Platelet-rich plasma to treat jumper’s knee: preliminary results

peer reviewedIntroduction: Tendinopathies, especially jumper’s knee, often remain rebel to conservative treatments. Several experimental studies have shown the healing properties of platelet and their growth factors. Researches have specifically demonstrated the platelets action as mediator and/or enhancer of tissue healing. The aim of our study was to investigate the effect of 1 injection of PRP in patients suffering from chronic jumper’s knee. Our protocol was approved by Ethic Committee of University and University Hospital of Liège. Methods: Patients performed imaging (US and MRI) and functional assessments, and a clinical examination using an algometer, before treatment and 6 weeks after PRP treatment. They were also invited to answer to questionnaire relative to pain and functional status. PRP was obtained from autologous blood using an apheresis system (COM.TEC, Fresenius). The injection of 6mL of PRP was realised without local anaesthesia into the proximal insertion of the patellar tendon. A 48h rest-time was recommended after infiltration. Afterwards, a submaximal eccentric reeducation was initiated 1 week after infiltration 3 times a week during 5 weeks. In case of pain, anti-inflammatory drugs were prohibited and patient were encouraged to take class I or II painbrakers. Results: At this time, 10 patients with jumper’s knee were included in our study. Pre-injection tests revealed pain of the upper part of the patellar tendon just below the patella, associated with loss of function. Imaging exams confirmed diagnosis. Six weeks post-injection, the clinical status was improved in all patients, with a significant decrease of algo-functional scores. The pain reported during functional assessments was decreased (in particular for the eccentric actions), yet no significant improvement of physical performances was observed. We found no significant differences between imaging exams before and 6 weeks after PRP injection. Conclusion: One in situ injection of PRP clinically improved patients with jumper’s knee 6 weeks after treatment. All the 10 patients reported a decrease of pain during day-life and through physical activities. However nor functional performances neither imaging were improved

Platelet-rich plasma (PRP) to treat patellar tendinopathy: preliminary results

Introduction: Patellar tendinopathy, often remain rebel to conservative treatments. Researches have specifically demonstrated the platelets action as mediator and/or enhancer of tissue healing. The aim of our study was to investigate the effect of 1 injection of PRP in patients suffering from chronic patellar tendinopathy. Methods: Patients performed imaging (US and MRI) and functional assessments, and a clinical examination using an algometer, before treatment and 6 weeks after PRP treatment. They were also invited to answer to questionnaire relative to pain and functional status. PRP was obtained from autologous blood using an apheresis system (COM.TEC, Fresenius). The injection of 6mL of PRP was realised without local anaesthesia into the proximal insertion of the patellar tendon. A 48h rest-time was recommended after infiltration. Afterwards, a submaximal eccentric reeducation was initiated 1 week after infiltration 3 times a week during 5 weeks. In case of pain, anti-inflammatory drugs were prohibited and patient were encouraged to take class I or II painkillers. Results: At this time, 10 patients with patellar tendinopathy were included in our study. Pre-injection tests revealed pain of the upper part of the patellar tendon just below the patella, associated with loss of function. Imaging exams confirmed diagnosis. Six weeks post-injection, the clinical status was improved in all patients, with a significant decrease of algo-functional scores. The pain reported during functional assessments was decreased (in particular for the eccentric actions), yet no significant improvement of physical performances was observed. We found no significant differences between imaging exams before and 6 weeks after PRP injection. Conclusion: One in situ injection of PRP clinically improved patients with patellar tendinopathy 6 weeks after treatment. All the 10 patients reported a decrease of pain during day-life and through physical activities. However nor functional performances neither imaging were improved

