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J Knee Surg 2015; 28(01): 011-018
DOI: 10.1055/s-0034-1384671
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Use of Platelet-Rich Plasma for Patellar Tendon and Medial Collateral Ligament Injuries: Best Current Clinical Practice

Isabel Andia
1   Regenerative Medicine Laboratory, BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
,
Nicola Maffulli
2   Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Salerno, Italy
3   Centre for Sport and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Mile End Hospital, London, United Kingdom
› Author Affiliations
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Publication History

02 April 2014

04 June 2014

Publication Date:
04 July 2014 (online)

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Abstract

Platelet-rich plasmas (PRPs) are complex molecular therapies prepared from the patient's own blood through minimal manipulation. Clinical studies examining the efficacy of PRPs to manage patellar tendinopathy and medial collateral ligament (MCL) injuries have been reviewed. We found three controlled trials, two of them randomized, and seven case series in the management of patellar tendinopathy. In addition, three other randomized studies showed that PRPs help to regenerate the patellar tendon harvest site for anterior cruciate ligament reconstruction and to reduce patellar donor site morbidity. On the other hand, the use of PRP in MCL injuries is reported in a single case study. Seven of the 11 studies used leukocyte and PRP which was buffered in four studies. Seven of the 11 studies applied two or three injections. Given the heterogeneity of PRP protocols and the paucity of high-quality data, the most effective approach to guide clinical decisions regarding patellar tendinopathy cannot be deduced from the present published studies.

