

Semiconductive neodymium laser IV produced by BTL (1064 wavelenght, 12 W)

7 sessions

Sham laser

VAS and dolorimetry decreased significantly in the therapeutic group after seven days

p<0.001

Low sample size, lack of assessment of structural changes

Basford et al. [19]

81

-

-

Thumb Osteoarthritis

Helium Neon Laser

HeNe 0.9mW

3 times a week for 3 weeks

Sham laser

Slightly lessened tenderness of the treated MCP and IP joints in laser group.
Small increase in three-finger chuck pinch strength in laser group.

MCP: p<0.01
IP: p,0.05
Three finger chuck p<0.04

-

Bertolucci et al. [20]

32

-

-

TMJ degenerative joint disease

Mid laser treatment

COMBY -I infra-red laser (904nm wavelenght, 27 W)

9 sessions, 3 per week for 3 weeks

Placebo laser

Improvement in pain and biomechanics

p<0.01

-

Bertolucci et al. [21]

48 (16 vs 16 vs 16)

-

-

TMJ degenerative joint disease

Group 1: MENS
Group 2: Mid Laser

COMBY -I infra-red laser (904nm wavelenght, 27 W)

9 sessions, 3 per week for 3 weeks

Group 3: Placebo laser

Both MENS and Mid-laser produced more significant changes than placebo, but Mid-laser treatment produced larger mean
changes in PI and rTVO than MENS.

MENS: p<0.01
Mid-laser: p<0.05

-

Brosseau et al. [22]

88 (42 vs 46)

19 / 69

64.5

Hand Osteoarthritis

active LLLT

Eriel laser, top laser 250, class IIIb (860nm wavelenght, 60mW)

3 sessions a week for 6 weeks

Sham LLLT

Carpometacarpal opposition (P = 0.011), grip strength, and patient global assessment improved in active LLLT participants.

Carpometal opposition (P = 0.001)
Grip strenght (P = 0.041)
Patient global assessment (P=0.041)

-

Cantero-Tellez et al. [23]

43 (22 vs 21)

All female

71 ± 12

Thumb carpometacarpal Osteoarthritis

HILT

Class IV K-Laser, Mod. K1200 (Eltech K-Laser S.r.l.)(800 nm + 970 nm wavelenght, 3 W)

3 times a week

Placebo laser

LT group had greater reduction in VAS at end of intervention as well as at 12 week

(P < 0.001)

All female group, no combination therapy, short follow-up, no assessment of functional outcomes

Chen et al. [24]

309 (158 vs 151)

77 / 232

64

Knee osteoarthritis

LM

SX10-C1 CO2 laser moxibustion (16um wavelenght, 16-18 W)

3 times a week for 4 weeks

Placebo LM

In LM group, 15-m walking times at both Week 4 and Week 12 were significantly reduced after treatment.
LM group exhibited shorter 15-m walking times than placebo.

p<0.05

Study conducted at multiple sites, only two acupoints used, no assurance patients kept diary.

de Matos Brunelli Braghin et al . [25]

60 (15 vs 15 vs 15 vs 15)

13 / 47

60

Knee osteoarthritis

Group 1: Laser Group (LG)
Group 2: Exercise Group (EG)
Group 3: LG + EG

low-level laser (Photon Lase III, DMC, Sao Carlos, Brazil)( 808nm wavelength, 100mW)

2 times a week for 2 months

Group 4: Control group

LG + EG showed best results

WOMAC: EG in pain (p = 0.006) and function (p = 0.01)

LG+EG showed increase in the cadence (p = 0.009) and duration of single right limb support (p = 0.04).

LG+EG and EG groups showed decrease in the duration of right limb support (p = 0.035 and p = 0.003)

All groups showed improvement in gait speed after 8 weeks: LG versus CG (p = 0.03); EG versus CG (p = 0.04) and LEG versus CG (p = 0.005).

de Oliveira et al. [26]

45 (15 each)

All female

69.3

Knee osteoarthritis

Group 1: LLLT
Group 2: NMES
Group 3: LLLT + NMES

THOR DD2 Control Unit (λ = 810 nm, 200 mW)
infrared gallium-aluminium-arsenide diode laser probe

2 times a week for 8 weeks

-

Muscle thickness and anatomical cross-sectional area increased in the electrical stimulation and combined groups. All groups presented similar improvements in torque, electrical activity and health status

p<0.05

Absence of control group, all females, small sample size

de Paula Gomes et al. [27]

60 (20 each)

5 / 55

65.5

Knee osteoarthritis

Group 1: Ex
Group 2: Ex + Phototherapy

nine-diode cluster device: one 905 nm super-pulsed diode laser, four 875 nm LED and four 640 nm LED

