Platelet-Rich Plasma Injections With Needle Tenotomy for Gluteus Medius Tendinopathy

Abstract

Background:Gluteal tendinopathy is a prevalent condition that can be associated with significant pain and disability. To date, no studies have prospectively assessed the efficacy of intratendinous platelet-rich plasma (PRP) injections as a minimally invasive treatment for gluteus medius tendinopathy.Purpose:To prospectively assess the efficacy of intratendinous PRP injections as treatment for chronic recalcitrant gluteus medius tendinopathy.Study Design:Case series; Level of evidence, 4.Methods:During the study period between July 2011 and November 2015, data were collected from the Hospital for Special Surgery Center for Hip Preservation Outcomes Registry on participants who underwent ultrasound-guided intratendinous PRP injections for recalcitrant gluteus medius tendinosis and/or partial tears of the tendon associated with moderate to severe lateral hip pain for longer than 3 months. All participants were assessed pre- and postinjection with 4 outcome measures: modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living subscale (HOS-ADL), Hip Outcome Score–Sport-Specific subscale (HOS-Sport), and the International Hip Outcome Tool–33 (iHOT-33). Demographic data, including age, sex, height, weight, body mass index, and smoking status, were also collected.Results:A total of 21 patients were included in the study, with a mean follow-up of 19.7 months (range, 12.1-32.3 months). The mean improvements from preinjection to postinjection follow-up were 56.73 to 74.17 for mHHS, 68.93 to 84.14 for HOS-ADL, 45.54 to 66.72 for HOS-Sport, and 34.06 to 66.33 for iHOT-33. All mean outcome measure improvements were clinically and statistically significant (P < .001). Length of follow-up was positively correlated with improvements in HOS-ADL (P = .021) and HOS-Sport (P = .004) scores. No adverse events were observed during or after the procedure.Conclusion:In this registry study with prospective follow-up, we found ultrasound-guided intratendinous PRP injections to be a safe and effective treatment option for chronic recalcitrant gluteus medius tendinopathy due to moderate to severe tendinosis and/or partial tendon tears. Well-powered randomized controlled studies are warranted to confirm our findings and further define the ideal candidates for this treatment.

Ultrasound-guided Platelet-rich Plasma Application Versus Corticosteroid Injections for the Treatment of Greater Trochanteric Pain Syndrome: A Prospective Controlled Randomized Comparative Clinical Study

“…This can be explained by their analgesic effects on local neuropeptides and neurotransmitters that relay pain and not by their anti-inflammatory properties [16]. This is supported by histopathological studies that found that there is no association between gluteal tendinopathies and serious inflammations, which means that CSI cannot provide long-term pain relief [16,18]. Additionally, it was found that there is a risk of rupture if corticosteroids are injected into a tendon [12,19 ].…”

“…However, CSI have been shown to provide only short-term pain relief [2,9]. This can be explained by their analgesic effects on local neuropeptides and neurotransmitters that relay pain and not by their anti-inflammatory properties [16]. This is supported by histopathological studies that found that there is no association between gluteal tendinopathies and serious inflammations, which means that CSI cannot provide long-term pain relief [16,18].…”

“…This is due to the fact that PRP contains concentrated platelets, biologically active molecules and proteins, which activate and accelerate the body's mechanisms of healing into forming new tissue [12]. PRP contains high concentrations of different growth factors like vascular endothelial growth factor (VEGF), insulin-like growth factor 1 (IGF-1), fibroblast growth factor (FGF), plateletderived growth factor (PDGF) and transforming growth factor β1 (TGF-β1) [16]. VEGF stimulates angiogenesis of avascular chronically torn tendons [16].…”

“…PRP contains high concentrations of different growth factors like vascular endothelial growth factor (VEGF), insulin-like growth factor 1 (IGF-1), fibroblast growth factor (FGF), plateletderived growth factor (PDGF) and transforming growth factor β1 (TGF-β1) [16]. VEGF stimulates angiogenesis of avascular chronically torn tendons [16]. IGF-1 stimulates collagen synthesis at the site of tendon injury [12,16].…”

“…Lately, platelet-rich plasma (PRP) has become very popular among the orthopaedic community as a minimally invasive method of enhancing tissue healing in conditions such as rotator cuff tears, patellar tendinopathy, lateral epicondylitis, osteochondral lesions, and knee osteoarthritis [11][12][13][14][15]. It has been proved that PRP promotes soft tissue healing by delivering a high concentration of platelet-derived growth factors to the diseased area and by enhancing cellular chemotaxis, proliferation and differentiation, removal of tissue debris, angiogenesis and lying down extracellular matrix [12,16].…”