Platelet-rich plasma does not enhance return to play in hamstring injuries: a randomised controlled trial

Abstract

BackgroundTo evaluate the efficacy of a single platelet-rich plasma (PRP) injection in reducing the return to sport duration in male athletes, following an acute hamstring injury.MethodsA randomised, three-arm (double-blind for the injection arms), parallel-group trial, in which 90 professional athletes with MRI positive hamstring injuries were randomised to injection with PRP-intervention, platelet-poor plasma (PPP-control) or no injection. All received an intensive standardised rehabilitation programme. The primary outcome measure was time to return to play, with secondary measures including reinjury rate after 2 and 6 months.ResultsThe adjusted HR for the PRP group compared with the PPP group was 2.29 (95% CI 1.30 to 4.04) p=0.004; for the PRP group compared with the no injection group 1.48 (95% CI 0.869 to 2.520) p=0.15, and for the PPP group compared with the no injection group 1.57 (95% CI 0.88 to −2.80) p=0.13. The adjusted difference for time to return to sports between the PRP and PPP groups was −5.7 days (95% CI −10.1 to −1.4) p=0.01; between the PRP and no injection groups −2.9 days (95% CI −7.2 to 1.4) p=0.189 and between the PPP and no injection groups 2.8 days (95% CI −1.6 to 7.2) p=0.210. There was no significant difference for the secondary outcome measures. No adverse effects were reported.ConclusionsOur findings indicate that there is no benefit of a single PRP injection over intensive rehabilitation in athletes who have sustained acute, MRI positive hamstring injuries. Intensive physiotherapy led rehabilitation remains the primary means of ensuring an optimal return to sport following muscle injury.Trial registration numberClinicalTrials.gov Identifier:NCT01812564.

Effectiveness of PRP Injection in Reducing Recovery Time of Acute Hamstring Injury: A Critically Appraised Topic

“…Two articles showed no benefit of PRP injection in combination with rehabilitation compared to rehabilitation alone (Total N=170). [9][10][11] One study (N=28), however, demonstrated that PRP injections combined with a rehabilitation program allowed significantly higher levels of pain relief, faster regeneration, and shorter recovery time following an acute hamstring injury than rehabilitation alone. 1 It is important to note that in this study, the control group demonstrated a very large standard deviation for time to return to play (42.5 days + 20.6 vs. 26.7 days + 7.0 for the PRP group).…”

“…3,4,8,13 Furthermore, the articles included in this CAT suggest that age and severity of injury are two factors that may be affecting PRP effects on hamstring injury outcomes. The study supporting PRP injection 1 included subjects with a median age of 21 years, as compared to the other two studies whose subjects ranged from 18-50 years old, with only one study 9 reporting a mean age (25.9 + 5.8 years). Furthermore, PRP injection 1 may be supported in acute grade IIa hamstring injuries, or those with recurrent injuries as opposed to lower severity injuries.…”

“…However, hamstring injuries have been shown to be more common in men's football, as well as men's and women's soccer. 5 Only one article provided mean or median ages in the early-20s, 1 while one had a mean age in the mid-to late-twenties 9 , and one only specified that inclusion criteria required participants be at least 18 years old. [10][11] This is important to note since literature has suggested that age can affect muscle healing.…”

“…One study used a placebo saline injection in the comparison group. 8,9  All three studies included participants with acute hamstring injuries 1,[9][10][11] . Two studies [9][10][11] included both Grade I and II hamstring injury, while one 1 included only grade 2a hamstring injury.…”

Autologous Platelet Rich Plasma for Neck and Lower Back Pain Secondary to Spinal Disc Herniation: Midterm Results

“…Platelet-rich plasma is an orthobiologic that has recently gained popularity as an adjuvant treatment for musculoskeletal injuries [10][11][12][13][14][15][16][17][18]. It is a volume of fractionated plasma from the patient's own blood that contains platelet concentrate.…”