Hip – Ligament/Tendon Disorders – PRP
ROSM uses research-based methods to lead patients back to full function and health. Our team is dedicated to providing effective, minimally-invasive options to maintain and enhance our patients’ quality of life. Please review these studies for more information on our treatment modalities. If you have any further questions, do not hesitate to contact us.
Platelet-Rich Plasma Injections for the Treatment of Hamstring Injuries: A Randomized Controlled Trial
Abstract
Read MoreBackground:
A hamstring injury is one of the most common types of injury affecting athletes. Despite this, the optimal management of hamstring muscle injuries is not yet defined. The effect of autologous platelet-rich plasma (PRP) therapy on the recovery of hamstring injuries is unclear.
Purpose:
To investigate the effect of a single PRP injection in the treatment of grade 2 hamstring muscle injuries.
Study Design:
Randomized controlled trial; Level of evidence, 2.
Methods:
Twenty-eight patients diagnosed with an acute hamstring injury were randomly allocated to autologous PRP therapy combined with a rehabilitation program or a rehabilitation program only. The primary outcome of this study was time to return to play. In addition, changes in pain severity and pain interference scores over time were examined.
Results:
Patients in the PRP group achieved full recovery significantly earlier than controls (P = .02). The mean time to return to play was 42.5 6 20.6 days in the control group and 26.7 6 7.0 days in the PRP group. Significantly lower pain severity scores were observed in the PRP group throughout the study. However, no significant difference in the pain interference score was found between the 2 groups.
Conclusion:
A single autologous PRP injection combined with a rehabilitation program was significantly more effective in treating hamstring injuries than a rehabilitation program alone.
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Ultrasound-Guided Intratendinous Injections With Platelet-Rich Plasma or Autologous Whole Blood for Treatment of Proximal Hamstring Tendinopathy
Abstract
Read MoreObjectives
To compare the effects of ultrasound-guided platelet-rich plasma (PRP) and whole blood (WB) injections in patients with chronic hamstring tendinopathy.
Methods
In a prospective double-blind randomized controlled trial, PRP or WB was injected under ultrasound guidance into the proximal hamstring tendon in a cohort of patients with clinically suspected hamstring tendinosis. Questionnaires were administered before injection and 2, 6, and 12 weeks and 6 months after injection. Pain and function outcomes were measured via the Modified Harris Hip Score (MHHS), Hip Outcome Scores for activities of daily living (ADL) and sport-specific function, and International Hip Outcome Tool 33 (IHOT-33). Diagnostic ultrasound was used to compare preinjection and 6-month postinjection tendon appearances.
Results
The WB group showed greater improvements in pain and function over the PRP group before 12 weeks, whereas the PRP group showed improved outcomes over WB at 6 months. None of these between-group outcome measures, except 6-week IHOT-33, showed statistical significance. Comparing preinjection and 6-month scores, the PRP group showed significant improvements in ADL (P = .018) and IHOT-33 (P = .28) scores, whereas the WB group showed no significant improvements from baseline. The WB group showed significantly decreased pain with 15-minute sitting (P= .008) at 6 months. Ultrasound imaging showed no significant differences between PRP and WB group tendon appearances.
Conclusions
Both PRP and WB groups showed improvements in all outcome measures at 6 months. The PRP group showed significant improvements in 6-month ADL and IHOT-33 scores. The WB group reached significance in 15-minute sitting pain. No significant between-group differences were observed at any time point.
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Platelet-rich plasma treatment improves outcomes for chronic proximal hamstring injuries in an athletic population
Abstract
Read MoreBackground:
Chronic proximal hamstring tendinopathies is a disabling activity related condition. Currently, there is no well-accepted or extensively documented nonoperative treatment option that provides consistently successful results.
Purpose:
To evaluate the efficacy of ultrasound guided platelet-rich plasma injections in treating chronic proximal hamstring tendinopathies.
Methods:
A total of 18 consecutive patients were retrospectively analyzed. All patients received a single injection of platelet rich plasma via ultrasound guidance by a single radiologist. Outcome measures included a questionnaire evaluating previous treatments, visual analog scale (VAS) for pain, subjective improvement, history of injury, and return to activity.
Results:
The patient population included 12 females and 6 males. The average age at the time of the injection was 42.6 years (19-60). Provocative activities included running, biking, swimming. The average body mass index of patients was 22.9 (17.2-30.2). The average time of chronic pain prior to receiving the first injection was 32.6 months (6-120). All patients had attempted other forms of non-surgical treatment prior to entering the study. The average VAS pre-injection was 4.6 (0-8). Six months after the injection, 10/18 patients had 80% or greater improvement in their VAS. Overall, the average improvement was 63% (5-100). The only documented side effect was post-injection discomfort that resolved within seventy-two hours.
