Pain and Activity Levels Before and After L-PRP Treatment of Patellar Tendinopathy: A Prospective Cohort Study and the Influence of Previous Treatments

Department of Orthopaedics and Traumatology, St Elisabeth Hospital Tilburg, Tilburg, The Netherlands.
International Orthopaedics (Impact Factor: 2.11). 04/2012; 36(9):1941-6. DOI: 10.1007/s00264-012-1540-7
Source: PubMed


The aim of this study was to evaluate the outcome of patients with patellar tendinopathy treated with platelet-rich plasma injections (PRP). Additionally, this study examined whether certain characteristics, such as activity level or previous treatment affected the results.
Patients (n = 36) were asked to fill in the Victorian Institute of Sports Assessment - Patellar questionnaire (VISA-P) and visual analogue scales (VAS), assessing pain in activities of daily life (ADL), during work and sports, before and after treatment with PRP. Of these patients, 14 had been treated before with cortisone, ethoxysclerol, and/or surgical treatment (group 1), while the remaining patients had not been treated before (group 2).
Overall, group 1 and group 2 improved significantly on the VAS scales (p < .0.05). However, group 2 also improved on VISA-P (p = .0.003), while group 1 showed less healing potential (p = 0.060). Although the difference between group 1 and group 2 at follow-up was not considered clinically meaningful, over time both groups showed a clinically significant improvement.
After PRP treatment, patients with patellar tendinopathy showed a statistically significant improvement. In addition, these improvements can also be considered clinically meaningful. However, patients who were not treated before with ethoxysclerol, cortisone, and/or surgical treatment showed the improvement.

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Available from: Taco Gosens, Jan 12, 2014
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    • "Gosens et al. [27] aimed to evaluate the outcome of patients with patellar tendinopathy treated with PRP injections, and they examined whether certain characteristics, such as activity level or previous treatment, affected the results. Clinical evaluations were made by VISA-P and VAS, assessing pain in activities of daily life (ADL), during work and sports, before and after treatment with PRP. "
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    ABSTRACT: Platelet-rich plasma (PRP), a blood derivative with high concentrations of platelets, has been found to have high levels of autologous growth factors (GFs), such as transforming growth factor-β (TGF-β), platelet-derived growth factor (PDGF), fibroblastic growth factor (FGF), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). These GFs and other biological active proteins of PRP can promote tissue healing through the regulation of fibrosis and angiogenesis. Moreover, PRP is considered to be safe due to its autologous nature and long-term usage without any reported major complications. Therefore, PRP therapy could be an option in treating overused tendon damage such as chronic tendinopathy. Here, we present a systematic review highlighting the clinical effectiveness of PRP injection therapy in patellar tendinopathy, which is a major cause of athletes to retire from their respective careers.
    BioMed Research International 07/2014; 2014:249498. DOI:10.1155/2014/249498 · 1.58 Impact Factor
    • "Filardo et al.49 evaluated the efficacy of PRP injections for refractory patellar tendinopathy and concluded that PRP injections had the potential to promote the achievement of a satisfactory clinical outcome, even in chronic refractory tendinopathy. Gosens et al.50 reported on the pain and the activity levels before and after PRP injection in patellar tendinopathy in a prospective cohort study and concluded that patients treated with PRP showed a statistically significant improvement. Vetrano et al.51 reported their results comparing PRP injections with extracorporeal shock wave therapy (ESWT) and reported a significantly better improvement in PRP group over the ESWT group after 12 months of followup [Table 7]. "
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    ABSTRACT: Orthobiologics have evolved to the extent that they significantly influence modern orthopedic surgical practice. A better understanding of the role of various growth factors and cells in the process of tendon healing, ligament repair, cartilage regeneration and bone formation has stimulated focused research in many chronic musculoskeletal ailments. Investigators have published results of laboratory as well as clinical studies, using orthobiologics like platelet rich plasma, stem cells, autologous conditioned serum etc., with variable results. However, a clear consensus over the best orthobiologic substance and the method of preparation and usage of these substances is lacking. Much of the confusion is due to the fact that studies ranging from RCTs to case reports present variable results, and the interpretations are wide-ranging. We have reviewed the available orthobiologics related data with a focus on platelet rich plasma in orthopedic conditions.
    Indian Journal of Orthopaedics 03/2014; 48(1):1-9. DOI:10.4103/0019-5413.125477 · 0.64 Impact Factor
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    • "Also clinical investigation, with persistent pain on palpation and swelling at the proximal MCL insertion, was suggesting an ongoing healing process. Thus, since a positive effect of PRP on pain has been reported in patellar human tendinopathy [20] , it may have happened that PRP acted on the pain, allowing an earlier return to sport activity without accelerating the healing process. "
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    ABSTRACT: Platelet-rich plasma (PRP) is derived from centrifuging whole blood to obtain a high platelet concentration containing numerous growth factors. Despite its widespread use, there is still a lack of high-level evidence regarding randomized clinical trials assessing the efficacy of PRP in treating ligament injuries. Although there is research showing an improvement in the early stages of healing in the animal model of acute medial collateral ligament (MCL) injury of the knee, there is no strong evidence to support the efficacy of PRP injections for treating MCL lesions in humans. In this report, we present a case of an elite football player, treated with multiple PRP local injections followed by rehabilitation, for a high grade MCL lesion of the knee. He was able to resume training at day 18, painfree, with full range of motion and the ability to complete a functional test based on all sport specific movements. He played matches at 25 days with no residual symptoms or functional deficit. There were no further complaints or recurrences at the 16 months follow up. On the basis of this report, we can assume that the treatment of high grade acute MCL lesions of the knee with PRP is a promising therapeutic option to be further explored with good quality Randomized Controlled Trials (RCTs).
    Asian Journal of Sports Medicine 06/2013; 4(2):158-162. DOI:10.5812/asjsm.34517
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