Platelet-Rich Plasma Shortens Return to Play in National Football League Players With Acute Hamstring Injuries

Bradley, James P.; Lawyer, Tracye J.; Ruef, Sonia; Towers, Jeffrey D.; Arner, Justin W.

doi:10.1177/2325967120911731

Cited by 29 publications

(43 citation statements)

References 23 publications

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“…Although 3 studies found patients receiving PRP achieved earlier RTP than controls by 10 to 15 days, 1 , 16 , 33 5 studies showed no such effect. 21 , 37 , 39 , 65 , 66 Despite finding no relationships between PRP injection and days or practices missed because of hamstring injury in National Football League athletes, Bradley et al 21 reported PRP injection to be associated with fewer games missed. Zanon et al 89 noted a decreased reinjury rate in patients receiving PRP in the short term; however, the long-term rate was not different from that of controls.…”

Section: Resultsmentioning

confidence: 99%

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Evidence-Based Management and Factors Associated With Return to Play After Acute Hamstring Injury in Athletes: A Systematic Review

Rudisill

Kucharik

Varady

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Considering the lengthy recovery and high recurrence risk after a hamstring injury, effective rehabilitation and accurate prognosis are fundamental to timely and safe return to play (RTP) for athletes. Purpose: To analyze methods of rehabilitation for acute proximal and muscular hamstring injuries and summarize prognostic factors associated with RTP. Study Design: Systematic review; Level of evidence, 4. Methods: In August 2020, MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and SPORTDiscus were queried for studies examining management and factors affecting RTP after acute hamstring injury. Included were randomized controlled trials, cohort studies, case-control studies, and case series appraising treatment effects on RTP, reinjury rate, strength, flexibility, hamstrings-to-quadriceps ratio, or functional assessment, as well as studies associating clinical and magnetic resonance imaging factors with RTP. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool for Randomized Trials or the Methodological Index for Non-Randomized Studies (MINORS). Results: Of 1289 identified articles, 75 were included. The comparative and noncomparative studies earned MINORS scores of 18.8 ± 1.3 and 11.4 ± 3.4, respectively, and 12 of the 17 randomized controlled trials exhibited low risk of bias. Collectively, studies of muscular injury included younger patients and a greater proportion of male athletes compared with studies of proximal injury. Surgery for proximal hamstring ruptures achieved superior outcomes to nonoperative treatment, whereas physiotherapy incorporating eccentric training, progressive agility, and trunk stabilization restored function and hastened RTP after muscular injuries. Platelet-rich plasma injection for muscular injury yielded inconsistent results. The following initial clinical findings were associated with delayed RTP: greater passive knee extension of the uninjured leg, greater knee extension peak torque angle, biceps femoris injury, greater pain at injury and initial examination, “popping” sound, bruising, and pain on resisted knee flexion. Imaging factors associated with delayed RTP included magnetic resonance imaging-positive injury, longer lesion relative to patient height, greater muscle/tendon involvement, complete central tendon or myotendinous junction rupture, and greater number of muscles injured. Conclusion: Surgery enabled earlier RTP and improved strength and flexibility for proximal hamstring injuries, while muscular injuries were effectively managed nonoperatively. Rehabilitation and athlete expectations may be managed by considering several suitable prognostic factors derived from initial clinical and imaging examination.

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Section: Resultsmentioning

confidence: 99%

“… ** References 3, 4, 11 –21, 23, 26, 33, 37, 39, 41, 42, 46 –54, 56 –58, 62, 65, 66, 68, 70, 72, 73, 77, 81, 82, 87 –89. …”

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Evidence-Based Management and Factors Associated With Return to Play After Acute Hamstring Injury in Athletes: A Systematic Review

Rudisill

Kucharik

Varady

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Several studies demonstrated the clinical efficacy of local platelet-rich plasma (PRP) administration for muscle injury treatment [ 19 , 20 , 21 , 22 , 23 ]. The effect of PRP is mediated by the platelet alpha-granules, which contain various growth factors, e.g., FGF-2, HGF, and TGF-β1.…”

Section: Introductionmentioning

confidence: 99%

Sport-Specific Rehabilitation, but Not PRP Injections, Might Reduce the Re-Injury Rate of Muscle Injuries in Professional Soccer Players: A Retrospective Cohort Study

