Platelet-Rich Plasma Injections as a Treatment for Refractory Patellar Tendinosis: A Meta-Analysis of Randomised Trials

Leanne Dupley, Charalambos P Charalambous, Leanne Dupley, Charalambos P Charalambous

Abstract

Purpose: Patellar tendinosis (PT) is a common condition amongst athletes. In this study, we perform a meta-analysis on randomised controlled trials (RCTs) to evaluate the use of platelet-rich plasma (PRP) for refractory PT.

Methods: A literature search was undertaken in various databases from their year of inception to October 2015. The primary outcome measure was the Victorian Institute of Sports Assessment-Patella (VISA-P) score.

Results: We identified 2 RCTs comparing PRP injections to alternative treatment options (extracorporeal shockwave therapy [ESWT] and dry needling of the tendon). Meta-analysis showed no significant difference in mean VISA-P scores between PRP injection and control at early assessment (2 or 3 months; estimated difference in means, 11.9; standard error [SE], 7.4; 95% confidence interval [CI], -2.7 to 26.4; p=0.109). However, PRP was statistically better than control with regards to VISA-P scores at longer follow-up (6 months or longer; estimated difference in means, 12.7; SE, 4.4; 95% CI, 4.1 to 21.3; p=0.004).

Conclusions: There is a paucity of RCTs evaluating the role of PRP in PT. Our results suggest that, based on limited evidence, PRP is superior over other established non-surgical treatments (dry needling and ESWT) for refractory PT. Larger RCTs may allow better characterisation of the role of PRP in this condition.

Keywords: Injection; Patella; Platelet-rich plasma; Tendinopathy.

Conflict of interest statement

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Literature search and methodology of selection. CINAHL: Cumulative Index to Nursing and Allied Health Literature, CENTRAL: Central Register of Controlled Trials.
Fig. 2
Fig. 2
Meta-analysis of short-term outcomes. CI: confidence interval, PRP: platelet-rich plasma.
Fig. 3
Fig. 3
Meta-analysis of long-term outcomes. CI: confidence interval, PRP: platelet-rich plasma.

