Tendinopathies et plasma riche en plaquettes (PRP) : applications cliniques. Revue de la littérature

Abstract

Certaines lésions tendineuses chroniques apparaissent régulièrement résistantes aux traitements conservateurs. Cette revue actualise le traitement des lésions tendineuses par plasma riche en plaquettes (PRP). Etant donné le caractère récent de ce traitement dans le domaine médico-sportif, les études cliniques réalisées à ce jour n'ont pas confirmé les effets bénéfiques obtenus in vitro. Certaines études démontrent une amélioration de la symptomatologie suite au traitement par PRP, mais d'autres études apparaissent contradictoires. L'avenir du PRP nécessite une standardisation de la procédure de recueillement ainsi que par la réalisation de protocoles standardisés permettant de comparer les futurs travaux. Mots clés Plasma riche en plaquettes, PRP, tendinopathies chroniques Abstract Tendinopathies are common and frequently resisting to actual conservative measures. The aim of this review was to gather the actual knowledge concerning the platelet-rich plasma (PRP) treatment in tendon lesion. However, given the relative recent knowledge about PRP in sports medical, the studies could not yet reproduce the beneficial effects obtained in-vitro. Most studies about the subject indeed show an improvement in symptoms after PRP treatment but, the few studies of high level of evidence are contradictory. Therefore, there is no evidence of formally advise the use of PRP in the treatment of tendinopathy. So the main research field in the close future will have to determine a standard for the manufacture of PRP and the protocols of the future studies in order to be able to compare them.

Comparison between platelet-rich plasma injections and hyaluronic acid injections in the treatment of patellar tendinopathies: a randomized trial

“…), others remain chronic. It is for this reason that a lot of research has been carried out to develop or adapt treatments for such rebel conditions, among which PRP and HA (13,28). Some clinical studies have previously evaluated the effect of PRP in the treatment of proximal patellar tendinopathies (6,23,24,29).…”

Tendinopathies and platelet-rich plasma (PRP): from pre-clinical experiments to therapeutic use

“…Studies on the patellar tendon appear to be more positive than other tendons. However, as already observed in previous reviews on PRP [5][6][7][8][9][10][11][12][13][14][15] , the more recent studies cannot conclude that PRP is really efficient in the treatment of tendinopathy, even if most of the low level studies remain very encouraging. Moreover, many of the authors of the articles reporting success of PRP application (essentially with leukocytes rich PRP) have conflicts of interest.…”

“…In a certain number of cases, the aim is also to reduce the duration of functional impotence and to encourage an early return to physical activity. However, currently the use of these PRPs remains a topic of debate and even controversy [7][8][9][10][11][12][13][14][15] . Table 1 presents the clinical studies discussed in this review.…”

“…This literature review analyses articles on the use of PRP in tendinous healing (experimental and clinical studies) published between 1 January 2012 and 31 December 2014. Several reviews have already appeared relating to earlier studies [5][6][7][8][9][10][11][12][13][14][15] . The results of both pre-clinical and clinical studies were analyzed separately in this review and finally discussed together in order to trying to improve this therapeutic modality.…”

Eccentric Training for Tendon Healing After Acute Lesion: A Rat Model

“…Previous research has demonstrated that PRP injection improves the healing process of acute tendon lesions in a rat model, 2,16,28 especially in the early phase of healing, 15 even though the efficacy of this treatment applied to human subjects is still debated. 3,5,6,13 Moreover, a 5-week eccentric training protocol performed on healthy rat tendons significantly increased the force and energy required to tear the tendon in a simple tensile test. 17 In human subjects undergoing physical therapy after a tendon injury, eccentric training is a key factor for a successful recovery, 1,7,8 if we assume that the latter is related to the biomechanical properties of the tendon.…”