Post‐Procedure Protocols Following Platelet‐Rich Plasma Injections for Tendinopathy: A Systematic Review

Abstract

Objective Platelet‐rich plasma (PRP) has been increasingly studied as a treatment for tendinopathy. Many factors may influence outcomes after PRP, including different protocols following administration. It was hypothesized that there would be heterogeneity in post‐PRP protocols. Literature Survey A systematized review of the literature on post‐PRP protocols for tendinopathy was conducted using an electronic search of MEDLINE and Embase databases through September 2018. Methodology After duplicates were removed, English language articles involving adult patients who received PRP for tendinopathy were reviewed. Exclusion criteria included studies with fewer than 10 patients, PRP used to treat pathology other than tendinopathy, multiple protocols in one study, and surgical settings. Protocol specifics were extracted including nonsteroidal anti‐inflammatory drugs (NSAID) restrictions before and after injection, postinjection restrictions on movement and weight bearing, use of orthoses, activity modifications, and postinjection rehabilitation protocols. Given limitations in the data, a meta‐analysis was not performed. Synthesis Eighty‐four studies met inclusion criteria. Following PRP injection, weight‐bearing restrictions were mentioned rarely (12% of protocols). Orthosis use was uncommon overall (18%) but more common in Achilles tendinopathy protocols (53%). The majority of protocols instituted a period of stretching (51%) and strengthening (54%). Stretching programs generally began 2‐7 days following injection, and strengthening programs began within 2‐3 weeks. Preinjection NSAID restriction was reported rarely (20%), whereas postinjection NSAID restriction was more common (56%), with a typical restriction of greater than 2 weeks (38%). Return to play or full activity was reported in 42% of protocols, most commonly at 4‐6 weeks following injection. Conclusion Although the clinical effectiveness of PRP remains controversial, even less is known about the effect of post‐PRP protocols, which may affect the outcomes attributed to PRP itself. No studies directly compare post‐PRP protocols, and the protocols studied demonstrate substantial heterogeneity. Some consensus regarding post‐PRP protocols exists, although the rationale for these recommendations is limited.

Variability in Patient-Incurred Costs and Protocols of Regenerative Medicine Procedures for Musculoskeletal Conditions in the United States

“…In addition to costs, information about pre- and postprocedure protocols for regenerative medicine treatments was obtained from our study. Currently, the literature is limited regarding protocols for regenerative medicine treatments [3,7]. While it is often mentioned as a critical component, there is little data supporting 1 protocol over another.…”

Application of Orthobiologics in Achilles Tendinopathy: A Review

“…This data is ascribed to biomechanical differences in the tendinous substances [ 126 ]. Townsend et al formulated post-PRP protocol for AT by the initiation of stretching exercises by 2 weeks after injection and then full return to play was advised after 6 weeks of PRP injection [ 127 ]. Despite controversy in the literature, many studies share a common ground in the sense that PRP consistently presents itself as a safe and effective biological agent for the amelioration of both chronic and acute Achilles tendon injuries, with significant improvements in pain and functional outcomes [ 112 , 123 , 128 , 129 ].…”

Tendinopathien

“…Diese scheinen bisher nicht berücksichtigt worden zu sein. Die Autoren Townsend et al [24] konnten in diesem systematischen Review Unter https://www.thieme-connect.de/products/ejournals/journal/10.1055/a-1350-2400 oder über den QR-Code kommen Sie direkt zum Artikel der Eingabe der Antworten.…”