Comparison between platelet-rich plasma injections and hyaluronic acid injections in the treatment of patellar tendinopathies a randomized trial - MLTJ 07-2019.pdf
[en] Background. As patellar tendinopathies are frequently chronic there has been plenty of research carried out to develop effective treatments, among which platelet-rich plasma (PRP) and hyaluronic acid (HA).
Hypothesis. Therefore we aimed to compare the effect after three months following injections of PRP compared with HA injections on patients with a proximal patellar tendinopathy.
Methods. 33 sportsmen with chronic proximal patellar tendinopathies were included and randomised into 2 groups and treated respectively with PRP (obtained using an apheresis machine) or HA injections. To assess the evolution of the pathology, algo-functional tests (VISA-P and IKDC) and isokinetic tests were carried out pre-injection, after 6 weeks and after 3 months post-injections.
Results. The results of VAS, algometric scores, IKDC scores and VISA-P showed a considerable
improvement in the two groups over time (p<0.01), except for the US findings. Isokinetic tests showed significant modifications for the quadriceps in C60 (p=0.01) for the pathological limb only at the end of the follow-up period. VAS associated with isokinetic tests decreased significantly for all contraction modes after three months in the HA group (p<0.05). Correlations showed that there was a significant negative association between VAS and strength in C60, C240 and E30 (p<0.01) only for the PRP group.
Conclusion. Both PRP and HA can alleviate the symptoms of proximal patellar tendinopathy in the medium term. However, only PRP leads to a decrease in pain associated with an increase in the strength of the quadriceps.
Disciplines :
Orthopedics, rehabilitation & sports medicine
Author, co-author :
Kaux, Jean-François ; Université de Liège - ULiège > Département des sciences de la motricité > Médecine physique, réadaptation et traumatologie du sport
Bornheim, Stephen ; Université de Liège - ULiège > Département des sciences de la motricité > Kinésithérapie générale et réadaptation
Dardenne, Nadia ; Université de Liège - ULiège > Département des sciences de la santé publique > Biostatistique
DEROISY, Rita ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Médecine de l'appareil locomoteur (Brull)
SAMSON, Antoine ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Médecine de l'appareil locomoteur (ST - Polyclinique)
Kaux, J.F., et al., Current opinions on tendinopathy. J Sports Sci Med, 2011. 10(2): pp. 238-53.
Kaux, J.F. and J.M. Crielaard, [Tendon et tendinopathie]. Journal de Traumatologie du Sport, 2014. 31(4): pp. 235-240.
Kaux, J.F., et al., Tendinopathies and platelet-rich plasma (PRP): from pre-clinical experiments to therapeutic use. J Stem Cells Regen Med, 2015. 11(1): pp. 7-17.
Rowan, T.L. and J.L. Drouin, A multidisciplinary approach including the use of platelet-rich plasma to treat an elite athlete with patellar tendinopathy-a case report. J Can Chiropr Assoc, 2013. 57(4): pp. 301-9.
Zayni, R., et al., Platelet-rich plasma as a treatment for chronic patellar tendinopathy: comparison of a single versus two consecutive injections. Muscles Ligaments Tendons J, 2015. 5(2): pp. 92-8.
Charousset, C., et al., Are multiple platelet-rich plasma injections useful for treatment of chronic patellar tendinopathy in athletes? a prospective study. Am J Sports Med, 2014. 42(4): pp. 906-11.
Dragoo, J.L., et al., Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am J Sports Med, 2014. 42(3): pp. 610-8.
Andia, I., et al., Platelet-rich plasma in the conservative treatment of painful tendinopathy: a systematic review and meta-analysis of controlled studies. Br Med Bull, 2014. 110(1): pp. 99-115.
Balasubramaniam, U., R. Dissanayake, and L. Annabell, Efficacy of platelet-rich plasma injections in pain associated with chronic tendinopathy: a systematic review. Phys Sportsmed, 2015: pp. 1-9.
Dupley, L. and C.P. Charalambous, Platelet-Rich Plasma Injections as a Treatment for Refractory Patellar Tendinosis: A Meta-Analysis of Randomised Trials. Knee Surg Relat Res, 2017. 29(3): pp. 165-171.
Di Matteo, B., et al., Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy-a systematic review. Musculoskelet Surg, 2015. 99(1): pp. 1-9.
Fitzpatrick, J., M. Bulsara, and M.H. Zheng, The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Clinical Trials. Am J Sports Med, 2017. 45(1): pp. 226-233.
Kaux, J.F., A. Samson, and J.M. Crielaard, Hyaluronic acid and tendon lesions. Muscles Ligaments Tendons J, 2015. 5(4): pp. 264-9.
