Efficacy of second intra-tendinous platelet-rich-plasma injection in case of incomplete response of the first injection: Three-year follow up experience

Dallaudière, B.; Meyer, P.; Hummel, Vincent; Perozziello, Anne; Peuchant, A.; Moreau-Durieux, M.H.; Silvestre, Alain; Pelé, E.; Wakim, N.; Loriaut, P.; Boyer, Patrick; Schouman-Claeys, É.; Serfaty, Jean Michel; Pesquer, Lionel

doi:10.1016/j.diii.2013.05.010

Cited by 18 publications

(10 citation statements)

References 42 publications

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“…The adequate number of injections over time is also a point of debate in naturally occurring human tendinopathy: In a long term clinical trial in humans it was shown that a second early PRP injection does not rapidly improve clinical signs of tendinopathy in case of incomplete resolution after the first treatment [65]. However, it has been shown in a controlled human clinical trial that patients with chronic patellar tendinopathy receiving two injections of a leucocyte poor platelet concentrate (autologous conditioned plasma®) showed better improvement in outcomes when compared to a monoinjection [66].…”

Section: Discussionmentioning

confidence: 99%

Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies – a randomized prospective controlled clinical trial

et al. 2016

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BackgroundRegenerative and anti-inflammatory effects on tendinopathies have been attributed to blood-derived biologicals. To date the evidence for the efficacy of autologous platelet-rich plasma (PRP) treatment of naturally occurring equine tendinopathies is limited. The purpose of this placebo-controlled clinical trial was to describe the effect of a single treatment of equine superficial digital flexor tendon (SDFT) disease with PRP on clinical and ultrasonographic parameters. Twenty horses with naturally occurring tendinopathies of forelimb SDFTs were randomly assigned to the PRP-treated group (n = 10) or control group (n = 10) after clinical and ultrasonographic examination. The SDFTs received an intralesional treatment with autologous PRP or were injected with saline, respectively (day 0). All horses participated in a standardized exercise programme and were re-examined clinically, with B-mode ultrasonography (5 times at regular intervals) and ultrasound tissue characterization (week 12 and 24 after treatment) until week 24. Long-term performance was estimated via telephone inquiry.ResultsCompared to day 0, lameness decreased significantly by week 8 after treatment with PRP and by week 12 in the control group. Ultrasonographically there was no difference in the summarized cross sectional area between the groups at any time point. Ultrasound tissue characterization showed that echo types representing disorganized matrix decreased significantly throughout the observation period in the PRP-treated group. Echo type II, representing discontinuous fascicles, not yet aligned into lines of stress was significantly higher 24 weeks after PRP treatment. Eighty percent of the PRP treated horses reached their previous or a higher level of performance after 12 months compared to 50 % in the CG. After 24 months these proportions were 60 % and 50 %, respectively.ConclusionsA single intralesional treatment with PRP up to 8 weeks after onset of clinical signs of tendinopathy contributes to an earlier reduction of lameness compared to saline treatment and to an advanced organization of repair tissue as the fibrillar matrix is getting organized into fascicles while remodelling continues. Long term, PRP treatment has the potential to increase the number of horses reaching their previous level of performance. Earlier treatment of tendinopathy with PRP should be considered to enhance these effects.

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Section: Discussionmentioning

confidence: 99%

Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies – a randomized prospective controlled clinical trial

et al. 2016

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“…Indeed, a 3-year follow-up case series study emphasizes the potential importance of a second PRP injection in painful tendon tears unresponsive to a single injection. 35 A recent cross-sectional retrospective survey gathered outcome data from different tendons treated with PRP. In this study involving a total of 180 patients, 106 patients were treated for PT and more than 80% of patients who received one or two injections and 76% of those who received three injections reported moderate-to-complete resolution of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Use of Platelet-Rich Plasma for Patellar Tendon and Medial Collateral Ligament Injuries: Best Current Clinical Practice

Andı́a

Maffulli

2014

J Knee Surg

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Patellar tendinopathy (PT), also named jumpers knee, is an overuse injury characterized by activity-related anterior knee pain, most often showing lesions at the inferior pole of the patella, even though the midzone, paratenon, tibia tubercle or superior pole can also be affected.PT is common among professional and recreational athletes 1 involved in sports with high demand of the knee extensors, in particular volleyball and basketball. 2 In this context, intrinsic risk factors such as patellar shape 3 and athlete's age, or extrinsic risk factors involving playing at high level competition, hours of training per week, and training errors among others make athletes vulnerable to PT. 4 So far, most research involves professional and recreational athletes. The personal and economic burden of PT is high, because swelling and pain impairs performance with loss of function (jumping and kneeling), often leading athletes to abandon their career. 5 Several nonoperative treatment modalities can be used to manage PT, including a variety of injectable substances with different mechanisms of action such as corticoids, polidocanol or platelet-rich plasma (PRP). The effect of high volume injections to mechanically modify the tissue has been explored both in chronic PT 6 and recalcitrant medial collateral ligament (MCL) injuries. 7 In addition, physical therapies (mainly eccentric training) and extracorporeal shock wave therapy (ESWT) are used. While some evidence supports the efficacy of eccentric exercises, not enough data demonstrate the effectiveness of polidocanol injection or ESWT. 8 Their efficacy may depend on the phase of PT. Here, we review the available data on the efficacy of PRP injections in the management of PT. Keywords► tissue regeneration ► signaling proteins ► biological therapy AbstractPlatelet-rich plasmas (PRPs) are complex molecular therapies prepared from the patient's own blood through minimal manipulation. Clinical studies examining the efficacy of PRPs to manage patellar tendinopathy and medial collateral ligament (MCL) injuries have been reviewed. We found three controlled trials, two of them randomized, and seven case series in the management of patellar tendinopathy. In addition, three other randomized studies showed that PRPs help to regenerate the patellar tendon harvest site for anterior cruciate ligament reconstruction and to reduce patellar donor site morbidity. On the other hand, the use of PRP in MCL injuries is reported in a single case study. Seven of the 11 studies used leukocyte and PRP which was buffered in four studies. Seven of the 11 studies applied two or three injections. Given the heterogeneity of PRP protocols and the paucity of high-quality data, the most effective approach to guide clinical decisions regarding patellar tendinopathy cannot be deduced from the present published studies.