One injection of platelet-rich plasma associated to a submaximal eccentric protocol to treat chronic jumper's knee

peer reviewedINTRODUCTION: Jumper's knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons. METHODS: Twenty patients with chronic upper patellar tendinopathy were enrolled. Assessments were made before infiltration of PRP, and 6 weeks and 3 months after the infiltration, using a 10--point Visual Analogic Scale, clinical examinations with a pressure algometer, algofunctional scores (IKDC and VISA--P), functional assessments (isokinetic and optojump evaluations) and imagery (ultrasounds and MRI). The PRP was obtained with an apheresis system (COM.TEC, Fresenius). Six millilitres of PRP were injected without local anaesthetic. One week after infiltration, patients started a standardised sub--maximal eccentric reeducation. RESULTS: Pain during daily activities significantly decreased with time. During functional evaluation, it decreased as well, but without significant functional improvement. No improvements in the imagery measurements were observed. Younger patients seemed to be more susceptible to have an improvement of pain by the PRP infiltration. CONCLUSION: This study demonstrates that a local infiltration of PRP associated with a submaximal eccentric protocol can improve symptoms of chronic jumper's knee in patients non--responsive to classical conservative treatments

Platelet-rich plasma (PRP) to treat upper patellar tendinopathies

peer reviewedIntroduction: Tendinopathies, especially upper patellar tendinopathy also known as jumper’s knee, often remain rebel to conservative treatments. Several experimental studies have shown the healing properties of platelet and their growth factors. These factors have the potentiality to improve healing of different tissues: bones, muscles, tendons... Researches have specifically demonstrated the platelets action as mediator and/or enhancer of tissue healing. On the other hand, such treatment has been totally removed of list of doping treatments. The aim of our study was to investigate the effect of 1 injection of PRP in patients suffering from chronic jumper’s knee. Methods: Patients performed imaging (US and MRI) and functional assessments, and a clinical examination using an algometer, before treatment and 6 weeks after PRP treatment. They were also invited to answer to questionnaire relative to pain and functional status. PRP was obtained from autologous blood using an apheresis system (COM.TEC, Fresenius). The injection of 6mL of PRP was realised without local anaesthesia into the proximal insertion of the patellar tendon. A 48h rest-time was recommended after infiltration. Afterwards, a submaximal eccentric reeducation was initiated 1 week after infiltration 3 times a week during 5 weeks. In case of pain, anti-inflammatory drugs were prohibited and patient were encouraged to take class I or II painbrakers. Our protocol was approved by Ethic Committee of University and University Hospital of Liège. Results: Eighteen patients with jumper’s knee were included in our study. Pre-injection tests revealed pain of the upper part of the patellar tendon just below the patella, associated with loss of function. Imaging exams confirmed diagnosis. Six weeks post-injection, the clinical status was improved for the majority of the patients, with a significant decrease of algo-functional scores. The pain reported during functional assessments was decreased (in particular for the eccentric actions), yet no significant improvement of physical performances was observed. We found no significant differences between imaging exams before and 6 weeks after PRP injection. Conclusion: One in situ injection of PRP clinically improved patients with jumper’s knee 6 weeks after treatment. Most patients reported a decrease of pain during day-life and through physical activities. However nor functional performances neither imaging were improved. A followup at 3 months is actually in process to evaluate more long term efficacy of PRP treatment

Une infiltration de plasma riche en plaquettes (PRP) améliore les symptômes des tendinopathies patellaires supérieures

