Platelet Rich Plasma better than Shock Wave for Jumpers' Knee

Jumpers' knee also known as patellar tendinitis is a common problem for basketball and volleyball players among other athletes.  Patients treated with platelet-rich plasma for this condition when compared to shock wave treatment improved more at six and 12 months after treatment.  See abstract below.

This paper adds to the mounting data suggesting PRP is a valuable treatment for chronic tendon related problems such as Jumpers' knee.

MRI of Patellar Tendinopathy

Also Known as Jumpers' Knee

AM

TotalTendon

Am J Sports Med. 2013 Feb 13. [Epub ahead of print]

Platelet-Rich Plasma Versus Focused Shock Waves in the Treatment of Jumper's Knee in Athletes.

Vetrano M, Castorina A, Vulpiani MC, Baldini R, Pavan A, Ferretti A.

Source

Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.

Abstract

BACKGROUND:Tendinopathies represent a serious challenge for orthopaedic surgeons involved in treatment of athletes. PURPOSE:To compare the effectiveness and safety of platelet-rich plasma (PRP) injections and focused extracorporeal shock wave therapy (ESWT) in athletes with jumper's knee. STUDY DESIGN:Randomized controlled trial; Level of evidence, 1. METHODS:Forty-six consecutive athletes with jumper's knee were selected for this study and randomized into 2 treatment groups: 2 autologous PRP injections over 2 weeks under ultrasound guidance (PRP group; n = 23), and 3 sessions of focused extracorporeal shock wave therapy (2.400 impulses at 0.17-0.25 mJ/mm(2) per session) (ESWT group; n = 23). The outcome measures were Victorian Institute of Sports Assessment-Patella (VISA-P) questionnaire, pain visual analog scale (VAS), and modified Blazina scale. A reviewer who was blinded as to the group allocation of participants performed outcome assessments before treatment and at 2, 6, and 12 months after treatment. Nonparametric tests were used for within-group (Friedman/Wilcoxon test) and between-group (Kruskal-Wallis/Fisher test) testing, and the significance level was set at .05. RESULTS:The 2 groups were homogeneous in terms of age, sex, level of sports participation, and pretreatment clinical status. Patients in both groups showed statistically significant improvement of symptoms at all follow-up assessments. The VISA-P, VAS, and modified Blazina scale scores showed no significant differences between groups at 2-month follow-up (P = .635, .360, and .339, respectively). The PRP group showed significantly better improvement than the ESWT group in VISA-P, VAS scores at 6- and 12-month follow-up, and modified Blazina scale score at 12-month follow-up (P < .05 for all). CONCLUSION:Therapeutic injections of PRP lead to better midterm clinical results compared with focused ESWT in the treatment of jumper's knee in athletes.

Treatment of Patellar Tendinopathy with Platelet Rich Plasma

"Clinically Meaningful Improvements"

Statistically Significant Improvement (Pain and VISA Scores) 

Gosens et al, worldwide leaders in platelet rich plasma research have shown in their latest article how previous treatments influence outcomes.  This is a critical component to understanding outcomes.  This data suggests that previous treatment with cortisone or surgery may slow a healing response.  As the clinical research evolves, these crucial factors must be taken into consideration.  

See the recently published abstract below.

Allan Mishra @bloodcure  Total Tendon

Int Orthop. 2012 Apr 27. 

Pain and activity levels before and after platelet-rich plasma injection treatment of patellar tendinopathy: a prospective cohort study and the influence of previous treatments.

Gosens T, Den Oudsten BL, Fievez E, van 't Spijker P, Fievez A.

Source

Department of Orthopaedics and Traumatology, St Elisabeth Hospital Tilburg, Tilburg, The Netherlands, 

Abstract

PURPOSE:

The aim of this study was to evaluate the outcome of patients with patellar tendinopathy treated with platelet-rich plasma injections (PRP). Additionally, this study examined whether certain characteristics, such as activity level or previous treatment affected the results.

METHODS:

Patients (n = 36) were asked to fill in the Victorian Institute of Sports Assessment - Patellar questionnaire (VISA-P) and visual analogue scales (VAS), assessing pain in activities of daily life (ADL), during work and sports, before and after treatment with PRP. Of these patients, 14 had been treated before with cortisone, ethoxysclerol, and/or surgical treatment (group 1), while the remaining patients had not been treated before (group 2).

RESULTS:

Overall, group 1 and group 2 improved significantly on the VAS scales (p < .0.05). However, group 2 also improved on VISA-P (p = .0.003), while group 1 showed less healing potential (p = 0.060). Although the difference between group 1 and group 2 at follow-up was not considered clinically meaningful, over time both groups showed a clinically significant improvement.

CONCLUSION:

After PRP treatment, patients with patellar tendinopathy showed a statistically significant improvement. In addition, these improvements can also be considered clinically meaningful. However, patients who were not treated before with ethoxysclerol, cortisone, and/or surgical treatment showed the improvement.