Sonographic findings during and after Platelet Rich Plasma injections in tendons

Abstract

Platelet rich plasma has been used in the treatment of tendinopathies, but the sonographic modifications of tendons have received less attention. In this paper we report the results of an ultrasound evaluation, performed during and after plasma injection, in patients with tendinopathy. The sonographic abnormalities and neovascularization were registered in twenty tendons. Three plasma injections (once a week) were performed, and a rehabilitation program was recommended. Pain and patients' satisfaction were evaluated. During the injections plasma spread along the collagen fibers, and an intratendineous cleft produced by the injected volume was observed. At 12 months two tendons regained a normal echotexture, while neovessels were absent in seven. The remaining tendons showed less abnormalities and neovascularization in comparison with baseline. The clinical improvement was earlier and more consistent. The discrepancy between the ultrasound and clinical results may be explained by the peculiar modalities of tendon healing induced by plasma administration.

Keywords: neovascularization; platelet rich plasma; tendinopathy; ultrasound.

Figures

Figure 1.

Sonographic findings during, after, and at the end of an ultrasound guided injection for the treatment of Achilles mid-portion tendinopathy. Before the procedure, Achilles tendon appears thickened (calipers) and hypoechoic areas are observed at the midportion level (panel 1). Neovessels can be detected in the ventral and distal portion of the tendon (arrow) (panel 3). During the procedure, the injected volume unsticks the collagen fibers, also at some centimeters from the tip of the needle, and an interstitial cleft (anechoic area) is seen (dot lines); a simultaneous bulging of the whole tendon is observed (calipers) (panel 2). At the end of the injection neovessels completely disappear (panel 4). C= Calcaneal bone; *= retrocalcaneal bursitis

Figure 2.

Sonographic improvement in a patient with elbow extensors tendinopathy. At baseline, the extensor tendons appear thickened (calipers) and hypoechoic (*) (moderate damage) (panel 1); neovascularization is clearly seen at the insertional level with power doppler (3+++) (arrow) (panel 2). At 12 months follow-up, tendon thickness is reduced and tendon echotexture appears more normal, although some hypoechoic areas are seen at the insertional level (*) (panel 3); neovessels are reduced (arrow) (panel 4). E= Medial Epicondyle; C= Radial Capitellum

Graph 1.

VAS scores, at rest and during activities, in the follow-up periods.