[en] Background: The effectiveness of platelet-rich plasma (PRP) injections in chronic tendinopathies remains debated. Although the product's characteristics play a role, the impact of postinjection recommendations remains poorly investigated. Objective: To establish principles and guidelines for post-PRP injection rehabilitation and return to activity/sports. Design: We conducted a Delphi survey based on a "recommendations by formal consensus" methodology. Three clinicians and researchers of the GRIIP (International Research Group on Platelet Injections), experts in sports medicine and rehabilitation, performed a comprehensive literature review of MEDLINE, searching for (1) rehabilitation protocols after PRP injection for chronic tendinopathy and (2) fundamental studies of tendon healing. This review highlighted the main points to be clarified to establish a standardized
Disciplines :
Orthopedics, rehabilitation & sports medicine
Author, co-author :
Gremeaux, Vincent; Sport Medicine Unit, Division of Physical Medicine and Rehabilitation, Swiss Olympic Medical Center, Lausanne University Hospital, Lausanne, Switzerland
Lamontagne, Martin; Department of Physiatry, Hospital Center, Montreal University, Montreal, Canada
Bélanger, Valérie; Department of Medicine, Quebec City University Hospital Center, Physiatry service program, Quebec City, Canada
Dalmais, Etienne; Centre d'Orthopédie et de Traumatologie du Sport, Bassens, France
Noël, Eric; Santy Orthopedic Center, Lyon, France
Frey, Alain; Sport Medicine Department, Centre Hospitalier Intercommunal Poissy/St Germain, Poissy, France
Ornetti, Paul; Service de Rhumatologie, Plateforme d'Investigation Technologique, CIC 1432 Module Plurithématique, Dijon, France ; Inserm CAPS 1093, Université de Bourgogne, Dijon, France
Allali, Fadoua; Department of Rheumatology, El Ayachi Hospital, Salé, Morocco
Gross, Jimmy; Institut de Rhumatologie Interventionnelle (IRI), Paris, France
Michel, Fabrice; Centre Locomoteur de Vincennes (CLV), Vincennes, France
Hervé Bard, |; Department of Physical Medicine and Rehabilitation, Jean-Minjoz University Hospital, Besançon, France
Kaux, Jean-François ; Université de Liège - ULiège > Département des Sciences de l'activité physique et de la réadaptation > Médecine physique, réadaptation et traumatologie du sport ; Rhumatologue, Paris, France
Language :
English
Title :
Rehabilitation and return to activity after platelet-rich plasma injections in chronic tendinopathies: Consensus from international experts
Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43:409-416. doi:10.1136/bjsm.2008.051193
Kaux J-F, Drion P, Croisier J-L, Crielaard J-M. Tendinopathies and platelet-rich plasma (PRP): from pre-clinical experiments to therapeutic use. J Stem Cells Regen Med. 2015;11:7-17. doi:10.46582/jsrm.1101003
McKay J, Nasb M, Hafsi K. Mechanobiology-based physical therapy and rehabilitation after orthobiologic interventions: a narrative review. Int Orthop. 2022;46:179-188. doi:10.1007/s00264-021-05253-5
Sussman WI, Mautner K, Malanga G. The role of rehabilitation after regenerative and orthobiologic procedures for the treatment of tendinopathy: a systematic review. Regen Med. 2018;13:249-263. doi:10.2217/rme-2017-0110
Centeno CJ, Pastoriza SM. Past, current and future interventional orthobiologics techniques and how they relate to regenerative rehabilitation: a clinical commentary. Int J Sports Phys Ther. 2020;15:301-325.