Salti, N.I., R.J. Tuel, and D.P. Mass, Effect of hyaluronic acid on rabbit profundus flexor tendon healing in vitro. J Surg Res, 1993. 55(4): pp. 411-5.
Nishida, J., et al., Effect of hyaluronic acid on the excursion resistance of tendon grafts. A biomechanical study in a canine model in vitro. J Bone Joint Surg Br, 2004. 86(6): pp. 918-24.
Oryan, A., et al., Repeated administration of exogenous Sodi-um-hyaluronate improved tendon healing in an in vivo transec-tion model. J Tissue Viability, 2012. 21(3): pp. 88-102.
Merolla, G., P. Bianchi, and G. Porcellini, Ultrasound-guided subacromial injections of sodium hyaluronate for the management of rotator cuff tendinopathy: a prospective comparative study with rehabilitation therapy. Musculoskelet Surg, 2013. 97 Suppl 1: pp. 49-56.
Kumai, T., et al., The short-term effect after a single injection of high-molecular-weight hyaluronic acid in patients with enthe-sopathies (lateral epicondylitis, patellar tendinopathy, insertional Achilles tendinopathy, and plantar fasciitis): a preliminary study. J Orthop Sci, 2014. 19(4): pp. 603-11.
Lynen, N., Treatment of chronic tendinopathies with peritendinous hyaluronan injections under sonographic guidance-an interventional, prospective, single-arm, multi center study. Orthopädische und Unfallchirurgische Praxis, 2012. 1(10): pp. 7-11.
Gorelick, L., et al., Lateral epicondylitis injection therapy: a safety and efficacy analysis of hyaluronate versus corticosteroid injections. Adv Tech Biol Med, 2015. 3(2): pp. 1000130.
Lynen, N., et al., Comparison of Peritendinous Hyaluronan Injections Versus Extracorporeal Shock Wave Therapy in the Treatment of Painful Achilles’ Tendinopathy: A Randomized Clinical Efficacy and Safety Study. Arch Phys Med Rehabil, 2017. 98(1): pp. 64-71.
Kaux, J.F., et al., One injection of platelet-rich plasma associated to a submaximal eccentric protocol to treat chronic jumper’s knee. J Sports Med Phys Fitness, 2015. 55(9): pp. 953-61.
Kaux, J.-F., et al., One-year follow-up of platelet-rich plasma infiltration to treat chronic proximal patellar tendinopathies. Acta Orthop Belg, 2015. 81(2):251-6.
Kaux, J.F., et al., Using platelet-rich plasma to treat jumper’s knees: Exploring the effect of a second closely-timed infiltration. J Sci Med Sport, 2016. 19(3):200-204.
Moog, R., et al., Evaluation of a concurrent multicomponent collection system for the collection and storage of WBC-re-duced RBC apheresis concentrates. Transfusion, 2001. 41(9): pp. 1159-64.
Kaux, J.F., et al., Reflections about the optimisation of the treatment of tendinopathies with PRP. Muscles Ligaments Tendons J, 2015. 5(1): pp. 1-4.
Kaux, J.F., et al., Description of a standardized rehabilitation program based on sub-maximal eccentric following a platelet-rich plasma infiltration for jumper’s knee. Muscles Ligaments Tendons J, 2014. 4(1): pp. 85-9.
Kaux, J.F. and J.M. Crielaard, [Tendinopathies et plasma riche en plaquettes (PRP): Applications cliniques. Revue de la littérature]. Journal de Traumatologie du Sport, 2012. 29(3): pp. 174-178.
Andia, I. and N. Maffulli, Use of platelet-rich plasma for patellar tendon and medial collateral ligament injuries: best current clinical practice. J Knee Surg, 2015. 28(1): pp. 11-8.
Fogli, M., N. Giordan, and G. Mazzoni, Efficacy and safety of hyaluronic acid (500-730kDa) Ultrasound-guided injections on painful tendinopathies: a prospective, open label, clinical study. Muscles Ligaments Tendons J, 2017. 7(2): pp. 388-395.
Kaux, J.F. and T. Emonds-Alt, The use of platelet-rich plasma to treat chronic tendinopathies: A technical analysis. Platelets, 2018. 29(3):213-227.
Bruyère, O., et al., A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis-From evidence-based medicine to the real-life setting. Semin Arthritis Rheum, 2016. 45(4 Suppl): pp. S3-11.
Abate, M., C. Schiavone, and V. Salini, The use of hyaluronic acid after tendon surgery and in tendinopathies. Biomed Res Int, 2014. 2014: pp. 783632.
