Sonographic findings during and after Platelet Rich Plasma injections in tendons

Abate, Michele; Verna, Sandra; Gregorio, Patrizia Di; Salini, Vincenzo; Schiavone, Cosima

doi:10.11138/mltj/2014.4.1.029

Cited by 6 publications

(3 citation statements)

References 25 publications

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“…40 This increased the stiffness of the tendons and, combined with micro-ruptures of the fibers, probably decreased their ability to absorb the exercise loads in the course, and thus increased the risk of those soldiers being injured. [40][41][42] The increased prevalence of echo-type III and IV fibers in the currently injured group might also indicate that the compromised tendon structure is associated with compromised muscle activity around the joint. 43,44 Changed muscle activation may lead to a diminished capacity of the surrounding muscles to stabilize the joint, along with reduced maximal muscle force and altered neuromuscular control, which potentially predisposes the participants to musculoskeletal injury.…”

Section: Discussionmentioning

confidence: 99%

Can Achilles and patellar tendon structures predict musculoskeletal injuries in combat soldiers?

Steinberg

Pantanowitz

Funk

et al. 2020

Scandinavian Med Sci Sports

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Aiming to investigate whether Achilles tendon (AT) structure and patellar tendon (PT) structure are risk factors for musculoskeletal injuries in combat soldiers, 168 participants were recruited from an infantry commander's course. The AT and PT were examined pre‐course using UTC to capture the structure of four echo‐type fibers (I–IV). All injuries were assessed by military physicians pre‐course and throughout the 14‐week course. Soldiers who were injured during the course had a significantly higher pre‐course prevalence of AT and PT echo‐type III and echo‐type IV compared to soldiers that were not injured during the course. Variables that were found to be associated with injured/non‐injured participants were echo‐type III + IV of the PT (OR = 1.44, 95% CI = 1.24‐1.68) and echo‐type III of the AT (OR = 1.69, 95% CI = 1.35‐2.12). ROC analyses showed that the best model, exhibiting both high sensitivity and low specificity, was that participants with PT echo‐type III + IV > 10% or AT echo‐type III >8.5% had the highest risk of being injured during the course. In conclusions, the tendon structure at the beginning of high‐intensity activity or physical training program might be a risk factor for subsequent injury during the course. Soldiers and high‐level athletes should be aware of the cutoff points for fiber types in tendon structure that might put them at high risk for future injury. At‐risk soldiers/athletes should be provided with an intervention program before they start their training program, with the aim of improving the tendon structure and preventing subsequent injury.

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Section: Discussionmentioning

confidence: 99%

Can Achilles and patellar tendon structures predict musculoskeletal injuries in combat soldiers?

Steinberg

Pantanowitz

Funk

et al. 2020

Scandinavian Med Sci Sports

View full text Add to dashboard Cite

show abstract

“…In a letter to the editor by Knobloch, et al (Knobloch et al 2008 ) in response to a published study of intratendinous injections for Achilles tendinopathy (Maxwell et al 2007 ), the authors raised concerns regarding the unknown effect of intratendinous level of collagen distribution on the potential adverse effects of intratendinous injections. Our study specifically examined the biomechanical effects, but other deleterious effects on tendon beyond physical disruption and biomechanical detrimental effects are also hypothesized (Abate et al 2014 ). Such proposed effects include risk of pressure-induced tissue necrosis and focal infections, as well as focal tendon hypoxia and elevated lactate concentrations in tendons with tendinosis (Knobloch et al 2008 ).…”

Section: Discussionmentioning

confidence: 99%

Intratendinous injections of platelet-rich plasma: feasibility and effect on tendon morphology and mechanics