Galloway MT, Lalley AL, Shearn JT. The role of mechanical loading in tendon development, maintenance, injury, and repair. J Bone Joint Surg Am. 2013;95:1620-1628. doi:10.2106/JBJS.L.01004
Khan KM, Scott A. Mechanotherapy: how physical therapists' prescription of exercise promotes tissue repair. Br J Sports Med. 2009;43:247-252. doi:10.1136/bjsm.2008.054239
Masiello F, Pati I, Veropalumbo E, Pupella S, Cruciani M, De Angelis V. Ultrasound-guided injection of platelet-rich plasma for tendinopathies: a systematic review and meta-analysis. Blood Transfus. 2023;21:119-136. doi:10.2450/2022.0087-22
Nauwelaers A-K, Van Oost L, Peers K. Evidence for the use of PRP in chronic midsubstance Achilles tendinopathy: A systematic review with meta-analysis. Foot Ankle Surg. 2021;27:486-495. doi:10.1016/j.fas.2020.07.009
Simental-Mendía M, Vilchez-Cavazos F, Álvarez-Villalobos N, et al. Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review and meta-analysis of randomized placebo-controlled clinical trials. Clin Rheumatol. 2020;39:2255-2265. doi:10.1007/s10067-020-05000-y
Ye Z, Yuan Y, Kuang G, et al. Platelet-rich plasma and corticosteroid injection for tendinopathy: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2025;26:339. doi:10.1186/s12891-025-08566-3
Anitua E, Sánchez M. We cannot take oranges for apples in the field of platelet-rich plasma products. Scand J Med Sci Sports. 2012;22:147-148. doi:10.1111/j.1600-0838.2011.01427.x
Gremeaux V, Noël E, Kaux J-F. Platelet-Rich Plasma Injection vs Sham Injection and Tendon Dysfunction in Patients With Chronic Midportion Achilles Tendinopathy. JAMA. 2021;326:1974-1975. doi:10.1001/jama.2021.16055
van Ark M, van den Akker-Scheek I, Meijer LTB, Zwerver J. An exercise-based physical therapy program for patients with patellar tendinopathy after platelet-rich plasma injection. Phys Ther Sport. 2013;14:124-130. doi:10.1016/j.ptsp.2012.05.002
Finnoff JT, Fowler SP, Lai JK, et al. Treatment of chronic tendinopathy with ultrasound-guided needle tenotomy and platelet-rich plasma injection. PM R. 2011;3:900-911. doi:10.1016/j.pmrj.2011.05.015
Kaux J-F, Forthomme B, Namurois M-H, 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;4:85-89.
Mautner K, Malanga G, Colberg R. Optimization of ingredients, procedures and rehabilitation for platelet-rich plasma injections for chronic tendinopathy. Pain Manag. 2011;1:523-532. doi:10.2217/pmt.11.56
Eymard F, Ornetti P, Maillet J, et al. Intra-articular injections of platelet-rich plasma in symptomatic knee osteoarthritis: a consensus statement from French-speaking experts. Knee Surg Sports Traumatol Arthrosc. 2021;29:3195-3210. doi:10.1007/s00167-020-06102-5
Laver L, Filardo G, Sanchez M, et al. The use of injectable orthobiologics for knee osteoarthritis: A European ESSKA-ORBIT consensus. Part 1-Blood-derived products (platelet-rich plasma). Knee Surg Sports Traumatol Arthrosc. 2024;32:783-797. doi:10.1002/ksa.12077
Haute Autorité de Santé. Guide methodologique consensus formalisé. n.d.
Lamontagne M, Gremeaux V. Tendinopathies. Après l'injection, que faire? La postprocédure. PRP & Alternatives thérapeutiques en pathologie musculosquelettique. Sauramps Médical; 2022:169-182.
Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg. 2011;128:305-310. doi:10.1097/PRS.0b013e318219c171
Kaux J-F, Bouvard M, Lecut C, et al. Reflections about the optimisation of the treatment of tendinopathies with PRP. Muscles Ligaments Tendons J. 2015;5:1-4.