Keywords

tissue regeneration - signaling proteins - biological therapy
 

  • References

  • 1 Zwerver J, Bredeweg SW, van den Akker-Scheek I. Prevalence of Jumper's knee among nonelite athletes from different sports: a cross-sectional survey. Am J Sports Med 2011; 39 (9) 1984-1988
    CrossrefPubMedGoogle Scholar
  • 2 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 (4) 561-567
    CrossrefPubMedGoogle Scholar
  • 3 Panni AS, Cerciello S, Maffulli N, Di Cesare M, Servien E, Neyret P. Patellar shape can be a predisposing factor in patellar instability. Knee Surg Sports Traumatol Arthrosc 2011; 19 (4) 663-670
    CrossrefPubMedGoogle Scholar
  • 4 van der Worp H, van Ark M, Zwerver J, van den Akker-Scheek I. Risk factors for patellar tendinopathy in basketball and volleyball players: a cross-sectional study. Scand J Med Sci Sports 2012; 22 (6) 783-790
    CrossrefPubMedGoogle Scholar
  • 5 Kettunen JA, Kvist M, Alanen E, Kujala UM. Long-term prognosis for jumper's knee in male athletes. A prospective follow-up study. Am J Sports Med 2002; 30 (5) 689-692
    CrossrefPubMedGoogle Scholar
  • 6 Drumm O, Chan O, Malliaras P, Morrissey D, Maffulli N. High-volume image-guided injection for recalcitrant medial collateral ligament injuries of the knee. Clin Radiol 2014; 69 (5) e211-e215
    CrossrefPubMedGoogle Scholar
  • 7 Crisp T, Khan F, Padhiar N , et al. High volume ultrasound guided injections at the interface between the patellar tendon and Hoffa's body are effective in chronic patellar tendinopathy: A pilot study. Disabil Rehabil 2008; 30 (20-22) 1625-1634
    CrossrefPubMedGoogle Scholar
  • 8 Larsson ME, Käll I, Nilsson-Helander K. Treatment of patellar tendinopathy–a systematic review of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 2012; 20 (8) 1632-1646
    CrossrefPubMedGoogle Scholar
  • 9 Maffulli N, Testa V, Capasso G , et al. Similar histopathological picture in males with Achilles and patellar tendinopathy. Med Sci Sports Exerc 2004; 36 (9) 1470-1475
    CrossrefPubMedGoogle Scholar
  • 10 Bayer ML, Schjerling P, Herchenhan A , et al. Release of tensile strain on engineered human tendon tissue disturbs cell adhesions, changes matrix architecture, and induces an inflammatory phenotype. PLoS ONE 2014; 9 (1) e86078
    CrossrefPubMedGoogle Scholar
  • 11 Andia I, Sanchez M, Maffulli N. Tendon healing and platelet-rich plasma therapies. Expert Opin Biol Ther 2010; 10 (10) 1415-1426
    CrossrefPubMedGoogle Scholar
  • 12 Magra M, Maffulli N. Molecular events in tendinopathy: a role for metalloproteases. Foot Ankle Clin 2005; 10 (2) 267-277
    CrossrefPubMedGoogle Scholar
  • 13 Andia I, Maffulli N. Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nat Rev Rheumatol 2013; 9 (12) 721-730
    CrossrefPubMedGoogle Scholar
  • 14 Andia I, Maffulli N. Platelet-rich plasma for muscle injury and tendinopathy. Sports Med Arthrosc 2013; 21 (4) 191-198
    CrossrefPubMedGoogle Scholar
  • 15 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 (3) 610-618
    CrossrefPubMedGoogle Scholar
  • 16 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 (4) 795-803
    CrossrefPubMedGoogle Scholar
  • 17 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 (6) 909-915
    CrossrefPubMedGoogle Scholar
  • 18 Charousset C, Zaoui A, Bellaiche L, Bouyer B. Are multiple platelet-rich plasma injections useful for treatment of chronic patellar tendinopathy in athletes? a prospective study. Am J Sports Med 2014; 42 (4) 906-911 [Epub ahead of print]
    CrossrefPubMedGoogle Scholar
  • 19 Filardo G, Kon E, Di Matteo B, Pelotti P, Di Martino A, Marcacci M. Platelet-rich plasma for the treatment of patellar tendinopathy: clinical and imaging findings at medium-term follow-up. Int Orthop 2013; 37 (8) 1583-1589
    CrossrefPubMedGoogle Scholar
  • 20 van Ark M, Zwerver J, van den Akker-Scheek I. Injection treatments for patellar tendinopathy. Br J Sports Med 2011; 45 (13) 1068-1076
    CrossrefPubMedGoogle Scholar
  • 21 Gosens T, Den Oudsten BL, Fievez E, van 't Spijker P, Fievez A. Pain and activity levels before and after platelet-rich plasma injection treatment of patellar tendinopathy: a prospective cohort study and the influence of previous treatments. Int Orthop 2012; 36 (9) 1941-1946
    CrossrefPubMedGoogle Scholar
  • 22 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 (6) 598-603
    CrossrefPubMedGoogle Scholar