2 times a week for 5 weeks

Group 3: Ex + Placebo phototherapy

Group 2 was better than Group 1 and 3 only with regard to the NRPS

p<0.05

Small sample size, mostly female

de Paula Gomes et al. [28]

100 (20 each)

8 / 92

67

Knee osteoarthritis

Group 1: Ex
Group 3: Ex + ICT
Group 4: Ex + SDT
Group 5: Ex + PHOTO

laserpulse device (Ibramed, Amparo, SP, Brazil)(904nm wavelenght, 70 W)

3 times a week for 8 weeks

Group 2: Ex + placebo

In all groups, there was a significant improvement in all variables (WOMAC, NRPS, PPT, STST) over time, except pressure pain threshold.

p<0.05

Therapists not blinded, no follow-up, only two physiotherapists for evaluations, no control over painkillers

Ekici and Ordahan [29]

60 (30 vs 30)

-

-

Knee osteoarthritis

Group 1: Hotpack, (TENS), exercise
Group 2: HILT

10 W

9 sessions, 3 days a week for 3 weeks

Group 3: Sham laser

Decrease in VAC, an increase in flexion range of motion, WOMAC, and femoral cartilage thickness in groups 1 & 2.

Increase in the average peak torque flexion muscle strength measurements post treatment and at 3rd month in groups 1 & 2

(p < 0.005)
(p<0.05)

-

Elboim-Gabyzom et al. [30]

40 (20 vs 20)

12 / 28

62.85

Knee osteoarthritis

Group 1: LLLT
Group 2: PEMFT

-

6 sessions 3 weeks

-

Pain and physical function improved in both groups but PEMFT was more effective in reducing pain at rest, when standing from a sitting position, and when climbing the stairs, and in improving both WOMAC scores and TUG results

(p ≤ 0.0001)
(p ≤ 0.0003)

No control over medication use, results not applicable for KOA <2 or >4, no true control

Fang et al. [31]

86 (43 vs 43)

-

-

Knee osteoarthritis

Group 1: TM
Group 2: LM

-

3 times a week for 4 weeks

-

Both LM and TM significantly decreased the WOMAC (pain, function and stiffness) score, VAS score and the 15-m walking time at the end of the trial.

p<0.05

No true control

Gur et al. [32]

90 (30 vs 30 vs 30)

18 / 72

59.43 ± 7.36

Knee osteoarthritis

Group 1: actual LPLT
Group 2: actual LPLT + Ex

Ga-As infrared laser, class III b Laser Product, (Frank
Line IR 30, Fysiomed Belgium)(904 nm wavelenght, 20W)

10 sessions over 14 weeks

Group 3: placebo laser group + Ex

All parameters improved in Group 1 and 2.

Compared to placebo:
All parameters Group 1 (p<0.01)
WOMAC Group 2 (p<0.05)

-

Haladaj et al. [33]

150 (75 vs 75)

81 / 69

45.5

Cervical spine OA

Group 1: Saunders method
Group 2: HILT

-

-

-

The results obtained by Saunders method remained significantly higher than those obtained when HILT laser therapy

p<0.05

-

Hegedus et al. [34]

27

5 / 22

49.48

Knee osteoarthritis

active LLLT

diode laser (830nm wavelenght, 50mW)

2 times a week for 4 weeks

placebo LLLT

With active LLLT, improvement was found in VAS, circumference, pressure sensitivity, and flexion.

p<0.05

Small sample size, more females

Helianthi et al. [35]

59 (30 vs 29)

34 / 25

69

Knee osteoarthritis

active laser acupuncture

Single-probe gallium
aluminum arsenide laser device (Handylaser
Trion RJ-Laser®, Waldkirch, Germany)(785nm wavelength, 50mW)

2 times a week for 5 weeks

placebo laser acupuncture

VAS scores were significantly improved in the active laser acupuncture group compared to the placebo group.

VAS improved after 4, 9 sessions and 2 weeks (p<0.0001)

Lequesne index improved after 4, 9 sessions and 2 weeks (p<0.0001)

Short follow up

Hinman et al. [36]

282 (71 vs 70 vs 71 vs 70)

143 / 139

63.55

Knee osteoarthritis

Group 1:Needle
Group 2: Laser

Standard Class 3B laser (10mW)

12 weeks

Group 3: Sham Laser
Group 4: No acupuncture

Compared with control, needle and laser acupuncture resulted in modest improvements in pain at 12 weeks, but not at 1 year.

p<0.05

19% of patients dropping out

Huang et al. [37]

70 (30 vs 40)

