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 Significantly Improves Pain and Function for Patellar Tendonitis

In a randomized controlled trial, platelet rich plasma significantly improved pain and function in patients with patellar tendinopathy (also known as patellar tendonitis).  In the study, PRP was compared to dry needling.  The PRP used in the study contained concentrated platelets and white blood cells, also known as leukocytes (prepared via the Biomet Biologics GPS system).   Both groups were also given an eccentric exercise program.

“Importantly, we also showed that PRP is both clinically and statistically significantly better than dry needling based on the Victorian Institute of Sports Assessment  (VISA) score of patella tendinopathy symptoms.”  (See Full Article)

MRI showing significant patellar tendinopathy

This important data contributes significantly to the growing body of evidence suggesting PRP has value in the treatment of tendon related disorders.  


AM (@bloodcure)
Total Tendon

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.

Platelet Rich Plasma Helps Heal Patellar Tendon Graft Site after ACL Surgery

In a prospective, randomized controlled trial, platelet rich plasma was found to improve patellar tendon graft site healing and decrease pain in the immediate post operative period.  See abstract below:

AM
TotalTendon

From the American Journal of Sports Medicine

Patellar Tendon Healing With Platelet-Rich Plasma: A Prospective Randomized Controlled Trial

1. Adriano Marques de Almeida, MD, MS (adrianoalmeida@usp.br),
2. Marco Kawamura Demange, MD, PhD, 
3. Marcel Faraco Sobrado,
4. Marcelo Bordalo Rodrigues, MD, 
5. André Pedrinelli, MD, PhD and
6. Arnaldo José Hernandez, MD, PhD

+Author Affiliations

1. Department of Orthopedics and Traumatology, São Paulo University Medical School, São Paulo, Brazil
2. Department of Orthopedics and Traumatology, São Paulo University Medical School, São Paulo, Brazil
3. São Paulo University Medical School, São Paulo, Brazil
4. Department of Orthopedics and Traumatology, São Paulo University Medical School, São Paulo, Brazil
5. Department of Orthopedics and Traumatology, São Paulo University Medical School, São Paulo, Brazil
6. Department of Orthopedics and Traumatology, São Paulo University Medical School, São Paulo, Brazil

Abstract

Background: The patellar tendon has limited ability to heal after harvesting its central third. Platelet-rich plasma (PRP) could improve patellar tendon healing.

Hypothesis: Adding PRP to the patellar tendon harvest site would improve donor site healing and improve clinical outcome at 6 months after anterior cruciate ligament (ACL) reconstruction with a patellar tendon graft.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: Twenty-seven patients were randomly divided to receive (n = 12) or not receive (n = 15) PRP in the patellar tendon harvest site during ACL reconstruction. The primary outcome was magnetic resonance imaging (MRI) assessment of patellar tendon healing (gap area) after 6 months. Secondary outcomes were questionnaires and isokinetic testing of ACL reconstruction with a patellar tendon graft comparing both groups.

Results: Patellar tendon gap area was significantly smaller in the PRP group (4.9 ± 5.3 mm²; 95% confidence interval [CI], 1.1-8.8) than in the control group (9.4 ± 4.4 mm²; 95% CI, 6.6-12.2; P = .046). Visual analog scale score for pain was lower in the PRP group immediately postoperatively (3.8 ± 1.0; 95% CI, 3.18-4.49) than in the control group (5.1 ± 1.4; 95% CI, 4.24-5.90; P = .02). There were no differences after 6 months in questionnaire and isokinetic testing results comparing both groups.

Conclusion: We showed that PRP had a positive effect on patellar tendon harvest site healing on MRI after 6 months and also reduced pain in the immediate postoperative period. Questionnaire and isokinetic testing results were not different between the groups at 6 months.

Stanford Football Player may start after PRP San Francisco Chronicle

Tom Fitzgerald of the San Francisco Chronicle wrote an article about a Stanford football player who may start after being treated with platelet rich plasma.  To read more, click here.

There is now mounting evidence that a specific type of PRP that contains increased concentrations of platelets AND white blood cells has value in the treatment of chronic tendinopathy.  Several studies are underway and some will soon be published. 

To view more about PRP and sports medicine videos, go to HalfDome.tv

AM
Total Tendon

PRP at the Advanced Team Physician Course

Dr. Allan Mishra and Dr. Nicola Maffulli debated how to diagnosis and treat patellar tendinopathy at the Advanced Team Physician Course. It was a spirited discussion of when to use imaging, when to hold an athlete out of competition and then how to treat these patients. It was clear from the meeting that there is no consensus about how to treat this sometimes difficult problem. Dr. Mishra advocated early imaging and a biologically enhanced rehabilitation. The biologic enhancement would come from a platelet rich plasma procedure early on at 6-8 weeks after the onset of symptoms.

Obviously we need better prospective randomized trials of PRP, surgery and other therapies for chronic patellar tendinopathy.

Emerging Trends in Tendinopathy

AM with Dr. Robert Nirschl at AMSSM Meeting in Tampa

Dr. Kim Harmon, president of the American Medical Society for Sports Medicine organized an amazing group to discuss tendinopathy in Tampa last week. Dr. Robert Nirschl, the Godfather of tennis elbow spoke about his pioneering work in surgery. Dr. Hakan Alfredson from Sweden discussed the value of eccentric exercises for chronic tendinopathy. Dr. John McShane outlined the value of percutaneous tenotomy and Dr. David Connell from London spoke about the use of blood and stem cells for severe cases. AM presented the case for using platelet rich plasma for tendon related problems.

Overall, it was one of the best sessions ever presented on the topic. Great work and thanks to Dr. Harmon for bringing us all together.

AM
Total Tendon
ApexPRP.com

Platelet Rich Plasma New York Times Article

The New York Times just published an article about the use of Platelet Rich Plasma for professional and weekend warrior athletes.

NY Times PRP Article

Check it out and post your comments here.

AM
Total Tendon

ApexPRP

Stanford Football Player returns after PRP

A Stanford football player who had chronic severe patellar tendonitis has returned to play this year after being treated with platelet rich plasma by Dr. Mishra.
Click here to read the full story.

Total Tendon

Apex PRP.com

San Francisco Chronicle Article: "Miracle Cure"

The San Francisco Chronicle calls platelet rich plasma a "Miracle Cure". To read the full story, click here.

Join the FREE Total Tendon Network to interact with patients and providers familar with platelet rich plasma as a treatment.

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