Hyaluronic Acid Versus Platelet-Rich Plasma for Chronic Tendinopathy and Enthesopathy
Comparative Analysis of the Efficacy of Hyaluronic Acid and Platelet-Rich Plasma Injections in the Treatment of Chronic Tendinopathies and Enthesopathies: A Prospective, Randomized Comparative Study
Chronic tendinopathies and enthesopathies are common musculoskeletal conditions in orthopedics and sports medicine, frequently leading to pain, impaired function, and significantly reduced quality of life. Their pathogenesis involves tissue degeneration and ineffective repair response, often without an active inflammatory process.
Standard conservative management based on physiotherapy and activity modification is often prolonged and not always satisfactory. Minimally invasive injectable interventions supporting tendon and enthesis regeneration represent a promising alternative due to their favorable safety profile and outpatient feasibility.
Hyaluronic acid (HA) is a glycosaminoglycan naturally present in connective tissues. In the context of tendinopathy, it is thought to modulate inflammatory processes, provide mechanical protection by reducing friction and adhesion within the tendon sheath, and support the proper organization of collagen fibers in the tendon matrix.
Platelet-rich plasma (PRP) is an autologous concentrate of platelets providing high local concentrations of growth factors, including platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-β), and vascular endothelial growth factor (VEGF), which initiate and support repair processes, cellular proliferation, and angiogenesis.
This prospective, randomized, open-label, two-arm study aims to compare the clinical efficacy of hyaluronic acid (HA) and platelet-rich plasma (PRP) injections in 80 participants with chronic Achilles tendinopathy or medial epicondylopathy of the elbow. Participants will be randomly assigned in a 1:1 ratio to receive either two HA injections or two PRP injections administered two weeks apart under ultrasonographic guidance. Follow-up will continue for 12 months after the second injection. The primary outcomes are the changes from baseline to 6 months in pain intensity measured using a 100-millimeter (mm) Visual Analog Scale (VAS), upper-limb function measured using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire in participants with medial epicondylopathy, and Achilles tendon symptoms and function measured using the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire in participants with Achilles tendinopathy. The results will provide evidence to support the selection of injectable treatment for chronic tendinopathies and enthesopathies.
Tutkimuksen yleiskatsaus
Tila
Interventio / Hoito
Opintotyyppi
Ilmoittautuminen (Arvioitu)
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Opiskeluyhteys
- Nimi: Tomasz Wnuk, MD, PhD
- Puhelinnumero: +48 538 360 332
- Sähköposti: tomashorto@gmail.com
Opiskelupaikat
-
-
Lublin Voivodeship
-
Lublin, Lublin Voivodeship, Puola, 20-841
- Rekrytointi
- Ortonika Orthopedic Medical Clinic in Lublin
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Ottaa yhteyttä:
- Tomasz Wnuk, MD, PhD
- Puhelinnumero: +48 538 360 332
- Sähköposti: tomashorto@gmail.com
-
Päätutkija:
- Tomasz Wnuk, MD, PhD
-
Alatutkija:
- Piotr Przybylski, MD, PhD
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Alatutkija:
- Mateusz Matyjaszczyk, MD
-
Alatutkija:
- Przemysław Golonka, MD
-
Alatutkija:
- Damian Borys, MD
-
Alatutkija:
- Beata Krupska, MSc
-
Alatutkija:
- Emilia Antoniewska, MSc
-
-
Osallistumiskriteerit
Kelpoisuusvaatimukset
Opintokelpoiset iät
- Aikuinen
- Vanhempi Aikuinen
Hyväksyy terveitä vapaaehtoisia
Kuvaus
Inclusion Criteria:
- Chronic tendinopathy or enthesopathy of the Achilles tendon or tendon insertion in the elbow region (medial epicondylopathy, so-called golfer's elbow)
- Symptom duration exceeding 3 months
- Pain intensity of at least 40 millimeters (mm) on a 100-mm Visual Analog Scale (VAS)
- Age 18-65 years
- Signed written informed consent
Exclusion Criteria:
- Previous surgical treatment of the studied tendon or tendon insertion
- Prior injection of corticosteroids, platelet-rich plasma (PRP), or hyaluronic acid into the area being studied within 3 months before enrollment
- Active systemic or local infection at the planned injection site
- Systemic inflammatory or autoimmune disease involving the joints, including rheumatoid arthritis, spondyloarthritis, or systemic lupus erythematosus
- Pregnancy or breastfeeding
- Body mass index (BMI) of 40 kilograms per square meter (kg/m²) or greater
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
|---|---|
|
Active Comparator: Arm 1 - Hyaluronic Acid (HA)
Two peritendinous or intratendinous injections of hyaluronic acid (HA), containing 32 milligrams (mg) of sodium hyaluronate in 2 milliliters (mL) per injection, administered two weeks apart under ultrasonographic guidance.
|
Assigned to: Arm 1
|
|
Kokeellinen: Arm 2 - Platelet-Rich Plasma (PRP)
Two peritendinous or intratendinous injections of autologous platelet-rich plasma (PRP), administered two weeks apart under ultrasonographic guidance.
