Abstract :
[en] INTRODUCTION: Although PRP is very popular in sport, especially since it was removed from the doping list, it remains controversed in literature (3). Up to now, there exists no general agreement on the preparation and the use of PRP. Some clinical series have previously evaluated the effect of PRP in the treatment of proximal patellar tendinopathies. Although it is possible that a single infiltrative administration may prove to be an effective treatment for this indication, most of the existing studies evaluated the effects of two or three successive infiltrations. The multiplication of infiltrations is arguably likely to increase the risks of complications, and this treatment can be expensive.
PURPOSE: We aimed to evaluate whether two infiltrations of PRP prove more effective than a single
treatment.
METHODS: Our study is a single blinded, randomized controlled clinical trial on leisure sportsmen with chronic proximal patellar tendinopathies, rebel to classical management, including physiotherapy, shock wave therapy… Twenty patients suffering from proximal patellar tendinopathies for over than 3 months were enrolled into the study. PRP was obtained using an aphaeresis machine (1). The subjects were split into two randomized groups and beneficed of 1 or 2 infiltrations of pure PRP, respectively. The one-year followup evaluation consisted of VAS, IKDC and VISAP scores, while algometer, isokinetic and ultrasounds evaluations were carried out up to 3 months.
RESULTS: The concentration of the PRP used for each infiltration was similar in both groups (913.20 ± 65.60 × 103/ L for group 1 and 917.90 ± 63.08for group 2, with virtually no red (<0.001 × 106/ L) nor white cells (<0.001 × 103/ L) in either group). The VAS significantly decreased with time over the 3 month followup period (p = 0002), with no difference observed between the two groups (p = 0.2). Values obtained with the pressure algometer increased with time across both groups over the 3 month followup period (p < 0.0001), and values were significantly higher for Group 1 (p = 0.001). The IKDC score increased with time in both groups over the followup period (p = 0.034), with values again significantly higher for Group 1 (p = 0.0026). The VISAP score increased with time in both groups over the followup period (p = 0.0023), with no difference observed between the groups (p = 0.41). No improvements in isokinetic physical performance were observed in either group. However, pain during E30 significantly decreased over the 3 month followup period (p = 0.027) for patients in both groups. No improvement in either jumping performances or in pain was observed in either group during optojump evaluation. No improvements in US findings were observed. However, an increase of the sagittal hypoechoic area was observed in Group1 (p = 0.0038). After one year, 90% patients of group 1 did not report anymore pain during daily activities, in comparison with only 20% in group 2. In group 1, 20% of subjects still described pain during work activities and 40% during practicing sports versus 40% and 70%, respectively, in group 2. One patient in each group did not return to sport; both subjects still experienced pain through daily and occupational work activities. Six subjects among the group 1 (67%) and 7 among the group 2 (78%) returned to their former sport, and 55% of both groups to the former level than before the tendinopathy. However, 44% of the group 1 and 78% of the group 2 still experienced pain during sports activities. The practiced sports were football, handball, cycling, running, fitness.On the other hand, patients with only few months of symptoms did not evolved more favorably than those with symptoms for longer.
CONCLUSIONS: The comparison between 1 or 2 infiltrations of PRP did not reveal any difference between the 2 groups after a followup period of 3 months. A second closely timed infiltration of PRP to treat proximal patellar tendinopathies is not necessary to improve the efficacy of this treatment in the short term (2). However, there remains a need to evaluate the longer term results.
REFERENCES:
Kaux JF, Croisier JL, Bruyere O, Rodriguez De La Cruz C, Forthomme B, Brabant G, Lapraille S, Lonneux V, Noel D, Le Goff C, Gothot A, Collette J, Crielaard JM. One injection of plateletrich
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Kaux JF, Croisier JL, Forthomme B, Le Goff C, Buhler F, Savanier B, Delcour S, Gothot A, Crielaard JM. Using plateletrich plasma to treat jumper's knees: Exploring the effect of a second closelytimed
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