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“…Reports assessing autologous blood, PRP or varicose vein-sclerosing drugs, injected in different sites (intra, peritendinous) under different conditions (clinically-guided, imaging-guided), in heterogeneous populations, including patients with T+ and patients with rupture, with no long term follow-up and no histological examination 9,22,23 have provided contradictory results. Thus, there is no clear conclusion regarding the curative effect of PRP in T+.…”

Section: Discussionmentioning

confidence: 99%

The molecular systemic and local effects of intratendinous injection of Platelet Rich Plasma in tendinosis: preliminary results on a rat model with ELISA method

Dallaudière

Louedec

Lenet

et al. 2015

MLTJ

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showed no significant modification of their biological markers at D7, D13, D18 and D25 (p>0.22). Comparison of immunological sample tendon markers of PRPT+, PST+ and T+ groups also showed no significant modification of markers at D7, D13, D18 and D25 (p>0.16) considering each biological marker and also all subgroups confounded. Conclusion: our study strongly suggests that a single intratendinous US-guided injection of PRP in Achilles and patellar T+ doesn't increase biological markers such as growth factors compared to a control group in mid-term and long-term follow-up. KEY WORDS: tendinosis, rat, platelet, PRP, ELISA.Key Points: our goal was to assess the systemic and local molecular effect of intratendinous injection of PRP in tendinosis. We used patellar and Achilles tendinosis in a rat model with adequate controls. We precisely defined platelet, leukocyte concentrations in PRP, on a large cohort. We evaluated PRP biological molecular systemic and local effects. We provide strong evidence that PRP didn't increase biological markers, particularly growth factors, in serum and tendon dosages in PRP treated tendinosis compared to placebo group in mid-term and longterm follow-up. IntroductionTendinosis (T+) is a very common and disabling condition, resulting in impairment of quality of life. Indeed, T+ of the rotator cuff is the most common musculoskeletal cause of shoulder pain in the general population, mainly women between 40 and 65 year old in Europe whereas Achille's T+ affects 5-6% of the general population, especially young men in North America. In most cases, this condition progresses to a disabling pain or tendon rupture 1,2 . The healthy tendon is composed of type 1 collagen and a few elastic fibers, within a ground substance containing cells (tenocytes and tenoblasts) and water. In case of T+, histology mainly shows thinned and disorganized collagen fibers and increased interfibrillar glycosaminoglycans deposition with production of prostaglandins [PGE2, Interleukines (IL6, IL1B), cyclooxygenase (COX2) and matrix metalloproteinase SummaryPurpose: the aim of our study was thus to quantify the effect of Platelet Rich Plasma (PRP) injection on systemic and local growth factors and to identify molecular markers in a rat model of patellar and Achilles tendinosis treated with PRP. Material and method: twenty two rats were used for the study. Two healthy rats were used as control (T-). We induced tendinosis (T+) in 20 rats (80 tendons by injecting under ultrasonography (US) guidance Collagenase 1® (day 0 = D0, patellar=40 and Achilles=40). At D3, these 20 rats with tendinosis were separated in treatment by either PRP (PRPT+, n=28), physiological serum (PST+, n=28, control) USguided intratendinous injection, or without no PRP or PS (T+, n=24, control of natural evolution of tendinopathy). Follow-up at D7, D13, D18 and D25 using serum sample and local tendon removal with ELISA technics and comparison between the 3 groups were performed. Results: during biological follow up, comparison of all serum samples of P...

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Efficacy of second intra-tendinous platelet-rich-plasma injection in case of incomplete response of the first injection: Three-year follow up experience

Cited by 18 publications

References 42 publications

Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies – a randomized prospective controlled clinical trial

Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies – a randomized prospective controlled clinical trial

Use of Platelet-Rich Plasma for Patellar Tendon and Medial Collateral Ligament Injuries: Best Current Clinical Practice

The molecular systemic and local effects of intratendinous injection of Platelet Rich Plasma in tendinosis: preliminary results on a rat model with ELISA method

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