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Assigned to: Arm 2
|
Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Mean Change From Baseline in Pain Intensity Measured Using the 100-Millimeter Visual Analog Scale at 6 Months
Aikaikkuna: Baseline and 6 months after the second injection
|
Pain intensity will be measured using a 100-millimeter (mm) Visual Analog Scale (VAS), ranging from 0 mm, indicating no pain, to 100 mm, indicating the worst imaginable pain.
The outcome will be the mean change in VAS score from baseline to 6 months after the second injection.
A decrease in score indicates improvement.
|
Baseline and 6 months after the second injection
|
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Mean Change From Baseline in the Quick Disabilities of the Arm, Shoulder and Hand Score at 6 Months
Aikaikkuna: Baseline and 6 months after the second injection
|
Upper-limb symptoms and function will be assessed using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire in participants with medial epicondylopathy.
The total score ranges from 0 to 100 points, with higher scores indicating greater disability.
The outcome will be the mean change from baseline to 6 months after the second injection.
A decrease in score indicates improvement.
|
Baseline and 6 months after the second injection
|
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Mean Change From Baseline in the Victorian Institute of Sport Assessment-Achilles Score at 6 Months
Aikaikkuna: Baseline and 6 months after the second injection
|
Symptoms and function associated with Achilles tendinopathy will be assessed using the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire in participants with Achilles tendinopathy.
The total score ranges from 0 to 100 points, with higher scores indicating better function and fewer symptoms.
The outcome will be the mean change from baseline to 6 months after the second injection.
An increase in score indicates improvement.
|
Baseline and 6 months after the second injection
|
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Mean Change From Baseline in Pain Intensity Measured Using the 100-Millimeter Visual Analog Scale at 1, 3, and 12 Months
Aikaikkuna: Baseline and 1, 3, and 12 months after the second injection
|
Pain intensity will be measured using a 100-millimeter (mm) Visual Analog Scale (VAS), ranging from 0 mm, indicating no pain, to 100 mm, indicating the worst imaginable pain.
Mean changes from baseline will be assessed separately at 1, 3, and 12 months after the second injection.
A decrease in score indicates improvement.
|
Baseline and 1, 3, and 12 months after the second injection
|
|
Mean Change From Baseline in the Quick Disabilities of the Arm, Shoulder and Hand Score at 1, 3, and 12 Months
Aikaikkuna: Baseline and 1, 3, and 12 months after the second injection
|
Upper-limb symptoms and function will be assessed using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire in participants with medial epicondylopathy.
The total score ranges from 0 to 100 points, with higher scores indicating greater disability.
Mean changes from baseline will be assessed separately at 1, 3, and 12 months after the second injection.
A decrease in score indicates improvement.
|
Baseline and 1, 3, and 12 months after the second injection
|
|
Mean Change From Baseline in the Victorian Institute of Sport Assessment-Achilles Score at 1, 3, and 12 Months
Aikaikkuna: Baseline and 1, 3, and 12 months after the second injection
|
Symptoms and function associated with Achilles tendinopathy will be assessed using the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire in participants with Achilles tendinopathy.
The total score ranges from 0 to 100 points, with higher scores indicating better function and fewer symptoms.
Mean changes from baseline will be assessed separately at 1, 3, and 12 months after the second injection.
An increase in score indicates improvement.
|
Baseline and 1, 3, and 12 months after the second injection
|
|
Time From the Second Injection to Return to the Pre-Injury Level of Physical Activity
Aikaikkuna: From the second injection through 12 months of follow-up
|
The number of days from the second injection to the first documented return to the participant's pre-injury level of physical activity without activity restrictions will be recorded.
Participants who do not return to their pre-injury activity level during follow-up will be considered not to have experienced the event by the end of the 12-month follow-up period.
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From the second injection through 12 months of follow-up
|
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Number of Participants With Adverse Events, Serious Adverse Events, or Adverse Device Effects
Aikaikkuna: From the first injection through 12 months after the second injection
|
The number and percentage of participants experiencing one or more adverse events (AEs), serious adverse events (SAEs), or adverse device effects (ADEs) will be reported.
Events will be assessed according to their type, severity, seriousness, and relationship to the administered intervention.
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From the first injection through 12 months after the second injection
|
Yhteistyökumppanit ja tutkijat
Tutkijat
- Päätutkija: Tomasz Wnuk, MD, PhD, Ortonika Orthopedic Medical Clinic
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Todellinen)
Ensisijainen valmistuminen (Arvioitu)
Opintojen valmistuminen (Arvioitu)
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
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- 1.0 13.04.2026
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