Safety and efficacy of infiltration with platelet-rich plasma (PRP) and low molecular weight hyaluronic acid in treatment of achilles and patellar tendinopathy.

Congress:

ECR 2018

Poster Number:

C-2013

Type:

Scientific Exhibit

Keywords:

Musculoskeletal system, Interventional non-vascular, Extremities, Ultrasound, Ultrasound-Power Doppler, MR, Puncture, Inflammation

Authors:

A. Meli¹, C. Lupo², V. Incarbone¹, N. Casamassima³, L. Callegari¹; ¹Varese/IT, ²Palermo/IT, ³Varese , It/IT

DOI:

10.1594/ecr2018/C-2013

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-2013

Fig. 1: Preliminary ultrasound investigation demonstrating hypoechoic lesion in the...

Fig. 2: Infiltration of the tendon lesion by PRP and hyaluronic acid.

Fig. 3: The ultrasound examination performed at 6 months from the end of the...

Fig. 4: The sagittal DP T2 FAT SAT section shows, even after the post-treatment...

Aims and objectives

To evaluate safety and efficacy of degenerative achilles and patellar tendinopathy treatment by ecoguided infiltrations of autologous platelet-rich plasma (PRP) associated with low molecular weight hyaluronic acid (HA 0.8%).

Methods and materials

From January 2016 to September 2016 we selected 19 Patients with achilles and patellar tendinopathy. All Patients were subjected to a preliminary ultrasound examination (T0) that demonstrated: hypoechogenic structural alteration of the tendons, loss of normal fibrillation design and enhancement of intra-tendon vascularization to the Power Doppler evaluation. In 12/19 cases a preliminary MR was also performed. All Patients performed a cycle of 3 ecoguided infiltrations with 2 cc of PRP and 2 cc of HA, one every three weeks. Six months after the procedure...

Results

There were no major complications in our series. In 3/19 cases, small pain was reported in the puncture site in the days immediately following the procedure.19/19 patients improved pain with a statistically significant difference (p <0.001) of VAS scale before and after treatment. In 17/19 cases there was a reduction of intra-tendon vascularization, evaluated by Power Doppler, after six months from the procedure (T2). No substantial alterations of the RM reliefs were found.

Conclusion

The injection of PRP combined with low molecular weight HA (0.8%) is a well-tolerated procedure in treatment of achilles and patellar tendinopathy. The marked improvement in pain symptoms (19/19 patients), as well as the reduction of hyperaemia to the Power-Doppler assessment (17/19 patients), also demonstrates the effectiveness of this treatment. We have not found, however, important modifications of the MRI images: this datum can be partly justified because the intra-tendon reparative alterations, with granulation tissue formation, sometimes show the same MRI signal hyper-intensity of the...

Personal information

References

Krogh TP "Ultrasound-Guided Injection Therapy of Achilles Tendinopathy With Platelet-Rich Plasma or Saline: A Randomized, Blinded, Placebo-Controlled Trial." Am J Sports Med. 2016;44(8):1990-7.Jeong DU "Clinical applications of platelet-rich plasma in patellar tendinopathy." Biomed Res Int. 2014;2014:2494-98. Balasubramaniam U. "Efficacy of platelet-rich plasma injections in pain associated with chronic tendinopathy: A systematic review." Phys Sportsmed. 2015;43(3):253-61