-

73

Knee osteoarthritis

ALLLT

-

-

Sham LLLT

The experimental group displayed better joint flexion and less stiffness on days 2 and 3 than did the control group

p<0.05

-

Ip and Fu [38]

70

1: 2.5

75

Knee osteoarthritis

Group 1: LLLT + Hyaluronic acid injection

GaAlAs semiconductor (810nm wavelength, 20mW)

3 sessions per week for 6 weeks

Group 2: Sham laser + Normal saline injection

1 patient needed knee replacement in Group 1, while 15 needed surgery in Group 2

p<0.05

-

Ip et al. [39]

100

1:1.5

65

Knee osteoarthritis

Group 1: LLLT + Ex + Electrical stimulation + Diathermy

GaAlAs semiconductor (810nm wavelength, 20mW)

3 sessions per week for 12 weeks

Group 2: Ex + Electrical stimulation + Diathermy

1 patient needed knee replacement in Group 1, while 9 needed surgery in Group 2

p<0.05

-

Jankaew et al. [40]

48

10 / 38

68

Knee osteoarthritis

Group1: 808nm laser
Group 2: 660nm laser

Laser 808nm wavelenght, 300mW
Laser 660nm wavelength, 300mW

3 days per week for 8 weeks

Group 3: Sham laser

Muscle strenght and functional performance was improved in both intervention groups.

Knee extensor strength was more improved in the 808 nm group (p < 0.001) .
Knee flexor strenght was improved in the 808 nm (p = 0.009) and sham control groups (p< 0.001).
The number of 30 sit‑to‑stand was increased only in the 660 nm group (p = 0.006).

Small sample size, no combined therapy, short follow up.

Kalo et al. [41]

18

4 / 14

51.8 ± 7.3

Knee osteoarthritis

Neuromuscular exercise

Laser ACUbeam, Laser Acumed GmbH, Beverungen, Germany

placebo laser acupuncture

The MPF pre-post differences of the exercise intervention were higher compared to the MPF pre-post differences of the placebo treatment

p<0.05

Individual effort difference, technical issues with equipment

Langella et al. [42]

18 (8 vs 9)

55.5 / 44.4%

69 ± 5.6

Hip osteoarthritis

Photobiomodulation therapy (LLLT + LEDT)

Superpulsed laser of (905 nm, 2.7mW), Four infrared LEDs of (875 nm, 15mW) and Four red LEDs (640 nm, 17mW)

Placebo

VAS, TNF-α and IL-8 serum levels decreased in the active PBMt group compared to placebo-control group

p<0.05

Lack of assessment of cytokines before surgery

Lin et al. [43]

163 (88 vs 55)

58 / 105

62.5

Knee osteoarthritis

Moxibustion + Infrared CO2 Laser

SX10-C1 infrared laser moxibustion instrument (10.6 μm wavelenght, 160-180 mW)

3 sessions per week for 12 weeks

Moxibustion + Sham laser

Benefit associated with laser moxibustion compared with traditional moxibustion in physical function at the follow-up of 4 weeks

(P=0.006)

No proper random assignment, treatment protocols different from both RCTs

Madani et al. [44]

20 (10 vs 10)

1 / 19

TMJ osteoarthritis

LLLT

Mustang 2000z (810 nmwavelength, 50mW)

3 sessions per week for 4 weeks

Placebo

LLLT no more effective than the placebo treatment for reducing pain and improving mouth opening in patients with TMJ osteoarthritis

Some change in VAS for body of masseter and TMJ; otherwise no significant difference (p>0.05)

-

Marini et al. [45]

99 (39 vs 30 vs 30)

25 / 74

41.93±11.51 versus 36.23±11.30

TMJ osteoarthritis

Group 1: SLLLT
Group 2: Ibuprofen

gallium-arsenide diode superpulsed laser (910 nm wavelenght, 400mW)

10 sessions over 2 weeks

Group 3: sham laser

Mandibular function improved in all SLLLT patients

Mean VAS in SLLLT group was
significantly lower than in nonsteroidal anti-inflammatory drug
group and control group (P=0.0001)

-

Melo et al. [46]

45

All female

Knee osteoarthritis

Group 1: Electrical stimulation
Group 2: Laser group
Group 3: Combined

4 week control followed by 8 week intervention

Low-level laser therapy did not improve the effects of electrical stimulation on the evaluated parameters.

