Adjuvant Interventions in Levofloxacin-Exposed Rabbit Achilles Tendons: An Exploratory Controlled Pilot Study with Histopathological and Ultrasonographic Endpoints
Abstract
Background/Objectives: Fluoroquinolones cause Achilles tendinopathy within a narrow, early therapeutic window, yet preventive strategies given alongside these antibiotics remain largely untested. This exploratory pilot study assessed whether four mechanistically distinct adjuvants attenuated histopathological tendon change in a rabbit model of levofloxacin exposure. Methods: Twenty-one male New Zealand White rabbits received oral levofloxacin (100 µg/kg/day, seven days). A contralateral-limb design yielded 42 tendons (two cohorts provided paired limb-specific comparisons and a third cohort received the systemic intervention). Animals were allocated to various groups, receiving platelet-rich plasma (PRP), injectable porcine collagen, oral vitamin E + selenium, topical essential oils with augmented soft-tissue mobilization (ASTM), or a levofloxacin-only control. The main outcome was a modified Bonar composite (tenocyte morphology, cellularity, vascularity, paratendinous fibrosis; 0–12) at three months; additional outcomes were the individual domains and ultrasonographic tendon thickness. Results: Composite scores were low throughout (group medians 2.0–4.0) and did not differ between groups (H = 3.663, p = 0.45); no domain differed, and the untreated control did not show the greatest change. Within animals, collagen-treated tendons scored higher than the paired essential-oil tendons (median difference +3.0, nominal p = 0.031, Bonferroni-adjusted p = 0.062). Tendon thickness…
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