Platelet-Rich Plasma as a Treatment for Patellar Tendinopathy

Abstract

Background: Previous studies have shown improvement in patellar tendinopathy symptoms after platelet-rich plasma (PRP) injections, but no randomized controlled trial has compared PRP with dry needling (DN) for this condition. Purpose: To compare clinical outcomes in patellar tendinopathy after a single ultrasound-guided, leukocyte-rich PRP injection versus DN. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 23 patients with patellar tendinopathy on examination and MRI who had failed nonoperative treatment were enrolled and randomized to receive ultrasound-guided DN alone (DN group; n = 13) or with injection of leukocyte-rich PRP (PRP group; n = 10), along with standardized eccentric exercises. Patients and the physician providing follow-up care were blinded. Participants completed patient-reported outcome surveys before and at 3, 6, 9, 12, and ≥26 weeks after treatment during follow-up visits. The primary outcome measure was the Victorian Institute of Sports Assessment (VISA) score for patellar tendinopathy at 12 weeks, and secondary measures included the visual analog scale (VAS) for pain, Tegner activity scale, Lysholm knee scale, and Short Form (SF-12) questionnaire at 12 and ≥26 weeks. Results were analyzed using 2-tailed paired and unpaired t tests. Patients who were dissatisfied at 12 weeks were allowed to cross over into a separate unblinded arm. Results: At 12 weeks after treatment, VISA scores improved by a mean ± standard deviation of 5.2 ± 12.5 points ( P = .20) in the DN group (n = 12) and by 25.4 ± 23.2 points ( P = .01) in the PRP group (n = 9); at ≥26 weeks, the scores improved by 33.2 ± 14.0 points ( P = .001) in the DN group (n = 9) and by 28.9 ± 25.2 points ( P = .01) in the PRP group (n = 7). The PRP group had improved significantly more than the DN group at 12 weeks ( P = .02), but the difference between groups was not significant at ≥26 weeks ( P = .66). Lysholm scores were not significantly different between groups at 12 weeks ( P = .81), but the DN group had improved significantly more than the PRP group at ≥26 weeks ( P = .006). At 12 weeks, 3 patients in the DN group failed treatment and subsequently crossed over into the PRP group. These patients were excluded from the primary ≥26-week analysis. There were no treatment failures in the PRP group. No adverse events were reported. Recruitment was stopped because interim analysis demonstrated statistically significant and clinically important results. Conclusion: A therapeutic regimen of standardized eccentric exercise and ultrasound-guided leukocyte-rich PRP injection with DN accelerates the recovery from patellar tendinopathy relative to exercise and ultrasound-guided DN alone, but the apparent benefit of PRP dissipates over time.

Arcabouço de PRP-gel associado a células tronco mesenquimais: uso em lesões condrais em modelo experimental equino

“…Observamos apenas estudos analisando as diferentes repostas celulares e moleculares de articulações saudáveis após a aplicação do PRP, na presença ou não de CTMs (Dhar et al 2015, Moraes et al 2015. Dragoo et al (2014) relataram que o PRP rico em leucócitos e hemácias demonstraram ser citotóxico para sinoviócitos em humanos, além de serem capazes de ativar a inflamação através da liberação de IL-1, TNF-α e IL-6, e Lee et al (2013) relataram que o excesso de PRP poderia levar a formação de fibrose. Moraes et al (2015) igualmente relataram reação inflamatória transitó-ria após a aplicação de PRP em articulações saudáveis.…”

Emerging Potential of Cell Based Therapies for Articular Cartilage Repair and Regeneration

“…Delivery of high concentration of cytokines and growth factors to damaged tissues by PRP is considered to have a beneficial effect on tendon and cartilage tissue repair and regeneration. 61 In some in vitro and in vivo studies, antiinflammatory and reparative effects of PRP on cartilage, tendon, and ligament recovery have been shown. [62][63][64] The rationale for the use of Several studies have reported PRP to be clinically safe and effective in reducing pain following intra-articular injection of PRP up to 12 months following treatment.…”

Is there a treatment protocol in which platelet-rich plasma is effective?

“…[37][38][39][40] When the studies in which PRP was obtained from autologous blood in clinics were considered, it was found that it was prepared from 10 to 20 min. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Nevertheless, it takes time to apply it to cases, which makes its bioactive and effective treatment results controversy.…”

“…On the other hand, they emphasized that although there was not an increase in PRP group in the 12th week, there was not a significant difference between the groups in the 26th week. 12 Dohan Ehrenfest et al, in their manuscript, informed that PLT concentrations -through topical and infiltrating routes -gained popularity primarily in sports medicine and orthopaedic surgery. Nonetheless, although they presented treatment perspective, they reported that the studies in literature were confusing.…”

“…6 For this very reason, it is applied in all fields of medicine including orthopaedic surgery in tissue damage treatments. 7,8 PRP's use has been increasing in many cases such as primarily osteoarthritis, 9 proximal hamstring, 10 Achilles, 11 patellar tendinopathies, 12 talar osteochondral lesions, 13 rotator cuff damage repair, 14 lateral epicondylitis treatment, 15 relieving pains following arthroplasty 8 and contributing to bone healing of tibia in distraction osteogenesis. 8 However, as there are contradictory results reported in some cases in literature where PRP was applied, there are some questions regarding the efficiency of PRP treatment.…”