Single injection of platelet-rich plasma (PRP) for the treatment of refractory distal biceps tendonitis: long-term results of a prospective multicenter cohort study

Sanli, Ilknur; Morgan, Barnes; Tilborg, Fiek van; Funk, Lennard; Gosens, Taco

doi:10.1007/s00167-014-3465-8

Cited by 35 publications

(19 citation statements)

References 27 publications

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“…Although recent investigations have demonstrated clinical success with use of US-guided injections for distal bicep tendinopathy [5,6], this article is the first to describe a posterior approach to this area on a live subject, which we believe to be very important for the safe, easy, and effective delivery of the injectate. We believe that a significant risk of injury exists with an anterior approach because of the multiple neurovascular structures in the area and increased difficulty in visualizing the tendon.…”

Section: Discussionmentioning

confidence: 96%

“…However, one set of investigators [4] noted a 27% percent complication rate, with the most common complications being nerve dysfunction and radioulnar synostosis. Use of platelet-rich plasma (PRP) has been reported as a potential alternative treatment for this condition [5,6]; however, an anterior approach has been used to inject the PRP, which increases the chance of a neurovascular injury.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound‐Guided Distal Bicep Tendon Injection Using a Posterior Approach

Mautner

Stafford

Nguyen

2015

PM&R

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Distal biceps tendinopathy is an uncommon but increasingly diagnosed condition in persons with elbow pain. When traditional treatments are unsuccessful, practitioners have performed ultrasound (US)-guided tendon injections in this region using an anterior approach. Although success has been reported with this technique, this approach may lead to neurovascular injury. This case report is the first in the literature to describe a US-guided distal bicep tendon injection using a posterior approach. The patient had an excellent clinical outcome with no adverse events. This outcome suggests that a US-guided posterior percutaneous tendon injection might be a safe, viable, nonsurgical option for recalcitrant distal biceps tendinopathy.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Ultrasound‐Guided Distal Bicep Tendon Injection Using a Posterior Approach

Mautner

Stafford

Nguyen

2015

PM&R

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“…Notably, two protocols continued NSAID restriction for 6 months after injection. 10,89 47 --------"Strengthening" indicates any activity beyond range of motion and stretching. "Return to play" indicates completion of all physical restrictions.…”

Section: Nsaid Restrictionmentioning

confidence: 99%

Post‐Procedure Protocols Following Platelet‐Rich Plasma Injections for Tendinopathy: A Systematic Review

Townsend

Rickenbach

Bailowitz

et al. 2020

PM&R

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Objective Platelet‐rich plasma (PRP) has been increasingly studied as a treatment for tendinopathy. Many factors may influence outcomes after PRP, including different protocols following administration. It was hypothesized that there would be heterogeneity in post‐PRP protocols. Literature Survey A systematized review of the literature on post‐PRP protocols for tendinopathy was conducted using an electronic search of MEDLINE and Embase databases through September 2018. Methodology After duplicates were removed, English language articles involving adult patients who received PRP for tendinopathy were reviewed. Exclusion criteria included studies with fewer than 10 patients, PRP used to treat pathology other than tendinopathy, multiple protocols in one study, and surgical settings. Protocol specifics were extracted including nonsteroidal anti‐inflammatory drugs (NSAID) restrictions before and after injection, postinjection restrictions on movement and weight bearing, use of orthoses, activity modifications, and postinjection rehabilitation protocols. Given limitations in the data, a meta‐analysis was not performed. Synthesis Eighty‐four studies met inclusion criteria. Following PRP injection, weight‐bearing restrictions were mentioned rarely (12% of protocols). Orthosis use was uncommon overall (18%) but more common in Achilles tendinopathy protocols (53%). The majority of protocols instituted a period of stretching (51%) and strengthening (54%). Stretching programs generally began 2‐7 days following injection, and strengthening programs began within 2‐3 weeks. Preinjection NSAID restriction was reported rarely (20%), whereas postinjection NSAID restriction was more common (56%), with a typical restriction of greater than 2 weeks (38%). Return to play or full activity was reported in 42% of protocols, most commonly at 4‐6 weeks following injection. Conclusion Although the clinical effectiveness of PRP remains controversial, even less is known about the effect of post‐PRP protocols, which may affect the outcomes attributed to PRP itself. No studies directly compare post‐PRP protocols, and the protocols studied demonstrate substantial heterogeneity. Some consensus regarding post‐PRP protocols exists, although the rationale for these recommendations is limited.

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“…In a recent multicenter, prospective, cohort study of 12 patients with refractory distal biceps tendinitis who underwent ultrasonographyguided PRP injection, Sanli et al 40 performed the injections with the patients in the supine position and the ultrasonographic probe in orientation with the longitudinal axis of the tendon. They did not report whether the injection was localized in the tendon sheath or in the intrasubstance of the tendon.…”

Section: Distal Biceps Tendonmentioning

confidence: 99%

“…The authors reported improved pain and functional resting and activity outcome scores in all the patients at a mean follow-up of 47 months. 40…”

Section: Distal Biceps Tendonmentioning

confidence: 99%

Clinical Applications of Ultrasonography in the Shoulder and Elbow

Lin

Gasbarro

Sakr

2018

J Am Acad Orthop Surg

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In the past 30 years, the use of ultrasonography in the field of orthopaedics has evolved. As ultrasonography has been refined, smaller machines with higher fidelity and better transducers have become available at a lower cost. Diagnostic and therapeutic applications of ultrasonography in the shoulder and elbow have expanded imaging options and provided alternatives to surgical management. Ultrasonography is a dynamic tool that affords immediate diagnostic assessment for clinical correlation and can be used for serial examinations and image guidance during therapeutic procedures. This imaging modality is highly reliable and accurate and may limit the need for costly imaging referrals, particularly in geographic areas where advanced imaging is not readily available. However, clinical expertise is paramount for ultrasonography, which is an operator-dependent modality. Ultrasonography is an effective educational resource; therefore, the curriculum in orthopaedic residency training programs should include education on this modality as the use of ultrasonography increases among orthopaedic surgeons.

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Single injection of platelet-rich plasma (PRP) for the treatment of refractory distal biceps tendonitis: long-term results of a prospective multicenter cohort study

Abstract: III.

Cited by 35 publications

References 27 publications

Ultrasound‐Guided Distal Bicep Tendon Injection Using a Posterior Approach

Ultrasound‐Guided Distal Bicep Tendon Injection Using a Posterior Approach

Post‐Procedure Protocols Following Platelet‐Rich Plasma Injections for Tendinopathy: A Systematic Review

Clinical Applications of Ultrasonography in the Shoulder and Elbow

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