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PRP injections did not improve symptoms of patellar tendinopathy
A single injection of either leukocyte-rich platelet-rich plasma or leukocyte-poor platelet-rich plasma combined with an exercised-based rehabilitation program was not more effective than saline for patients with patellar tendinopathy, according to recently published results.
Researchers assessed 57 athletes with patellar tendinopathy for 6 months or more. They randomly assigned 19 patients to receive an injection with leukocyte-rich platelet-rich plasma (LR-PRP), 19 patients to receive leukocyte-poor PRP (LP-PRP) and 19 patients to receive saline. After patients received the injection, they had 6 weeks of supervised rehabilitation. At 6 and 12 weeks and at 6 and 12 months, outcome measures assessed included Victorian Institute of Sport Assessment (VISA-P), pain during activity and global rating of change. The primary outcome was the VISA-P at 12 weeks.
At 12 weeks, study retention was 93%. At 1 year, it was 79%.
Among the three treatment groups, no differences were seen in the mean change in VISA-P, pain or global rating of change at 12 weeks. The mean VISA-P score for the LR-PRP, LP-PRP and saline groups after 1 year for was 58, 71 and 80, respectively. The mean pain score was 4 for patients who received LR-PRP, was 2.4 for those who received LP-PRP and was 2 for those who received saline. The global rating of change for patients who received LR-PRP, LP-PRP and saline was 4.7, 5.6 and 5.7, respectively. – by Monica Jaramillo
Disclosures: Scott reports a grant from the American Orthopaedic Society for Sports Medicine for research expenditures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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Patellar tendinopathy remains a challenging clinical problem, and there has been interest in the use of biologic agents to treat this condition. This international, multicenter randomized controlled trial was performed comparing leukocyte-rich platelet rich plasma (PRP), leukocyte-poor PRP, and saline ultrasound-guided injections and therapy for the treatment of patellar tendinopathy. Outcome measures (Victorian Institute of Sport Assessment, pain during activity and global rating of change) were assessed at 6 and 12 weeks and 6 and 12 months. All groups showed some improvement; however, there were no statistically significant differences between groups at any time point, although there was a trend to worse outcomes and less improvement for leukocyte-rich PRP (P=.059).
This was a very well-done study performed by researchers at three sites: The University of Washington; the Olympic training center in Oslo, Norway; and the Rizzoli Orthopaedic Institute in Bologna, Italy, which speaks to the generalizability of the results. The patients were blinded, and study retention was excellent. These results indicate that for patellar tendinopathy, the injection of either leukocyte-poor or leukocyte-rich PRP provides no substantial benefit than saline when used in combination with an appropriate physical therapy program (slow heavy resistance; Kongsgaard, et al. Scand J Med Sci Sports. 2009). The authors hypothesized that leukocyte-rich PRP may have had an adverse inflammatory effect. Appropriate physical therapy remains an important treatment modality for this condition.
University HealthSystem
Evanston, Illinois