Are Multiple Platelet-Rich Plasma Injections Useful for Treatment of Chronic Patellar Tendinopathy in Athletes?

Charousset, Christophe; Zaoui, Amine; Bellaïche, Laurence; Bouyer, Benjamin

doi:10.1177/0363546513519964

Cited by 108 publications

(100 citation statements)

References 45 publications

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“…In a case-series study, the efficacy of three ultrasound-guided PRP injections at 1-week intervals was assessed in 28 professional and recreational athletes with patellar tendinopathy [41]. Improvements in the clinical outcome measures and magnetic resonance imaging (MRI) findings were apparent as early as 3 months after the injections, and the MRI improvements were sustained in patients who underwent repeat MRI after 2 years.…”

Section: Use Of Prp In Patellar Tendinopathy (Jumper's Knee)mentioning

confidence: 99%

Does platelet-rich plasma deserve a role in the treatment of tendinopathy?

et al. 2015

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Section: Use Of Prp In Patellar Tendinopathy (Jumper's Knee)mentioning

confidence: 99%

Does platelet-rich plasma deserve a role in the treatment of tendinopathy?

et al. 2015

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“…A number of papers have previously reported the results of multiple injections 14,22 but, to our knowledge, there have been no previous studies comparing a one PRP injection to a two PRP injection protocol. Most growth factors contained in platelets are shortlived and the benefit of PRP may dissipate over time 9,23 .…”

Section: Discussionmentioning

confidence: 99%

“…It is hypothesized that the growth factors and other bioactive molecules released by the alpha granules in platelets present in PRP have the potential to enhance cellular migration, proliferation, angiogenesis, and matrix deposition in tendon healing [10][11][12][13] . To date, the ideal protocol of PRP application concerning the volume, number and timing of injections has not been established 14 . An animal model study…”

Section: Introductionmentioning

confidence: 99%

Platelet-rich plasma as a treatment for chronic patellar tendinopathy: comparison of a single versus two consecutive injections

Zayni

Thaunat

Fayard

et al. 2015

MLTJ

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IntroductionChronic patellar tendinopathy (PT) remains a challenging problem for both orthopedic surgeons and sport medicine practitioners. It is often caused by overuse of the knee extensors in activities such jumping, running and kicking. Clinically, this tendinopathy is characterized by anterior knee pain and focal tenderness at the distal border of the patella. It affects athletes in numerous sports, at all levels of participation and can severely limit performance 1 . The precise etiology of this tendinopathy is not clear. Several histopathological studies have shown a degenerative process with tendon thickening, disturbed collagen distribution, neovascularization and increased cellularity with incompletely healed tendon micro-ruptures 2-5 . There is currently no consensus on its optimal treatment. Conservative management is the first line treatment including eccentric physical therapy, icing, activity modification, and non-steroidal anti-inflammatory drugs (NSAIDs) 6,7 . Despite conservative treatment, patellar tendinopathy may remain resistant to therapy and can often lead to a prolonged clinical course. Autologous PRP intra-lesional injection is being used increasingly in the treatment of many soft tissue injuries. Recently, there has been great interest in using PRP for sports related injuries, particularly patellar tendinopathy 8 , although the rationale for use PRP is still unclear 9 . It is hypothesized that the growth factors and other bioactive molecules released by the alpha granules in platelets present in PRP have the potential to enhance cellular migration, proliferation, angiogenesis, and matrix deposition in tendon healing [10][11][12][13] . To date, the ideal protocol of PRP application concerning the volume, number and timing of injections has not been established 14

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“…Over eight clinical human trials, the vast majority of patients suffering from chronic, recalcitrant tendinosis saw significant and substantial reductions in pain [88][89][90][91][92][93][94][95] and increases in joint function [72,88,90,[92][93][94][95] when treated with PRP without supplemental procedures. These patients had experienced symptoms of tendonosis for at least 3 months and had not responded to nonsurgical interventions [88][89][90][92][93][94][95]. Raymond Monto treated 30 patients experiencing severe, persistent Achilles tendinopathy with a single 4 mL injection of PRP [90].…”

Section: Prp For Chronic Tendinopathiesmentioning

confidence: 99%

Biologic and Tissue Engineering Strategies for Tendon Repair

Sigal

Grande

Dines

et al. 2016

Regen. Eng. Transl. Med.

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This review summarizes recent developments in biologic treatments-including growth factors, platelet-rich plasma (PRP), stem cells, and cell-seeded scaffolds-for tendon repair. Growth and differentiation faction-5 (GDF-5), insulin-related growth factor-1 (IGF-1), and basic fibroblast growth factor (bFGF) all improved extracellular matrix (ECM) production and tensile strength of treated tendons; however, no clinical trials were done on GDF-5. Platelet-derived growth factor-BB (PDGF-BB) improved proliferation and ECM production, but did not consistently improve mechanical properties. The literature was mixed on the efficacy of PRP for the treatment of chronic and acute tendinopathies. However, PRP did cause any complications, and its benefits may be enhanced once an ideal, standardized composition is developed. Therefore, PRP may be a valid treatment, especially once nonsurgical management options have failed. Mesenchymal stem cells (MSCs) significantly and substantially improved the quality of tendon repairs and demonstrated the ability to regenerate an enthesis. Adipose-derived stem cells (ADSCs) have similar effects and are easier to harvest. The periosteum may also regenerate the tendon-bone attachment. Tenocytes, meanwhile, may be ideal for midsubstance tendon repairs. Cell-seeded scaffolds-especially ECMderived scaffolds-were demonstrated to improve ECM production, enhancing the healing abilities of tenocytes or stem cells while providing early mechanical support to healing tendons.Each of these treatments demonstrated enhanced healing compared to common surgical techniques; moreover, patient outcomes may be enhanced by combining these treatments. Lay SummaryTendon injuries are very prevalent and can be debilitating. Tendon heals poorly, and the scar tissue that forms is weak and susceptible to reinjury. A major focus of orthopedic research is regenerative medicine, encouraging the formation of healthy tendon rather than mechanically inferior scar tissue. This review summarizes the recent scientific literature on biologic treatments for tendon repair, such as growth factors, platelet-rich plasma, and stem cells. The purpose of which is to show which treatments are promising candidates for clinical use and research, helping to guide physicians and to lay out a path for future research.

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Are Multiple Platelet-Rich Plasma Injections Useful for Treatment of Chronic Patellar Tendinopathy in Athletes?

Cited by 108 publications

References 45 publications

Does platelet-rich plasma deserve a role in the treatment of tendinopathy?

Does platelet-rich plasma deserve a role in the treatment of tendinopathy?

Platelet-rich plasma as a treatment for chronic patellar tendinopathy: comparison of a single versus two consecutive injections

Biologic and Tissue Engineering Strategies for Tendon Repair

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