Comparative Efficacy of Bromelain and Ascorbic Acid in the Healing of Acute Crush Achilles tendon Injury: A Preliminary Study

Abstract

Background: Ascorbic acid (AA) has been reported to stimulate tenocyte proliferation and increase collagen synthesis in healing tendons. Bromelain, an enzyme from the pineapple plant has also been suggested to augment tendon healing though it has been reported to be associated with blood clotting and gastrointestinal disturbances.
Objective: This study compared the effects of Bromelain and Ascorbic acid (AA) on tenocyte proliferation and oxidative stress level in the early stage of healing in a crush injury to the Achilles tendon of Sprague-Dawley rats.
Methods: Twenty four male rats all had induced crush injury to the left Achilles tendon and were divided randomly into three groups. Group 1; no treatment, Group 2; oral Bromelain and Group 3; AA. Bromelain was given at a dosage of 7mg/kg body weight and Ascorbic acid at a dosage of 1.4mg/kg body weight daily over the first 14 days post-injury. On the 15th day post injury, the animals were sacrificed and the tendons excised and processed for histological studies and Malondialdehyde (MDA) assay.
Results: Results showed a significant proliferation of tenocytes in the Bromelain treated group compared with the control and AA groups (p<0.05). There was however no significant difference in the MDA level among the three groups (p>0.05). The bromelain and AA treated tendons groups had better organized bundles of collagen fibres with few tenocytes indicating an advanced healing response compared with the control group.
Conclusion: Based on this study, both Bromelain and AA are capable of augmenting the healing of acute tendon injuries. However, because of the documented effects of Bromelain on blood clotting and GIT disturbances, AA may be a better option to consider in the management of acute tendon injuries.

Keywords: Bromelain, Tenocyte proliferation, Tendon injury, Ascorbic acid, MDA