Platelet-rich plasma vs. steroid injections for hamstring injury—is there really a choice?

Park, Peter Yong Soo; Cai, Chunyan; Bawa, Pritish; Kumaravel, Manickam

doi:10.1007/s00256-018-3063-9

Cited by 22 publications

(15 citation statements)

References 24 publications

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“…Partial avulsions that fail injections, physical therapy, or activity modifications, or patients who want to continue a very active lifestyle are typically recommended for surgical intervention. 11 Overall, the authors of the current study recommend surgical repair if more than 1 tendon is involved in a soft tissue injury or if a bony avulsion is displaced >2 cm. 12,15 Evidence exists that if tendon retraction is >2 cm, surgical fixation leads to improved outcomes; however, no studies exist comparing different distances of retraction.…”

Section: Discussionmentioning

confidence: 93%

Functional Results and Outcomes After Repair of Partial Proximal Hamstring Avulsions at Midterm Follow-up

et al. 2019

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Background: Partial avulsions of the proximal hamstring origin remain a challenging problem with nonoperative treatments frequently providing limited success. The literature is limited regarding the outcomes of operative management in the active and athletic population. Hypothesis: Surgical fixation of proximal hamstring ruptures will have favorable outcomes at midterm follow-up. Study design: Case series; Level of evidence, 4. Methods: A total of 64 patients with partial avulsions of the proximal hamstring origin treated with surgical fixation by a single surgeon were reviewed at a 2-year minimum follow-up. All patients had initially undergone failed nonoperative treatment. Patient-reported outcome scores on the Lower Extremity Functional Score (LEFS), Marx Activity Rating Scale, custom LEFS and Marx scales, and total proximal hamstring score were evaluated. Data on patient-perceived strength, return to sport, and satisfaction were also collected. Results: The cohort included 27 male and 37 female (N = 64) patients with a mean age of 47.3 years (range, 16-65 years), and all were reviewed at a mean 6.5-year (range, 2-12.5 years) follow-up. The average postoperative LEFS was 96% (range, 68%-100%), with the custom LEFS being 90% (range, 39%-100%). The mean Marx score was 12.4 (range, 4-16). The Marx custom score demonstrated no disability with activities of daily living. The mean total proximal hamstring score was 94% (range, 69%-100%). No differences in any outcome measures were seen when comparing acute versus chronic repairs. Three patients underwent further hamstring surgery. No patients reported symptoms of numbness in the operative extremity at rest, while 3 patients had a superficial stitch abscess treated with antibiotics alone. The most commonly reported difficulty was with prolonged sitting. Ninety-seven percent were satisfied with surgery, 92% reported they could participate in strenuous activity, and 97% estimated their strength to be >75%, while 64% estimated it to be 100% of their contralateral side. Patients returned to sport at an average of 11.1 months, and all that returned were satisfied with their performance. Conclusion: Both early and delayed anatomic surgical repair of partial proximal hamstring avulsions leads to successful functional outcomes, a high rate of return to athletic activity, and low complication rates at the 6.5-year follow-up. Nonoperative treatments should first be attempted.

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Section: Discussionmentioning

confidence: 93%

Functional Results and Outcomes After Repair of Partial Proximal Hamstring Avulsions at Midterm Follow-up

et al. 2019

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“…This group found superior outcomes in the PRP group and recommended against steroid injection in favor of PRP. 16 Although the current study evaluates an NFL cohort, hamstring injuries are very common in all sports. Reducing pain, time to return to sport, and recurrence are advantageous in all athletes, as hamstring injuries can be quite disabling.…”

Section: Discussionmentioning

confidence: 99%

“…This group found superior outcomes in the PRP group and recommended against steroid injection in favor of PRP. 16…”

Section: Discussionmentioning

confidence: 99%

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

Bradley

Lawyer

Ruef³

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Hamstring injuries are prevalent in professional athletes and can lead to significant time loss, with recurrent injury being common. The efficacy of platelet-rich plasma (PRP) for augmentation of nonoperative treatment of partial musculotendinous hamstring injuries is not well established. Hypothesis: The addition of PRP injections to nonoperative treatment for acute partial musculotendinous hamstring injuries will lead to a shortened return to play in National Football League (NFL) players. Study Design: Cohort study; Level of evidence, 3. Methods: NFL players from a single team who sustained acute grade 2 hamstring injuries, as diagnosed on magnetic resonance imaging (MRI) by a musculoskeletal radiologist from 2009 to 2018, were retrospectively reviewed. Average days, practices, and games missed were recorded. Players who did and did not receive PRP (leukocyte-poor) injections were compared. Those who received PRP did so within 24 to 48 hours after injury. Results: A total of 108 NFL players had MRI evidence of a hamstring injury, and of those, 69 athletes sustained grade 2 injuries. Thirty players received augmented treatment with PRP injections and 39 players underwent nonoperative treatment alone. Average time missed in those treated with PRP injections was 22.5 days, 18.2 practices, and 1.3 games. In those who did not receive PRP injections, time missed was 25.7 days ( P = .81), 22.8 practices ( P = .68), and 2.9 games ( P < .05). Conclusion: Augmentation with PRP injections for acute grade 2 hamstring injuries in NFL players showed no significant difference in days missed or time to return to practice but did allow for faster return to play, with a 1 game overall difference. Owing to the possible large financial impact of returning to play 1 game sooner, PRP injections for treatment of grade 2 hamstring injuries may be advantageous in professional athletes.

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“…These treatments may be considered for patients with chronic hamstring insertional tendinopathy. [39][40][41] Non-operative management is considered the preferred option for partial avulsions, tears involving one or two tendons only, for sedentary individuals, patients with medical comorbidities, or those that are unable to adhere to postoperative rehabilitation. 24 Aggressive strengthening to optimize function is recommended.…”

Section: Non-operative Treatmentmentioning

confidence: 99%

Proximal hamstring tendon avulsion: state of the art

et al. 2021

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Complete proximal hamstring tendon avulsions from the ischial tuberosity, though infrequent, are the most severe type of hamstring muscle injury in the field of sport medicine. These serious injuries are commonly associated with a delayed or even misdiagnosis, despite obvious clinical findings. The published literature favours surgical repair even though the studies represent lower levels of evidence. Non-surgical treatment is a viable option for lower physical demand patients. This state-of-the-art article reviews the relevant anatomy, the clinical assessment including specific physical examination signs and diagnostic testing in patients suspected of a proximal hamstring avulsion. Up-to-date evidence is reviewed to address surgical and non-surgical treatment options and outcome assessment. The authors provide a detailed description of what would be considered the current worldwide standard of care; an open, suture-anchor-based repair of the avulsed tendon complex (semitendinosus, long head of biceps femoris and semimembranosus) securely to the ischial tuberosity. Also included are surgical tips and tricks, with advice on postsurgical management and rehabilitation. Future perspectives should involve higher quality, prospective research to better define the indications for surgery, evaluate the emerging role of endoscopic repair and disclose complications along with measuring patient-reported outcomes.

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Platelet-rich plasma vs. steroid injections for hamstring injury—is there really a choice?

Abstract: The PRP group had shown more favorable response compared to steroid group at 1 week post-injection, which suggests that PRP therapy can be considered as a conservative treatment choice for grade 2 proximal hamstring injuries with better short-term pain relief based on limited pilot data.

Cited by 22 publications

References 24 publications

Functional Results and Outcomes After Repair of Partial Proximal Hamstring Avulsions at Midterm Follow-up

Functional Results and Outcomes After Repair of Partial Proximal Hamstring Avulsions at Midterm Follow-up

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

Proximal hamstring tendon avulsion: state of the art

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