Platelet-rich plasma (PRP) to treat chronic upper patellar tendinopathies

in Abstract Book of the 3rd Congress of the ECOSEP (2013, April)

Background: Upper patellar tendinopathies remain often chronic and rebel to a thorough conservative treatment. Moreover, the option of a surgical treatment could be disappointing. New treatments are being ... [more ▼]

Background: Upper patellar tendinopathies remain often chronic and rebel to a thorough conservative treatment. Moreover, the option of a surgical treatment could be disappointing. New treatments are being developed. Injection of PRP is one of these. Platelets contain lot of growth factors which would have the potentiality to enhance the healing process of tendons. Even if in vitro and animal experiments have demonstrated this stimulation of tendon healing process1, clinical series are subject to controversy2. Methods: Twenty patients with chronic upper patellar tendinopathy were enrolled. Assessments ［VAS, clinical examination with an algometer, algofunctional scores (IKDC and VISA-P), functional assessments (isokinetic and Optojump) and imagery (ultrasounds and MRI)］were made before infiltration of PRP, and 6 weeks and 3 months after. The PRP was obtained by an apheresis system (COM.TEC, Fresenius). Six millilitres of PRP were injected without local anaesthetic. One week after infiltration, patients started a 6-week standardised sub-maximal eccentric reeducation. Results: We observed a very significant improvement of the algofunctional status as soon as 6 weeks after the infiltration of PRP, and continued to a lesser extent up to 3 months. During functional evaluation, pain decreased as well, but without significant improvement of performances. No significant improvements in the imagery were observed. Interestingly, patients who had a VAS equal or below 1 after 3 months post-infiltration were younger (24.7 vs 32.2 y.o.). Moreover, these younger patients had a significant increase of the IKDC score (p=0.003), a significant improvement of pain during isokinetic evaluations (p<0.05), and during Optojump assessments (p=0.01). Seventy-five percent of subjects were able to return to sport, even if only half of these patients recovered the same level than before the tendinopathy. Discussion / Conclusions: This study demonstrates that a local infiltration of PRP associated with a submaximal eccentric protocol is efficient to improve symptoms of chronic upper patellar tendinopathies, non-responsive to classical conservative treatments. However, up to now, there is no consensus on the method to prepare the PRP. Indeed, each technique could provide a very different PRP (variations in the platelet concentrations and of the amount of red and white cells). [less ▲]

Syndrome des loges en traumatologie du sport

in Revue Médicale de Liège (2005), 60(2), 109-16

Compartment syndrome is defined as an increased intracompartmental pressure within inelastic fascia which surround muscular compartments. That pathology can be either acute or chronic. The acute situation ... [more ▼]

Compartment syndrome is defined as an increased intracompartmental pressure within inelastic fascia which surround muscular compartments. That pathology can be either acute or chronic. The acute situation is generally a medical emergency. Unless a fasciotomy is rapidly performed, increasing pressure may completely cut off blood flow and cause necrosis of the affected limb. The chronic compartment syndrome, more frequent, is characterized by exercise-induced pain and swelling that is relieved by rest. It results from an excessive intra-muscular pressure increase. The anterior compartment of the leg is most commonly involved. To accurately diagnose the compartment syndrome, physicians perform measurements of compartment pressure. By means of miniature digital instruments, exercise and rest intramuscular pressure are recorded. If pressures reach the critical threshold (30 mm Hg) and remain high five minutes after exercise, compartment syndrome is present. Treatment is nearly exclusively surgical. It consists in an fasciotomy allowing a complete recovery and a return to sport activities. [less ▲]

Treatment of recurrent tendinitis by isokinetic eccentric exercises

in Isokinetics & Exercise Science (2001), 9(2-3), 133-141

The purpose of this study was to determine the effectiveness of eccentric training models in treating various types of tendinitis and evaluate protection from re-injury when returning to causal activities ... [more ▼]

The purpose of this study was to determine the effectiveness of eccentric training models in treating various types of tendinitis and evaluate protection from re-injury when returning to causal activities, Isokinetic eccentric training was administered to 34 patients with chronic tendinitis (9 Achilles, 10 patellar and 15 epicondyllar) with a long duration of symptoms and failure of conventional treatment. Following training which consisted of 20 to 30 sessions of progressive increase of load and speed parameters, a significant reduction of pain indicated by the visual analog scale (average initial value > 6.5, final score less than or equal to 2.5). Seventy four percent of the patients were completely relieved or presented marked decrease in symptoms when returning to sport and occupational activities. and only 12% reported no change in their functional state. At the end of treatment. isokinetic assessment revealed no significant concentric or eccentric peak torque asymmetries between involved and non-involved sides. In comparison with pretreatment ultrasound observations which showed systematic hypoechoic lesions and thickness, 14/34 patients recovered homogeneous tendon structure and normalization of the diameter and 15 presented improvement in echostructure. Our treatment model proposing isokinetic eccentric exercises presents a very satisfactory short-term effect on three different localizations of chronic tendinitis. [less ▲]

Exercices excentriques appliqués au traitement des tendinites

in Actes du Congrès Eurokiné 1999 (1999, November)

Tendinites rotuliennes et achilléennes: intérêt des exercices isocinétiques excentriques

in Progrès en Médecine Physique et de Réadaptation (3ème série) (1999)