peer reviewedIntroduction : Le plasma riche en plaquettes (PRP) aurait des effets bénéfiques sur les symptômes des tendinopathies grâce à la libération locale de leurs nombreux facteurs de croissance. Le but de cette étude est d’évaluer les résultats d’une injection de PRP sur la symptomatologie des patients présentant une tendinopathie patellaire supérieure. Matériels et Méthodes : Vingt patients atteints d’une tendinopathie patellaire supérieure, rebelle aux traitements conservateurs classiques depuis au moins 3 mois, ont bénéficié d’une évaluation du statut algo-fonctionnel (EVA, algomètre de pression, VISA-P et IKDC) et des performances physqiues (isocinétique et optojump), ainsi que d’un bilan d’imagerie (échographie et IRM). Ces analyses ont été réalisées en pré-injection ainsi qu’aux 6èmeet 12èmesemaines post-injection. Le test isocinétique évaluait la force des quadriceps et des ischios-jambiers des deux membres suivant différentes modalités (C60°/sec, C240°/sec et E30°/sec). Le test Optojump évaluait la détente et la puissance musculaire par la mesure de la hauteur de saut via deux modalités («Counter Movement Jump » et « Drop Jump »). Le PRP est obtenue à l’aide d’une machine d’aphérèse (COM.TEC, Fresenius-Kabi), permettant d’obtenir une concentration plaquettaire reproductible d’un patient à l’autre, en l’absence quasi totale de globules rouges et blancs. L’infiltration intratendineuse de PRP (6mL) est réalisé à la pointe de la rotule in loco dolenti sans anesthésie locale. Résultats : Les résultats de notre expérimentation démontrent qu’une seule injection locale de PRP accompagnée d’un programme de rééducation excentrique améliore significativement la cicatrisation du tendon patellaire au niveau du score EVA, de l’algomètre de pression, des scores VISA-P et IKDC. Lors du test isocinétique, seuls l’augmentation du MFM des ischios jambiers en C240°/sec, de la différence bilatérale des ischios jambiers en C60°/sec ainsi que de l’EVA en E30°/sec était significative. Les résultats optojump en terme de détente et puissance musculaire ne montrent pas d’amélioration des performances. Néanmoins, l’EVA du « Counter Movement Jump » se voit significativement diminuée après l’infiltration. Enfin, les résultats de l’imagerie (échographie et IRM) ne démontrent pas de modification significative du tendon. Conclusions : L’injection locale de PRP dans le cadre de tendinopathies patellaires supérieure permet une diminution de la symptomatologie douloureuse à 6 semaines, se poursuivant à 12 semaines. La performance fonctionnelle et l’imageries, quant à elles, ne sont pas modifiées

Platelet-rich plasma (PRP) to treat chronic upper patellar tendinopathies

Background: Upper patellar tendinopathies remain often chronic and rebel to a thorough conservative treatment. Moreover, the option of a surgical treatment could be disappointing. New treatments are being developed. Injection of PRP is one of these. Platelets contain lot of growth factors which would have the potentiality to enhance the healing process of tendons. Even if in vitro and animal experiments have demonstrated this stimulation of tendon healing process1, clinical series are subject to controversy2. Methods: Twenty patients with chronic upper patellar tendinopathy were enrolled. Assessments ［VAS, clinical examination with an algometer, algofunctional scores (IKDC and VISA-P), functional assessments (isokinetic and Optojump) and imagery (ultrasounds and MRI)］were made before infiltration of PRP, and 6 weeks and 3 months after. The PRP was obtained by an apheresis system (COM.TEC, Fresenius). Six millilitres of PRP were injected without local anaesthetic. One week after infiltration, patients started a 6-week standardised sub-maximal eccentric reeducation. Results: We observed a very significant improvement of the algofunctional status as soon as 6 weeks after the infiltration of PRP, and continued to a lesser extent up to 3 months. During functional evaluation, pain decreased as well, but without significant improvement of performances. No significant improvements in the imagery were observed. Interestingly, patients who had a VAS equal or below 1 after 3 months post-infiltration were younger (24.7 vs 32.2 y.o.). Moreover, these younger patients had a significant increase of the IKDC score (p=0.003), a significant improvement of pain during isokinetic evaluations (p<0.05), and during Optojump assessments (p=0.01). Seventy-five percent of subjects were able to return to sport, even if only half of these patients recovered the same level than before the tendinopathy. Discussion / Conclusions: This study demonstrates that a local infiltration of PRP associated with a submaximal eccentric protocol is efficient to improve symptoms of chronic upper patellar tendinopathies, non-responsive to classical conservative treatments. However, up to now, there is no consensus on the method to prepare the PRP. Indeed, each technique could provide a very different PRP (variations in the platelet concentrations and of the amount of red and white cells)