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Exuberant inflammatory reaction after an infiltration of platelet-rich plasma (PRP)
Kaux, Jean-François; Croisier, Jean-Louis; LEONARD, Philippe et al.
2013In British Journal of Sports Medicine, 47 (10 (e3)), p. 92
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Abstract :
[en] Background: PRP, obtained from centrifuged autologous blood, contains a large quantity of growth factors, which may enhance the tissue healing processes. Local infiltration of PRP represents a relatively new treatment for tendinopathies. To date, no side effects have been reported after infiltration of PRP to treat tendinopathy. Case report: A 35-year-old patient had a right upper patellar tendinopathy which was resistant to all conservative treatments for more than 6 months. The patient was a type 1 diabetic (well controlled). He had an intratendinous infiltration of 6 mL of PRP (8.105 platelets/mm3, almost no red or white blood cells) after disinfection but without local anaesthetic. Immediately following the infiltration, local cryotherapy was performed for 15 minutes. NSAIDs were avoided, but class-1 or -2 pain-killers were authorised if necessary. A standardised sub-maximal eccentric rehabilitation should have been started 1 week after. However, the patient experienced local swelling with erythema, increased heating and pain which appeared just underneath the patella, but without biological inflammatory syndrome. A great Doppler signal in a thicker patellar tendon was observed by US, but there was no sign of local infectious disease demonstrated by either CT or MRI. However, the local inflammation did not decrease after a progressive 3-week treatment of local cryotherapy, local and oral NSAIDs and colchicine 1 mg. Thus, an insidious infection was suspected, even though there was neither evidence of biological inflammatory syndrome nor sign of infectious lesion on imagery examination. An antibiotic therapy (rifampicine 600 mg + minocycline 100 mg) was initiated for 3 months. Finally, a 3-phase bone scintigraphy suggested the presence of a complex regional pain syndrome type 1 treated by a classical physical therapy and concomitant class-2 pain killers. The evolution was favourable after 6 months of symptomatic treatment, and the pain decreased to a level similar to that before the infiltration of PRP. Discussion/Conclusions: This case report draws attention to potential side effects that are linked to this new therapy by infiltration of platelet rich plasma in case of tendinopathy, in particular when used in patients with type 1 diabetes. Thus, the balance between benefits and risks must be carefully evaluated before using this treatment in patients with type 1 diabetes. Reference: Platelet-rich plasma application in the management of chronic tendinopathies. Acta Orthop Belg 2013; 79: 10-15.
Disciplines :
Orthopedics, rehabilitation & sports medicine
Author, co-author :
Kaux, Jean-François  ;  Université de Liège - ULiège > Département des sciences de la motricité > Département des sciences de la motricité
Croisier, Jean-Louis ;  Université de Liège - ULiège > Département des sciences de la motricité > Kinésithérapie générale et réadaptation
LEONARD, Philippe ;  Centre Hospitalier Universitaire de Liège - CHU > Maladies infectieuses et médecine interne générale
LE GOFF, Caroline  ;  Centre Hospitalier Universitaire de Liège - CHU > Chimie médicale
Crielaard, Jean-Michel ;  Université de Liège - ULiège > Département des sciences de la motricité > Evaluation et entraînement des aptitudes physiques
Language :
French
Title :
Exuberant inflammatory reaction after an infiltration of platelet-rich plasma (PRP)
Publication date :
June 2013
Event name :
3rd Congress of the ECOSEP
Event organizer :
ECOSEP
Event place :
Francfurt, Germany
Event date :
25-27th October 2013
Audience :
International
Journal title :
British Journal of Sports Medicine
ISSN :
0306-3674
eISSN :
1473-0480
Publisher :
BMJ Group, London, United Kingdom
Volume :
47
Issue :
10 (e3)
Pages :
92
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 19 March 2013

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