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. 2012 Oct 8;15(4):260-6.
doi: 10.1016/j.jus.2012.09.006. Print 2012 Dec.

Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy

G Ferrero  1 , E Fabbro, D Orlandi, C Martini, F Lacelli, G Serafini, E Silvestri, L M Sconfienza
Affiliations

Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy

G Ferrero et al. J Ultrasound. .

Abstract
in English, Italian

Purpose: The efficacy of platelet-rich plasma (PRP) in the treatment and healing of chronic tendinopathy through stimulation of cell proliferation and total collagen production has been demonstrated by both in vitro and in vivo studies. The aim of this study is to evaluate the effectiveness of ultrasound (US)-guided autologous PRP injections in patellar and Achilles tendinopathy.

Materials and methods: Autologous PRP was injected under US-guidance into the Achilles and patellar tendons (30 Achilles tendons, 28 patellar tendons) in 48 prospectively selected patients (30 males, 18 females, mean age 38 ± 16 years, range 20-61 years). All patients were previously evaluated according to the Victoria Institute of Sport Assessment (VISA) scale, which assessed pain and activity level, and they all underwent US of the tendon before treatment and at follow-up after 20 days and 6 months. Statistical analysis was performed with Chi-square and Wilcoxon tests.

Results: 20 days after PRP injection the patients presented a non-significant improvement of clinical symptoms. At the 6-month follow-up VISA score increased from a mean value of 57-75.5 (p < .01). US evaluation revealed a reduction of hypoechoic areas in 26 tendons (p < .01) associated with a widespread improvement of fibrillar echotexture of the tendon and reduced hypervascularity at power Doppler.

Conclusion: PRP injection in patellar and Achilles tendinopathy results in a significant and lasting improvement of clinical symptoms and leads to recovery of the tendon matrix potentially helping to prevent degenerative lesions. US-guidance allows PRP injection into the tendon with great accuracy.

Scopo: Il plasma ricco di piastrine (PRP), provocando un iperafflusso di citochine nel sito di iniezione si è dimostrato efficace, sia in vitro che in studi clinici in vivo, come promotore della rigenerazione tissutale. Lo scopo di questo studio è quello di valutare l’efficacia dell’iniezione ecoguidata di PRP autologo nel trattamento delle tendinopatie croniche del rotuleo e dell’achilleo.

Materiali e metodi: Il PRP autologo è stato iniettato sotto guida ecografica in tendini rotulei e achillei (30 tendini di Achille, 28 tendini rotulei) di 48 pazienti selezionati in modo prospettico (30 maschi, 18 femmine, età media 38 ± 16 anni, range 20–61 anni). Tutti i pazienti erano stati precedentemente valutati mediante questionario Victoria Institute of Sport di valutazione (VISA) in cui si analizza il punteggio del dolore e il livello di attività. È stata poi eseguita una valutazione ecografica dei tendini mirata a valutarne l’ecostruttura e vascolarizzazione. La valutazione statistica dei dati ottenuti è stata eseguita mediante i test del Chi-quadrato e di Wilcoxon.

Risultati: Venti giorni dopo l’iniezione di PRP è stato rilevato un miglioramento dei sintomi clinici non significativo. Il punteggio VISA è migliorato da una base di 57 a 75,5 a 6 mesi (p < .01). La valutazione ecografica ha rilevato una riduzione delle aree ipoecogene tendinee in 26 tendini a 6 mesi (p < 0,01) con un generale miglioramento dell’ecostruttura fibrillare tendinea e riduzione dell’ipervascolarizzazione al power Doppler.

Conclusione: La terapia infiltrativa con PRP per il trattamento della tendinopatia rotulea e achillea si è rivelata efficace, determinando un miglioramento significativo e duraturo dei sintomi clinici e permettendo un recupero della fisiologica struttura tendinea. La guida ecografica permette inoltre di iniettare il PRP all'interno del tendine con elevata precisione.

Keywords: Achilles tendinopathy; Achilles tendon; Jumper's knee; Patellar tendon; Platelet-rich plasma.

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Figures

Figure 1
Figure 1
US-guided injection of platelet-rich plasma (PRP) in a patellar tendon of a 24-year-old football player.
Figure 2
Figure 2
A 26-year-old rugby player: axial scan of a patellar tendon: (a) The tendon is thickened (arrowheads) with a large focal hypoechoic area (asterisks); (b) Six months after US-guided platelet-rich plasma (PRP) injection, tendon thickness (arrows) is slightly decreased compared to baseline, but the hypoechoic area is markedly reduced. VISA-P score changed from 51 to 77.
Figure 3
Figure 3
VISA evaluation of patellar and Achilles tendinopathy: Baseline, 20 days and 6 months after US-guided percutaneous injection of platelet-rich plasma (PRP).
See this image and copyright information in PMC

References

    1. Lawrence R.C., Helmick C.G., Arnett F.C., Deyo R.A., Felson D.T., Giannini E.H. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;41:778–799. - PubMed
    1. Cook J.L., Khan K.M., Harcourt P.R., Kiss Z.S., Fehrmann M.W., Griffiths L. Patellar tendon ultrasonography in asymptomatic active athletes reveals hypoechoic regions: a study of 320 tendons. Victorian Institute of Sport Tendon Study Group. Clin J Sport Med. 1998;8:73–77. - PubMed
    1. Zantop T., Tillmann B., Petersen W. Quantitative assessment of blood vessels of the human achilles tendon: an immunohistochemical cadaver study. Arch Orthop Trauma Surg. 2003;123:501–504. - PubMed
    1. Maffulli N., Sharma P., Luscombe K.L. Achilles tendinopathy: aetiology and management. J R Soc Med. 2004;97:472–476. - PMC - PubMed
    1. Lian Ø., Refsnes P.E., Engebretsen L., Bahr R. Performance characteristics of volleyball players with patellar tendinopathy. Am J Sports Med. 2003;31:408–413. - PubMed