Racinais S, Dablainville V, Rousse Y, et al. Cryotherapy for treating soft tissue injuries in sport medicine: a critical review. Br J Sports Med. 2024;58:1215-1223. doi:10.1136/bjsports-2024-108304
Zhang J, Pan T, Wang JH-C. Cryotherapy suppresses tendon inflammation in an animal model. J Orthop Translat. 2014;2:75-81. doi:10.1016/j.jot.2014.01.001
Maiello M, Boeri D, Bonadonna R, Odetti P, Saccarello A, Adezati L. Platelet and clotting activities after cold stress in diabetic patients. Thromb Res. 1988;50:885-894. doi:10.1016/0049-3848(88)90348-9
Housner JA, Jacobson JA, Morag Y, Pujalte GGA, Northway RM, Boon TA. Should ultrasound-guided needle fenestration be considered as a treatment option for recalcitrant patellar tendinopathy? A retrospective study of 47 cases. Clin J Sport Med. 2010;20:488-490. doi:10.1097/JSM.0b013e3181f3617f
Palmes D, Spiegel HU, Schneider TO, et al. Achilles tendon healing: long-term biomechanical effects of postoperative mobilization and immobilization in a new mouse model. J Orthop Res. 2002;20:939-946. doi:10.1016/S0736-0266(02)00032-3
Braunstein M, Baumbach SF, Boecker W, Carmont MR, Polzer H. Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair. Knee Surg Sports Traumatol Arthrosc. 2018;26:846-853. doi:10.1007/s00167-015-3795-1
Kariyazono H, Nakamura K, Arima J, et al. Evaluation of anti-platelet aggregatory effects of aspirin, cilostazol and ramatroban on platelet-rich plasma and whole blood. Blood Coagul Fibrinolysis. 2004;15:157-167. doi:10.1097/00001721-200403000-00007
Leach T, Huang B, Kramer N, Challa S, Winder R. A review of platelet-rich plasma use in patients taking non-steroidal anti-inflammatory drugs for guideline development. Cureus. 2024;16(10):e71706.
Kon E, Filardo G, Delcogliano M, et al. Platelet-rich plasma: new clinical application: a pilot study for treatment of jumper's knee. Injury. 2009;40:598-603. doi:10.1016/j.injury.2008.11.026
Bassetto F, Volpin A, Vindigni V. Regenerative medicine for tendon regeneration and repair: the role of bioscaffolds and mechanical loading. Biomaterials science and engineering. InTech; 2011:369-386.
Behm DG, Blazevich AJ, Kay AD, McHugh M. Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review. Appl Physiol Nutr Metab. 2016;41:1-11. doi:10.1139/apnm-2015-0235
Aström M, Westlin N. Blood flow in chronic Achilles tendinopathy. Clin Orthop Relat Res. 1994;308:166-172.
Cardoso TB, Pizzari T, Kinsella R, Hope D, Cook JL. Current trends in tendinopathy management. Best Pract Res Clin Rheumatol. 2019;33:122-140. doi:10.1016/j.berh.2019.02.001
Kaux J-F, Libertiaux V, Leprince P, et al. Eccentric training for tendon healing after acute lesion: a rat model. Am J Sports Med. 2017;45:1440-1446. doi:10.1177/0363546517689872
Hody S, Croisier J-L, Bury T, Rogister B, Leprince P. Eccentric muscle contractions: risks and benefits. Front Physiol. 2019;10:536. doi:10.3389/fphys.2019.00536
Bohm S, Mersmann F, Arampatzis A. Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults. Sports Med Open. 2015;1:7. doi:10.1186/s40798-015-0009-9
Smith BE, Hendrick P, Smith TO, et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017;51:1679-1687. doi:10.1136/bjsports-2016-097383
Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med. 2016;50:946-951. doi:10.1136/bjsports-2015-095908
Docking SI, Ooi CC, Connell D. Tendinopathy: Is imaging telling us the entire story? J Orthop Sports Phys Ther. 2015;45:842-852. doi:10.2519/jospt.2015.5880
Maffulli N, Nilsson Helander K, Migliorini F. Tendon appearance at imaging may be altered, but it may not indicate pathology. Knee Surg Sports Traumatol Arthrosc. 2023;31:1625-1628. doi:10.1007/s00167-023-07339-6
Kaux JF, Croisier JL, Forthomme B, 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;19:200-204. doi:10.1016/j.jsams.2015.03.006
Kruse RC, Rossmiller KD, Fleagle TR. Postprocedure protocols after intraarticular orthobiologic injections-A scoping review. PM R. 2025;17:463-468. doi:10.1002/pmrj.13271
Levine OP, Kondapi K, Tjong VK, Gohal C. Postinjection protocols following platelet-rich plasma administration for knee osteoarthritis: A systematic review. PM R. 2024;16:1023-1029. doi:10.1002/pmrj.13139