Conclusion:
Chronic hamstring tendinopathy is a debilitating condition secondary to the pain, which limits an athlete’s ability to perform. For refractory cases of chronic insertional proximal hamstring injuries, platelet-rich plasma injections are safe and show benefit in the majority of patients in our study, allowing return to pre-injury activities.
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The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Clinical Trials
Abstract
Read MoreBackground:
Tendinopathy is very common in the general population. There are increasing numbers of clinical studies referring to platelet-rich plasma (PRP) and platelet-poor plasma (PPP) as treatments for tendinopathy.
Purpose:
To perform a meta-analysis of the outcomes of the PRP groups by preparation method and injection technique in tendinopathy. To determine the clinical effectiveness of the preparations and to evaluate the effect of controls used in the studies reviewed.
Methods:
The PubMed, EMBASE, CINAHL, and Medline databases were searched in March 2012, April 2014, and August 2015, and randomized controlled trials using autologous blood, PRP, PPP, or autologous conditioned plasma in tendinopathy with outcome measures of pain and follow-up time of 3 months were included in this review. Trials including surgery, tendon tears, and muscle or ligament injuries were excluded. Study quality was assessed using the Cochrane Collaboration risk-of-bias tool by 2 reviewers. Data were pooled using random-effects meta-analysis. The primary outcome measure was a change in pain intensity. Where more than 1 pain scale was included, a functional score was selected ahead of a visual analog scale score.
Results:
A total of 18 studies (1066 participants) were included. Eight studies were deemed to be at low risk of bias. The most significant outcomes in the PRP groups were seen in those treated with highly cellular leukocyte-rich PRP (LR-PRP) preparations: GPS kit (standardized mean difference [SMD], 35.75; 95% CI, 28.40-43.10), MyCells kit (SMD, 31.84; 95% CI, 17.56-46.13), Prosys kit (SMD, 42.99; 95% CI, 37.73-48.25), and unspecified LR-PRP (SMD, 34.62; 95% CI, 31.69-37.55). When the LR-PRP system types were grouped, there was a strongly positive effect (SMD, 36.38; 95% CI, 34.00-38.77) when compared with leukocyte-poor PRP (SMD, 26.77; 95% CI, 18.31-35.22). In assessing the control groups, there was no clear difference between different types of control injections: saline (SMD, 14.62; 95% CI, 10.74-18.50), local anesthetic (SMD, 15.00; 95% CI, 7.66-22.34), corticosteroid (SMD, 23.82; 95% CI, 10.74-18.50), or dry needling (SMD, 25.22; 95% CI, 21.27-29.16).
Conclusion:
There is good evidence to support the use of a single injection of LR-PRP under ultrasound guidance in tendinopathy. Both the preparation and intratendinous injection technique of PRP appear to be of great clinical significance.
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Treatment of Chronic Tendinopathy with Ultrasound-Guided Needle Tenotomy and Platelet-Rich Plasma Injection
Abstract
Read MoreObjective:
To determine whether ultrasound (US)-guided percutaneous needle tenotomy followed by a platelet-rich plasma (PRP) injection would result in pain reduction, functional improvement, or structural alterations in patients with chronic, recalcitrant tendinopathy.
Design:
Part A was a retrospective observational study. Part B was a prospective observational study.
Setting:
Outpatient academic sports medicine center.
Participants:
Patients were required to have chronic (3 months), recalcitrant tendinopathy treated with US-guided percutaneous tenotomy and PRP injection between January 2007 and October 2009. Fifty-one subjects met the inclusion criteria. Forty-one (80%) participated in part A of the study, whereas 34 subjects (67%) participated in part B.
Methods:
In part A, subjects completed a survey obtaining anthropomorphic, demographic, pain, and functional data. Subjects’ platelet, hemoglobin, and white blood cell concentrations from their whole-blood and PRP samples were also obtained. In part B, subjects returned to the clinic after US-guided percutaneous needle tenotomy and PRP injection for a diagnostic US, which was compared with their preprocedure diagnostic US. Main Outcome Measures: The main outcome measures included changes in pain, function, and tendon characteristics.