  • 23 Volpi P, Marinoni L, Bait C, De Girolamo L, Schoenhuber H. Treatment of chronic patellar tendinosis with buffered platelet rich plasma: a preliminary study. Med Sport 2007; 60 (4) 595-603
    PubMedGoogle Scholar
  • 24 Ferrero G, Fabbro E, Orlandi D , et al. Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy. J Ultrasound 2012; 15 (4) 260-266
    CrossrefPubMedGoogle Scholar
  • 25 Volpi P, Quaglia A, Schoenhuber H , et al. Growth factors in the management of sport-induced tendinopathies: results after 24 months from treatment. A pilot study. J Sports Med Phys Fitness 2010; 50 (4) 494-500
    PubMedGoogle Scholar
  • 26 Kartus J, Magnusson L, Stener S, Brandsson S, Eriksson BI, Karlsson J. Complications following arthroscopic anterior cruciate ligament reconstruction. A 2-5-year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc 1999; 7 (1) 2-8
    CrossrefPubMedGoogle Scholar
  • 27 Cervellin M, de Girolamo L, Bait C, Denti M, Volpi P. Autologous platelet-rich plasma gel to reduce donor-site morbidity after patellar tendon graft harvesting for anterior cruciate ligament reconstruction: a randomized, controlled clinical study. Knee Surg Sports Traumatol Arthrosc 2012; 20 (1) 114-120
    CrossrefPubMedGoogle Scholar
  • 28 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 (6) 1282-1288
    CrossrefPubMedGoogle Scholar
  • 29 Seijas R, Rius M, Ares O, García-Balletbó M, Serra I, Cugat R. Healing of donor site in bone-tendon-bone ACL reconstruction accelerated with plasma rich in growth factors: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 2013;
    PubMedGoogle Scholar
  • 30 Eirale C, Mauri E, Hamilton B. Use of platelet rich plasma in an isolated complete medial collateral ligament lesion in a professional football (soccer) player: a case report. Asian J Sports Med 2013; 4 (2) 158-162
    PubMedGoogle Scholar
  • 31 Bowman Jr KF, Muller B, Middleton K, Fink C, Harner CD, Fu FH. Progression of patellar tendinitis following treatment with platelet-rich plasma: case reports. Knee Surg Sports Traumatol Arthrosc 2013; 21 (9) 2035-2039
    CrossrefPubMedGoogle Scholar
  • 32 Dohan Ehrenfest DM, Andia I, Zumstein MA, Pinto Zhang NR, Bielecki T. Classification of platelet concentrates (Platelet-Rich Plasma-PRP, Platelet-Rich Fibrin-PRF) for topical and infiltrative use in orthopedic and sports medicine: current consensus, clinical implications and perspectives. MLTJ 2014; 4 (1) 3-9
    PubMedGoogle Scholar
    • 33 Kaux J-F, Forthomme B, Namurois M-H , et al. Description of a standardized rehabilitation program based on sub-maximal eccentric following aplatelet-rich plasma infiltration for jumper's knee. MLTJ 2014; 4 (1) 85-89
      PubMedGoogle Scholar
    • 34 van Ark M, van den Akker-Scheek I, Meijer LT, Zwerver J. An exercise-based physical therapy program for patients with patellar tendinopathy after platelet-rich plasma injection. Phys Ther Sport 2013; 14 (2) 124-130
      CrossrefPubMedGoogle Scholar
    • 35 Dallaudière B, Meyer P, Hummel V , et al. Efficacy of second intra-tendinous platelet-rich-plasma injection in case of incomplete response of the first injection: three-year follow up experience. Diagn Interv Imaging 2013; 94 (9) 871-877
      CrossrefPubMedGoogle Scholar
    • 36 Mautner K, Colberg RE, Malanga G , et al. Outcomes after ultrasound-guided platelet-rich plasma injections for chronic tendinopathy: a multicenter, retrospective review. PM R 2013; 5 (3) 169-175
      CrossrefPubMedGoogle Scholar
    • 37 Zhang J, Wang JHC. PRP treatment effects on degenerative tendinopathy: an in vitro model study. MLTJ 2014; 4 (1) 10-17
      PubMedGoogle Scholar
    • 38 Matsunaga D, Akizuki S, Takizawa T, Omae S, Kato H. Compact platelet-rich fibrin scaffold to improve healing of patellar tendon defects and for medial collateral ligament reconstruction. Knee 2013; 20 (6) 545-550
      CrossrefPubMedGoogle Scholar
    • 39 Yoshioka T, Kanamori A, Washio T , et al. The effects of plasma rich in growth factors (PRGF-Endoret) on healing of medial collateral ligament of the knee. Knee Surg Sports Traumatol Arthrosc 2013; 21 (8) 1763-1769
      CrossrefPubMedGoogle Scholar
    • 40 Harris NL, Huffer WE, von Stade E, Larson AI, Phinney S, Purnell ML. The effect of platelet-rich plasma on normal soft tissues in the rabbit. J Bone Joint Surg Am 2012; 94 (9) 786-793
      PubMedGoogle Scholar