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

Abstract

Background. As patellar tendinopathies are frequently chronic there has been plenty of research carried out to develop effective treatments, among which platelet-rich plasma (PRP) and hyaluronic acid (HA). Hypothesis. Therefore we aimed to compare the effect after three months following injections of PRP compared with HA injections on patients with a proximal patellar tendinopathy. Methods. 33 sportsmen with chronic proximal patellar tendinopathies were included and randomised into 2 groups and treated respectively with PRP (obtained using an apheresis machine) or HA injections. To assess the evolution of the pathology, algo-functional tests (VISA-P and IKDC) and isokinetic tests were carried out pre-injection, after 6 weeks and after 3 months post-injections. Results. The results of VAS, algometric scores, IKDC scores and VISA-P showed a considerable improvement in the two groups over time (p<0.01), except for the US findings. Isokinetic tests showed significant modifications for the quadriceps in C60 (p=0.01) for the pathological limb only at the end of the follow-up period. VAS associated with isokinetic tests decreased significantly for all contraction modes after three months in the HA group (p<0.05). Correlations showed that there was a significant negative association between VAS and strength in C60, C240 and E30 (p<0.01) only for the PRP group. Conclusion. Both PRP and HA can alleviate the symptoms of proximal patellar tendinopathy in the medium term. However, only PRP leads to a decrease in pain associated with an increase in the strength of the quadriceps.

Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies

“…Online supplemental table 1 shows the characteristics of the included studies 12–48. A total of 37 randomised controlled trials (RCTs) were found to be eligible, including 1332 patients (1407 tendons) with patellar tendinopathy (mean age 29.2 years).…”

The Impact of Hyaluronic Acid on Tendon Physiology and Its Clinical Application in Tendinopathies

“…Kaux et al compared US-guided injections of platelet-rich plasma (PRP) versus two HA injections, reporting that both treatments could be effective. The PRP group showed significant improvement in quadriceps strength, while HA had a greater impact on the improvement of symptoms [94]. Recently, Frizziero et al showed good results after three medium molecular weight US-guided HA injections.…”

The Role of Hyaluronic Acid Injection for the Treatment of Tendinopathy

“…In accordance to Achilles tendinopathy, Fogli et al and Frizziero et al found that three US-guided HA injections induce prompt improvement in pain (NRS), symptoms and function (VISA-A, VISA-P and EQ-5D-5L) and US parameters (47,48). Kaux et al compared platelet-rich plasma injections and hyaluronic acid injections under US guidance, evidencing that even both treatments could ameliorate symptoms, PRP group had significant improvement in quadriceps strength while HA seemed to have a prompt effect in pain-relief (51).…”