Results:
The tendinopathy location was in the upper extremity in 10 subjects (24.4%), was in the lower extremity in 31 subjects (75.6%), and had been present for a mean of 40 months. The mean postprocedure follow-up was 14 months, and the maximum benefits occurred 4 months postprocedure. There were mean functional and worst-pain improvements of 68% and 58%, respectively. Eighty-three percent of subjects were satisfied with their outcomes and would recommend the procedure to a friend. Although no tendons demonstrated a normal sonographic appearance after the procedure, 84% of subjects had an improvement in echotexture, 64% had a resolution of intratendinous calcifications, and 82% had a decrease in intratendinous neovascularity. None of the variables analyzed in this study demonstrated a significant correlation with pain or functional outcome measures.
Conclusions:
In this case series, we found US-guided percutaneous needle tenotomy followed by PRP injection to be a safe and effective treatment for chronic, recalcitrant tendinopathy, and this treatment was associated with sonographically apparent improvements in tendon morphology. However, because of the intrinsic limitations of the study design and the heterogeneity of treated tendons, further research is required to corroborate our findings.
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Platelet-rich Plasma as an Effective Treatment for Proximal Hamstring Injuries
Abstract
Read MoreProximal hamstring injuries can be disabling, and several traditional conservative treatments, including physiotherapy and nonsteroidal anti-inflammatory drugs, have been inconsistent. Corticosteroid injections have demonstrated success but can adversely affect local tissues. Platelet-rich plasma (PRP) has emerged as a safe, effective treatment for several orthopedic pathologies. The authors propose a PRP injection at the muscle origin as a novel treatment for proximal hamstring injuries. A retrospective review yielded 15 patients with 17 proximal hamstring injuries. Twelve injuries failed traditional conservative treatment and were ultimately treated with a PRP injection at the hamstrings muscle origin. Five patients were treated with traditional conservative treatment alone. Analysis included pre- and posttreatment visual analog scale scores, Nirschl Phase Rating Scale scores, and return to sport. No significant difference existed between the groups’ pretreatment visual analog scale scores ( P =.28) and Nirschl Phase Rating Scale scores (P =.15) and their posttreatment visual analog scale scores (P =.38) and Nirschl Phase Rating Scale scores (P =.22). The PRP group demonstrated a reduction in visual analog scale scores (P <.01) and Nirschl Phase Rating Scale scores (P <.01), but the traditional conservative treatment group did not demonstrate the same reduction (P =.06 and .06, respectively). All athletes returned to their desired activity level with no major complications.
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The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection
Abstract
Read MoreBackground:
Gluteus medius/minimus tendinopathy is a common cause of lateral hip pain or greater trochanteric pain syndrome.
Hypothesis:
There would be no difference in the modified Harris Hip Score (mHHS) between a single platelet-rich plasma (PRP) injection compared with a corticosteroid injection in the treatment of gluteal tendinopathy.
Study Design:
Randomized controlled trial; Level of evidence, 1.
Methods:
There were 228 consecutive patients referred with gluteal tendinopathy who were screened to enroll 80 participants; 148 were excluded (refusal: n = 42; previous surgery or sciatica: n = 50; osteoarthritis, n = 17; full-thickness tendon tear, n = 17; other: n = 22). Participants were randomized (1:1) to receive either a blinded glucocorticoid or PRP injection intratendinously under ultrasound guidance. A pain and functional assessment was performed using the mHHS questionnaire at 0, 2, 6, and 12 weeks and the patient acceptable symptom state (PASS) and minimal clinically important difference (MCID) at 12 weeks.
Results:
Participants had a mean age of 60 years, a ratio of female to male of 9:1, and mean duration of symptoms of .14 months. Pain and function measured by the mean mHHS showed no difference at 2 weeks (corticosteroid: 66.95 6 15.14 vs PRP: 65.23 6 11.60) or 6 weeks (corticosteroid: 69.51 6 14.78 vs PRP: 68.79 6 13.33). The mean mHHS was significantly improved at 12 weeks in the PRP group (74.05 6 13.92) compared with the corticosteroid group (67.13 6 16.04) (P = .048). The proportion of participants who achieved an outcome score of 74 at 12 weeks was 17 of 37 (45.9%) in the corticosteroid group and 25 of 39 (64.1%) in the PRP group. The proportion of participants who achieved the MCID of more than 8 points at 12 weeks was 21 of 37 (56.7%) in the corticosteroid group and 32 of 39 (82%) in the PRP group (P = .016).
Conclusion:
Patients with chronic gluteal tendinopathy .4 months, diagnosed with both clinical and radiological examinations, achieved greater clinical improvement at 12 weeks when treated with a single PRP injection than those treated with a single corticosteroid injection.
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