Bezuglov

Khaitin

Shoshorina

et al. 2022

JFMK

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Platelet-rich plasma (PRP) injections are extremely popular in the management of sports injuries in elite athletes. However, data on the use of various administration protocols of PRP are contradictory. The efficacy of platelet-rich plasma in the treatment of muscle injuries in professional soccer players has to be contextualized within the sport-specific rehabilitation program. Despite the questionable role of PRP, a well-structured rehabilitation program is still regarded as the gold standard. We examined the efficacy of various PRP protocols in the management of muscle injuries in professional soccer players in respect to treatment duration and injury recurrence. A retrospective cohort study. Muscle injuries in professional soccer players (n=79, height 182.1 ± 5.9 cm, weight 76.8 ± 5.8 kg, BMI 23.1 ± 1.4 kg/m²) from three elite soccer clubs from the Russian Premier League were recorded during the 2018–2019 season. The injuries were graded based on MRI, using the British Athletic Muscle Injury Classification. Treatment protocols included the POLICE regimen, short courses of NSAID administration, and the specific rehabilitation program. The sample group of players were administered PRP injections. The average treatment duration with PRP injection was significantly longer than conventional treatment without PRP, 21.5 ± 15.7 days and 15.3 ± 11.1 days, respectively (p = 0.003). Soccer-specific rehabilitation and obtaining MRI/US before the treatment was associated with significantly reduced injury recurrence rate (p < 0.001). There was no significant difference between the PRP injection protocol applied to any muscle and the treatment duration in respect of grade 2A–2B muscle injuries. The total duration of treatment of type 2A–2B injuries was 15 days among all players. In the group receiving local injections of PRP, the total duration of treatment was 18 days; in the group without PRP injections, the treatment duration was 14 days. In our study, PRP treatment was associated with longer treatment duration, regardless of which muscle was injured. This may reflect the tendency to use PRP in higher-degree injuries. Soccer-specific rehabilitation significantly reduced the injury recurrence rate when compared to the administration of PRP injections. MRI/US imaging before returning to play was also associated with a lower injury recurrence rate. There was no significant difference between the PRP injection protocol applied to any muscle and the treatment duration in treatment of type 2A–2B muscle injuries.

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“… 20 In addition, a large number of unproven therapies are being marketed directly to athletes, with unsubstantiated claims of efficacy and lack of information about risks, product manufacturing, and unrealistic expectations of outcomes. 27 While efforts have been made to evaluate biologic treatments in NFL athletes, 5 the considerable challenges of performing research on these players mean that there are currently few high-level studies to guide treatments. 20 …”

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confidence: 99%

The Use of Biologics in NFL Athletes: An Expert Consensus of NFL Team Physicians

Murray

McAdams

Hammond

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: There is a lack of published information outlining the use of biologics in National Football League (NFL) athletes and limited data to guide biologic treatment strategies. Purpose: To develop a consensus on the use of biologics among NFL team physicians. Study Design: Consensus statement. Methods: A working group of 6 experts convened a consensus process involving NFL team physicians using validated Delphi methodology. Physicians from 32 NFL teams as well as NFL London were invited to take part. This iterative process was used to define statements on the use of biologics in NFL athletes. A recent scoping review exploring biologics in professional athletes was used to inform the first of 3 rounds of surveys, with statements considered under 7 headings: biologics in general, challenges of treating NFL athletes, terminology/nomenclature, autologous blood products, cell-based therapies, guidance for NFL team physicians, and biologic research in the NFL. In addition to rating agreement, experts were encouraged to propose further items or modifications. Predefined criteria were used to refine item lists after each survey. For a consensus within the final round, defined a priori, items were included in the final information set if a minimum of 75% of respondents agreed and fewer than 10% disagreed. Results: Physicians from 26 NFL teams and NFL London responded to the initial invitation to participate in the Delphi process; 88.9% of participating team physicians completed the round 1 survey, with response rates of 87.5% in round 2 and 95.2% in round 3. After 3 rounds, 47 statements reached a consensus. A consensus was achieved that platelet-rich plasma has a positive impact on patellar tendinopathy and on symptoms in early osteoarthritis but not for other indications. NFL team physicians agreed that while cell therapies have the potential to improve symptoms, the misrepresentation of uncharacterized preparations as “stem cells” has contributed to the widespread use of unproven therapies. Conclusion: This study established an expert consensus on 47 statements relating to the use of biologics in NFL athletes. In addition to providing clinical guidance for the use of biologics in NFL athletes, this study identified key areas for future focus including the development of athlete education materials.

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Platelet-Rich Plasma Shortens Return to Play in National Football League Players With Acute Hamstring Injuries

Cited by 29 publications

References 23 publications

Evidence-Based Management and Factors Associated With Return to Play After Acute Hamstring Injury in Athletes: A Systematic Review

Evidence-Based Management and Factors Associated With Return to Play After Acute Hamstring Injury in Athletes: A Systematic Review

Sport-Specific Rehabilitation, but Not PRP Injections, Might Reduce the Re-Injury Rate of Muscle Injuries in Professional Soccer Players: A Retrospective Cohort Study

The Use of Biologics in NFL Athletes: An Expert Consensus of NFL Team Physicians

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