Mostafa et al. [47]

40 (20 vs 20)

40.12 ± 9.45 vs 46.62 ± 8.68

Knee osteoarthritis

ESWT

3 sessions a week for 4 weeks

HILT

HILT showed a superior effect compared with ESWT on pain, physical function, and disability in chronic KOA patients.

p<0.05

Muhammad et al. [48]

40 (20 vs 20)

6 / 34

Knee osteoarthritis

Laser acupuncture

Soft-laser 202 (808nm wavelenght, 90 mW) Galuim Aluminum Arsenide

12 sessions

Sham laser

Laser acupuncture is a safe and cheap tool for management of grade 2 knee osteoarthritis

improvement in VAS, increase in serum beta-endorphin and a decrease in substance P (p<0.05)

-

Nazari et al. [49]

90 (30 vs 30 vs 30)

41 / 49

62

Knee osteoarthritis

Group 1: HILT
Group 2: CET
Group 3: ET

E20780 - laser YAG HT (1064nm wavelenght, 5 W)

3 sessions a week for 4 weeks

HILT was significantly more
effective than the other groups in decreasing the VAS, increasing FROM and improving the scores of WOMAC both after treatment and after 12 weeks.

p<0.05

Patient had no control over exercise, no sonographic assessment, short follow up

Ozdemir et al. [50]

60

10 / 50

40.13 ±
10.31 and 40 ± 11.23

Cervical osteoarthritis

LPL

Endolaser 476 (830nm wavelenght, 50mW)

10 sessions

Placebo

Pain, paravertebral muscle
spasm, lordosis angle, the range of neck motion and
function were observed to improve significantly in the
LPL group

p<0.05

Yan et al. [51]

392 (201 vs 191)

98 / 294

62.5

Knee osteoarthritis

Laser moxibustion

10.6 µm wavelength, 160 to 180 mW

3 times a week for 4 weeks.

Sham laser

Laser moxibustion is effective for pain reduction and functional improvement in the treatment of KOA with KL grades 2 and 3

Patients with KL grades 2 and 3 had improvement scores in pain, function, and total scores.
Patients with KL grade 2 had significantly higher improvement scores in stiffness. (p<0.05)

Small sample size, lack of measurement of specialized psychiatric depression-related scales and posttreatment imaging of the patients

Yurtkuran et al. [52]

55 (28 vs 27)

2 / 53

52.6

Knee osteoarthritis

LLLT

Infrared 27 GaAs diode laser instrument, 4 mW

5 days per week (total 10 days)

placebo laser therapy

Laser acupuncture was found to be effective only in reducing periarticular swelling

Improvement was observed in PVAS, 50 foot, and KC in group 1.
In Group II, improvement was observed in PVAS, 50 foot, and WOMAC.
The improvement observed in KC was superior in Group I at the 2nd week (p = 0.005)

Applied doses may be less than the doses recommended by World Association with Laser Therapy (WALT) for musculoskeletal diseases.

Zhao et al. [53]

40 (20 vs 20)

5 / 35

60

Knee osteoarthritis

Laser acupuncture

Semiconducter (650 nm wavelenght, 36mW)

3 sessions a week for 4 weeks

Sham laser

Combined 10.6-mum-650-nm laser acupuncture-moxibustion on acupoint ST35 is safe to use and was effective after 2-wk treatment, but not at the 4-wk assessment

Improvement in the WOMAC pain score of the acupoint group was significantly greater than that of the control group (p<0.05)

1. Higher dropout rate. 2. lack of a longer follow-up period made it impossible to assess the long-term effects of this treatment. 3. the operator of the laser treatment was not blinded to the treatment assigned.

Zhao et al. [54]

392 (201 vs 191)

98 /294

63.1

Knee osteoarthritis

Laser moxibustion

SX10-C1 (Shanghai Wonderful Opto-Electrics Tech. Co., Ltd) (10.6 μm wavelength 160–180 mW)

3 sessions a week for 4 weeks

Sham laser

Laser moxibustion resulted in pain reduction and function improvement following a 4-week treatment

The median WOMAC pain score decreased and the physical component of the QoL improvedat Week 4 in the active group (P< 0.01). At Week 24, active laser treatment resulted in significant pain reduction and function improvement (P< 0.01).

Moxibustion has limitations due to smoke

Zou et al. [55]

104

26 / 78

66.3 ± 6.6 vs 64.8 ± 7.4

Knee osteoarthritis

Laser

BTL-6000, Laser Therapy Device, UK

2 times a week for 4 weeks

No laser

Decreased synovial fluid ghrelin levels are related to disease severity in patients with primary osteoarthritis and are increased following laser therapy

Synovial fluid ghrelin concentrations were negatively correlated with K-L grading (P<0.001)..
Attenuated synovial fluid ghrelin levels were also related to clinical severity determined by Lequesne index (P=0.025), VAS scores (P<0.001) and Lysholm scores (P=0.005).
Ghrelin levels were also negatively associated with TNF-α (P=0.002) and IL-6 concentrations (P=0.002).

Single center trial, only ghrelin levels measured