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 Update, JBJS Webinar

Worldwide interest in Platelet-Rich Plasma is increasing significantly.  471 new publications have appeared on PubMed about platelet-rich plasma in just the last year, making it quite challenging to keep up with the published literature.  There has also been a dramatic rise in Google "hits" for PRP to over 1.3 million.  (See the graphs below)   New data recently accepted for publication to the American Journal of Sports Medicine confirms the value of PRP in the treatment of chronic tennis elbow.  See American College of Surgeons Report on the paper.

Tonight the Journal of Bone and Joint Surgery will be holding a webinar on the topic.  Over 1000 professionals have already signed up for the event.  This is totally unprecedented for a major, elite journal to sponsor a discussion on a single specific biologic orthopedic topic.  Follow Dr. Mishra:  @BloodCure for real time updates about tonight's webinar.

Or, consider joining the Biologic Orthopedic Society Group on LinkedIN to participate in a discussion about the webinar and other biologic orthopedic topics.

AM

TotalTendon

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 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

"Tennis" Article

An article about the use of Platelet Rich Plasma for chronic tendonitis was just published on Tennis.com

Article Link

Total Tendon

ApexPRP

How PRP works for Tendonitis and Tendon Tears

Platelet Rich Plasma produced by AM at Total Tendon

Platelet rich plasma (PRP) continues its advance as a novel and increasingly valuable treatment for tendon related problems like chronic tendonitis (also medically known as tendinosis). It is important to realize that not all physicians and machines produce clinically valuable (meaning it helps improve your pain and function) PRP. Published peered reviewed data suggests that PRP should contain at least 5 times the number of whole blood platelets.

(See Dr. Mishra's study published in American Journal of Sports Medicine Nov. 2006 for details)


As PRP evolves, it is important to find physicians and surgeons who base their clinical decisions on the literature not on opinion. Also, they should use devices that produce PRP with the appropriate concentrations of platelets. Not all methods are the same.

PRP Website: ApexPRP.com

Platelet rich plasma has been found to work via three mechanisms:

1. Release of Growth Factors increase local cell division (producing more cells)

2. Inhibition of excess inflammation (decreased early macrophage proliferation)

3. Recruitment of circulating or bone marrow derived cells that help repair tissue.

This combination of mechanisms helps heal a tendon. Animal data confirm that PRP helps produce a biomechanically stronger tendon.

All of these statements are based on peer reviewed publications.


AM

Total Tendon.com
ApexPRP.com