et al. 2015

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BackgroundIntratendinous injections may have important effects on the properties of collagen microarchitecture, morphology, and subsequent mechanical properties of the injected tendon. The purpose of this study was to examine the effects of intratendinous PRP injections; the injectant retention within tendons, the distribution of intratendinous injectant, and whether intratendinous injection or needle fenestration alters tendon morphology or mechanics.MethodsDesign: Controlled Laboratory Study.Interventions: In the first part of the study, 18 lamb extensor tendons were selected to receive methylene blue-containing PRP injection (PRP/MB), methylene blue only injection (MB), or needle fenestration. The volume of retained injectant was measured and injectant distribution and tendon morphology were examined microscopically. In the second portion of the study, 18 porcine flexor tendons were divided into control, needle fenestration, or saline injection groups. Young’s Modulus was then determined for each tendon under 0-4% strain.Main outcome measures: 1) Injectant volume retained; 2) Injectant distribution; 3) Post-injection/fenestration alterations in morphology, biomechanics.ResultsIntratendinous injectant is retained within the tendon. The difference between PRP and PRP/MB groups was not significant (p = 0.78). Intratendinous spread of the injectant solution within the tendon occurs primarily in the proximodistal direction, with very little cross-sectional penetration. Intratendinous injections resulted in microscopic morphology disruption (e.g., separation and disorganization of both the collagen bundles and cellular distribution).There were significant differences in Young’s Modulus between control (Ectrl = 2415.48) and injected tendons (Einj = 1753.45) at 4% strain (p = 0.01). There were no differences in Young’s Modulus between fenestrated and control tendons.ConclusionsIntratendinous PRP injections are retained within the tendon, and primarily distributes longitudinally with minimal cross-sectional spread. Intratendinous injections may alter tendon morphology and mechanics.

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“…Results have shown only little or no structural improvement at short-to-midterm (6-14 months) follow-up while the data on tendon vascularity changes are conflicting. [4][5][6] Furthermore, these variables demonstrated poor correlation with clinical outcome. In a two-year prospective study evaluating the diagnostic and prognostic value of US and magnetic resonance (MR) imaging in the assessment of Achilles tendon disorders, Khan et al 7 reported that conventional US is not useful in monitoring Achilles tendon healing as US abnormalities persist even after patients have made good functional recovery.…”

Section: Introductionmentioning

confidence: 99%

Real-time sonoelastography evaluation of the Achilles tendon following ultrasound-guided platelet-rich plasma injection and eccentric exercise for the treatment of refractory Achilles tendinopathy

et al. 2018

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The objective of this study was to investigate the feasibility of using sonoelastography to depict Achilles tendon stiffness after platelet-rich plasma injection and eccentric exercise for chronic Achilles tendinopathy, and to correlate sonoelastography findings with clinical outcome up to 12 months after treatment. Forty-five Achilles tendons from 45 patients (33 males, 12 females; mean age 51 years) were examined using sonoelastography and ultrasound at baseline, 4–6 weeks, 6 months and 12 months post-treatment. The strain ratio (between Achilles tendon and Kager's fat) during sonoelastography was obtained. The proportion of tendons with hypoechogenicity and neovascularity were documented. Clinical outcomes were assessed by the Victorian Institute of Sport Assessment-Achilles questionnaire and correlated with sonographic findings. The Victorian Institute of Sport Assessment-Achilles improved significantly from 38.4 (±14.1) at baseline, 77.2 (±12.5) at 6 months ( p < 0.001) to 81.2 (±10.8) at 12 months ( p < 0.001). The strain ratio values were 2.16 (±1.02) at baseline, 2.03 (±0.67) at 4–6 weeks, 1.81 (±0.62) at 6 months and 1.19 (±0.34) at 12 months with a significant reduction observed at 6 months (p = 0.006) and 12 months ( p < 0.001). At 12-month evaluation, none of the tendons regained a normal echotexture. Strain ratio demonstrated a moderately good inverse correlation with Victorian Institute of Sport Assessment-Achilles (r = −0.610, p<0.001) while B-mode and Doppler ultrasound did not show a significant correlation (r = −0.041, p = 0.817, and r = −0.116, p = 0.514). Achilles tendon stiffness shows moderately good correlation with clinical symptom at 12-month post-treatment. Sonoelastography using strain ratio could be a promising ancillary tool for monitoring Achilles tendon healing after treatment.

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Sonographic findings during and after Platelet Rich Plasma injections in tendons

Cited by 6 publications

References 25 publications

Can Achilles and patellar tendon structures predict musculoskeletal injuries in combat soldiers?

Can Achilles and patellar tendon structures predict musculoskeletal injuries in combat soldiers?

Intratendinous injections of platelet-rich plasma: feasibility and effect on tendon morphology and mechanics

Real-time sonoelastography evaluation of the Achilles tendon following ultrasound-guided platelet-rich plasma injection and eccentric exercise for the treatment of refractory Achilles tendinopathy

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