Platelet Rich Plasma Helpful for Patellar Tendonitis in Athletes

A new study published in the American Journal of Sports Medicine that ultrasonic guided platelet rich plasma  (PRP) injections improved pain and function in athletes with chronic patellar tendinopathy.  (See abstract below)

Patellar tendinopathy typically affects running and jumping athletes such as tennis, volleyball and basketball players.  It manifests itself with pain in the front of the knee and typically is worse with repeated jumping activities.  Most often, it will resolve with appropriate non-invasive treatment such as rest, icing and physical therapy.  It can be difficult to treat.  When the symptoms persists, published data supports the use of PRP injections.

AM
TotalTendon

1. Christophe Charousset, MD*,†, 
2. Amine Zaoui, MD‡, 
3. Laurence Bellaiche, MD§ and 
4. Benjamin Bouyer, MD∥

+Author Affiliations

1. ^†Institut Osteo Articulaire Paris Courcelles, Paris, France
2. ^‡Laboratory of Bioengineering and Biomechanics for Bone Articulation, University of Paris, Paris, France
3. ^§Centre D’image Médicale Bachaumont, Paris, France
4. ^∥Biostatistics and Epidemiology Department, Hotel Dieu Hospital 1, Paris, France
5. Investigation performed at the Institut Ostéo Articulaire Paris Courcelles, Paris, France

1. ↵* Christophe Charousset, MD, Institut Osteo Articulaire Paris Courcelles–60 Rue de Courcelles, 75008 Paris, France (e-mail: dr.charousset@ioapc.fr).

Abstract

Background: Chronic patellar tendinopathy (PT) is one of the most common overuse knee disorders. Platelet-rich plasma (PRP) appears to be a reliable nonoperative therapy for chronic PT.

Purpose: To evaluate clinical and radiological outcomes of 3 consecutive ultrasound (US)–guided PRP injections for the treatment of chronic PT in athletes.

Study Design: Case series; Level of evidence, 4.

Methods: A total of 28 athletes (17 professional, 11 semiprofessional) with chronic PT refractory to nonoperative management were prospectively included for US-guided pure PRP injections into the site of the tendinopathy. The same treating physician at a single institution performed 3 consecutive injections 1 week apart, with the same PRP preparation used. All patients underwent clinical evaluation, including the Victorian Institute of Sport Assessment–Patella (VISA-P) score, visual analog scales (VAS) for pain, and Lysholm knee scale before surgery and after return to practice sports. Tendon healing was assessed with MRI at 1 and 3 months after the procedure.Results: The VISA-P, VAS, and Lysholm scores all significantly improved at the 2-year follow-up. The average preprocedure VISA-P, VAS, and Lysholm scores improved from 39 to 94 (P < .001), 7 to 0.8 (P < .0001), and 60 to 96 (P < .001), respectively, at the 2-year follow-up. Twenty-one of the 28 athletes returned to their presymptom sporting level at 3 months (range, 2-6 months) after the procedure. Follow-up MRI assessment showed improved structural integrity of the tendon at 3 months after the procedure and complete return to normal structural integrity of the tendon in 16 patients (57%). Seven patients did not recover their presymptom sporting level (among them, 6 were considered treatment failures): 3 patients returned to sport at a lesser level, 1 patient changed his sport activity (for other reasons), and 3 needed surgical intervention.

Conclusion: In this study, application of 3 consecutive US-guided PRP injections significantly improved symptoms and function in athletes with chronic PT and allowed fast recovery to their presymptom sporting level. The PRP treatment permitted a return to a normal architecture of the tendon as assessed by MRI.

http://ajs.sagepub.com/content/42/4/906.abstract

Platelet Rich Plasma and Stem Cell Treatments in Athletes

Platelet Rich Plasma (PRP) and Stem Cell Therapies are becoming more commonly used especially by elite athletes.  In order to better understand the scope of the situation, I have put up an interactive site with links to any and all articles about either PRP or Stem Cell Treatments in Athletes.   Reasons why elite athletes are seeking out stem cell and platelet rich plasma therapies:

• They want to get better and get back to their sport at the highest level as fast as possible.
• They are dissatisfied with present treatments or those treatments are not working.  
• They understand that using the regenerative components of your own blood, bone marrow or fat to treat injured or degenerative tissue makes intrinsic sense.
• They are further willing to be treated with these autologous biologic products despite the immaturity of the supporting data.

Please visit the site and add to the list of athletes and articles.  This is part of a project to better understand how and why athletes are seeking out these types of treatments and how effective they are. Please use a short one line description with links.  Part of the list is outlined below:  

• Tiger Woods (Golf) PRP
• Hines Ward (Football) PRP
• Peyton Manning (Football) Stem Cells
• Kobe Bryant (Basketball) PRP Stem Cells
• Terrell Owens (Football) Stem Cell
• Cliff Lee (Baseball) PRP

Updates can be found via twitter: @bloodcure and via this BloodCure.com blog


AM
Total Tendon

Platelet Rich Plasma used to treat Nadal's Knees

 
It appears as if Nadal has had his creaky knees treated with platelet rich plasma.  He has described it himself but only incompletely.  What we do not know is what type of PRP was used,  how it was injected and how he is being treated after the procedure.  These are all critical issues.  Presently, PRP with platelet concentrations around 5x baseline combined with concentrated white blood cells has the best published data supporting its use. 

It is clear that Nadal has chronic, severe tendonitis also know as tendinopathy.  It will help all of us who are studying how to best use PRP we knew more about his specific treatment.  Does anyone out there know any of the details?

AM
Total Tendon