References

    1. Ferretti A, Puddu G, Mariani PP, Neri M. The natural history of jumper’s knee: patellar or quadriceps tendonitis. Int Orthop. 1985;8:239–42. doi: 10.1007/BF00266866.
    1. Lian OB, Engebretsen L, Bahr R. Prevalence of jumper’s knee among elite athletes from different sports: a cross-sectional study. Am J Sports Med. 2005;33:561–7. doi: 10.1177/0363546504270454.
    1. Woodley BL, Newsham-West RJ, Baxter GD. Chronic tendinopathy: effectiveness of eccentric exercise. Br J Sports Med. 2007;41:188–98. doi: 10.1136/bjsm.2006.029769.
    1. Halpern B, Chaudhury S, Nguyen J, Hayter C, Hough L. Clinical and magnetic resonance imaging outcomes following platelet rich plasma treatment for elbow tendinosis. J Arthritis. 2015;4:182. doi: 10.4172/2167-7921.1000182.
    1. Filardo G, Kon E, Di Matteo B, Di Martino A, Tesei G, Pelotti P, Cenacchi A, Marcacci M. Platelet-rich plasma injections for the treatment of refractory Achilles tendinopathy: results at 4 years. Blood Transfus. 2014;12:533–40.
    1. Kon E, Filardo G, Delcogliano M, Presti ML, Russo A, Bondi A, Di Martino A, Cenacchi A, Fornasari PM, Marcacci M. 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.
    1. Filardo G, Kon E, Della Villa S, Vincentelli F, Fornasari PM, Marcacci M. Use of platelet-rich plasma for the treatment of refractory jumper’s knee. Int Orthop. 2010;34:909–15. doi: 10.1007/s00264-009-0845-7.
    1. de Almeida AM, Demange MK, Sobrado MF, Rodrigues MB, Pedrinelli A, Hernandez AJ. Patellar tendon healing with platelet-rich plasma: a prospective randomized controlled trial. Am J Sports Med. 2012;40:1282–8. doi: 10.1177/0363546512441344.
    1. Lyras DN, Kazakos K, Verettas D, Botaitis S, Agrogiannis G, Kokka A, Pitiakoudis M, Kotzakaris A. The effect of platelet-rich plasma gel in the early phase of patellar tendon healing. Arch Orthop Trauma Surg. 2009;129:1577–82. doi: 10.1007/s00402-009-0935-4.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8:336–41. doi: 10.1016/j.ijsu.2010.02.007.
    1. Visentini PJ, Khan KM, Cook JL, Kiss ZS, Harcourt PR, Wark JD. The VISA score: an index of severity of symptoms in patients with jumper’s knee (patellar tendinosis): Victorian Institute of Sport Tendon Study Group. J Sci Med Sport. 1998;1:22–8. doi: 10.1016/S1440-2440(98)80005-4.
    1. Dragoo JL, Wasterlain AS, Braun HJ, Nead KT. Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am J Sports Med. 2014;42:610–8. doi: 10.1177/0363546513518416.
    1. Vetrano M, Castorina A, Vulpiani MC, Baldini R, Pavan A, Ferretti A. Platelet-rich plasma versus focused shock waves in the treatment of jumper’s knee in athletes. Am J Sports Med. 2013;41:795–803. doi: 10.1177/0363546513475345.
    1. Khan KM, Bonar F, Desmond PM, Cook JL, Young DA, Visentini PJ, Fehrmann MW, Kiss ZS, O’Brien PA, Harcourt PR, Dowling RJ, O’Sullivan RM, Crichton KJ, Tress BM, Wark JD. Patellar tendinosis (jumper’s knee): findings at histopathologic examination, US, and MR imaging: Victorian Institute of Sport Tendon Study Group. Radiology. 1996;200:821–7. doi: 10.1148/radiology.200.3.8756939.
    1. Chen YJ, Wang CJ, Yang KD, Kuo YR, Huang HC, Huang YT, Sun YC, Wang FS. Extracorporeal shock waves promote healing of collagenase-induced Achilles tendinitis and increase TGF-beta1 and IGF-I expression. J Orthop Res. 2004;22:854–61. doi: 10.1016/j.orthres.2003.10.013.
    1. Berta L, Fazzari A, Ficco AM, Enrica PM, Catalano MG, Frairia R. Extracorporeal shock waves enhance normal fibroblast proliferation in vitro and activate mRNA expression for TGF-beta1 and for collagen types I and III. Acta Orthop. 2009;80:612–7. doi: 10.3109/17453670903316793.
    1. Vetrano M, d’Alessandro F, Torrisi MR, Ferretti A, Vulpiani MC, Visco V. Extracorporeal shock wave therapy promotes cell proliferation and collagen synthesis of primary cultured human tenocytes. Knee Surg Sports Traumatol Arthrosc. 2011;19:2159–68. doi: 10.1007/s00167-011-1534-9.
    1. Wang CJ, Wang FS, Yang KD, Weng LH, Hsu CC, Huang CS, Yang LC. Shock wave therapy induces neovascularization at the tendon-bone junction: a study in rabbits. J Orthop Res. 2003;21:984–9. doi: 10.1016/S0736-0266(03)00104-9.
    1. Wang CJ, Huang HY, Pai CH. Shock wave-enhanced neovascularization at the tendon-bone junction: an experiment in dogs. J Foot Ankle Surg. 2002;41:16–22. doi: 10.1016/S1067-2516(02)80005-9.
    1. Vulpiani MC, Vetrano M, Savoia V, Di Pangrazio E, Trischitta D, Ferretti A. Jumper’s knee treatment with extracorporeal shock wave therapy: a long-term follow-up observational study. J Sports Med Phys Fitness. 2007;47:323–8.
    1. Wang CJ, Ko JY, Chan YS, Weng LH, Hsu SL. Extracorporeal shockwave for chronic patellar tendinopathy. Am J Sports Med. 2007;35:972–8. doi: 10.1177/0363546506298109.
    1. Housner JA, Jacobson JA, Morag Y, Pujalte GG, 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;20:488–90. doi: 10.1097/JSM.0b013e3181f3617f.
    1. Nagraba L, Tuchalska J, Mitek T, Stolarczyk A, Deszczynski J. Dry needling as a method of tendinopathy treatment. Ortop Traumatol Rehabil. 2013;15:109–16. doi: 10.5604/15093492.1045947.
    1. Bahr R, Fossan B, Loken S, Engebretsen L. Surgical treatment compared with eccentric training for patellar tendinopathy (jumper’s knee): a randomized, controlled trial. J Bone Joint Surg Am. 2006;88:1689–98.
    1. Peers KH, Lysens RJ, Brys P, Bellemans J. Cross-sectional outcome analysis of athletes with chronic patellar tendinopathy treated surgically and by extracorporeal shock wave therapy. Clin J Sport Med. 2003;13:79–83. doi: 10.1097/00042752-200303000-00003.
    1. Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008;466:1539–54. doi: 10.1007/s11999-008-0260-1.
    1. Dhurat R, Sukesh M. Principles and methods of preparation of platelet-rich plasma: a review and author’s perspective. J Cutan Aesthet Surg. 2014;7:189–97. doi: 10.4103/0974-2077.150734.
    1. Kim ES, Park EJ, Choung PH. Platelet concentration and its effect on bone formation in calvarial defects: an experimental study in rabbits. J Prosthet Dent. 2001;86:428–33. doi: 10.1067/mpr.2001.115874.
    1. Sanchez AR, Sheridan PJ, Kupp LI. Is platelet-rich plasma the perfect enhancement factor? A current review. Int J Oral Maxillofac Implants. 2003;18:93–103.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