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See detailComparison of the effect of Platelet Rich Plasma (PRP) with Hyaluronic Acid (HA) injections to treat chronic Jumper's knee
Kaux, Jean-François ULiege; DEROISY, Rita ULiege; SAMSON, Antoine ULiege et al

in Journal of Rehabilitation Medicine (in press)

Introduction: Patellar Tendinopathies (PT) represent a very frequent disorder which incidence can reach 30-50% among jumping sports. This trouble is often rebel to classical treatment. Objective: To ... [more ▼]

Introduction: Patellar Tendinopathies (PT) represent a very frequent disorder which incidence can reach 30-50% among jumping sports. This trouble is often rebel to classical treatment. Objective: To compare the efficacy of a single injection of RPR to a double infiltration of HA at one week interval. Patients/Methods: Thirty-three patients suffering from PT were enrolled into the study and split into two randomized groups . Eighteen patients (Group 1) have received one PRP injection and the other fifteen subjects (Group 2) received two HA infiltrations. Pain and functionality of the knee were evaluated before injection (T0), 6 weeks (T2) and 3 months (T3) after injections: pain with VAS and pressure algometer, algofunctional scores with IKDC and VISA-P questionnaires, ultrasound, isokinetic evaluation (quadriceps contractions : concentric 60°/sec (C60), concentric 240°/sec (C240), excentric 30°/sec (E30) and VAS during testing). Results: At baseline, difference existed only between groups for algometer, tendon thickness and axial hypoechoic area. In both groups, VAS, algometer, IKCD, VISA-P, VAS for isokinetic testing C60, C240 and E30 were significantly improved at T2 and T3 compared to T0. Comparison between the 2 groups showed no difference excepted for algometer, tendon thickness (T2, T3) and axial hypoechoic area (T2). Discussion and conclusions: There existed a similar improvement of the symptoms in both groups. PRP has already shown its efficacy in PT. HA should probably be a new therapeutic opportunity in this indication. Nevertheless, it should better, for further studies, to include a more homogeneous population and a longer follow-up period of time. [less ▲]

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See detailPlatelet-rich plasma versus hyaluronic acid to treat patellar tendinopathies
Kaux, Jean-François ULiege; Roberjot, Mathieu; SAMSON, Antoine ULiege

in The Future of Football Medicine (2017, May)

Introduction: The treatment of patellar tendinopathies could be difficult. This is the reason why new treatments have been developed, among which platelet rich plasma (PRP) injections. Some clinical ... [more ▼]

Introduction: The treatment of patellar tendinopathies could be difficult. This is the reason why new treatments have been developed, among which platelet rich plasma (PRP) injections. Some clinical series have previously evaluated the effect of PRP in the treatment of proximal patellar tendinopathies. Recent systematic review concluded that PRP could be recommend as a treatment in such indication (1). Recently, the viscoelastic properties of hyaluronic acid (HA) on liquid connective tissue have been proposed for the treatment of tendinopathies (2). Some fundamental studies show encouraging results on HA’s ability to promote tendon gliding and reduce adhesion as well as to improve tendon architectural organisation. Some observations also support its use in a clinical setting to improve pain and function. Purpose: We aimed to compare the effect of PRP injection versus two injections of HA after three months on patients who have a proximal patellar tendinopathy. Methods: Eleven leisure football players with proximal patellar tendinopathies being not relieved after minimum three months of physiotherapy treatments where included. Six of them (group 1: 29.5±9.9 y.o.; 78.9±12.8kg; 177.4±6;9cm) have received a leukocyte poor PRP injection (obtained using an aphaeresis machine) under US guidance. This technique of PRP collection enable to obtain reproducible pure PRP with the same chosen concentration of 850 000 platelets/microliter. The other five subjects (group 2: 29.3±8.1 y.o.; 77.1±10.6kg; 178.1±5.8cm) received two HA 2% (40mg/2mL) injections (2mL) at one week apart. All of them have benefited of standardized rehabilitation, 3 times a week. Concerning the evaluation of the pathology, algo-functional tests (visual analogic scale (VAS), pressure algometer, IKDC score, VISA-P score), isokinetics (Cybex Norm; concentric 60°/s (C60), concentric 240°/s (C240) and eccentric 30°/s(E30)) associated to VAS, along with the patellar tendon ultrasonography (US) have been realized over three times (pre-injection, after 6 weeks, after 3 months post-injections). Results: The results of VAS (p<0,01), algometric scores (p<0,01), IKDC scores (p<0,01) and VISA-P (p<0,01) show a considerable improvement in the two groups, but not for the US findings. For the group 1 (Table 1), isokinetic tests show significant results for the hamstrings in C60°/s with an improvement of maximum peak torque (p=0,01) for the pathological limb, a diminution (p>0,05) for the healthy limb and during the analysis of the bilateral difference (p=0,0002). For the group 2, the improvement of quadriceps maximum peak torque in C240°/s is significant (p>0,01) for the pathological knee after 6 weeks post-injections only. The VAS associated with isokinetic tests decreases significantly for all contraction modes after three months of study. Conclusions: Both PRP and HA can improve the symptoms of proximal patellar tendinopathy, even if the results are slightly better in the PRP group. [less ▲]

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See detailIntérêt d’une seconde infiltration de plasma riche en plaquettes dans le traitement des tendinopathies patellaires ?
Kaux, Jean-François ULiege; Croisier, Jean-Louis ULiege; Buhler, Frédéric et al

in 7ème Congrès National SFMES & SFTS 2014 (2014, September)

Introduction : Des études cliniques ont évalué l’effet du plasma riche en plaquettes (PRP) dans le traitement de la tendinopathie patellaire. Même si une seule infiltration peut améliorer les symptômes du ... [more ▼]

Introduction : Des études cliniques ont évalué l’effet du plasma riche en plaquettes (PRP) dans le traitement de la tendinopathie patellaire. Même si une seule infiltration peut améliorer les symptômes du sportif dans cette indication, la majorité des études évaluent les effets de 3 infiltrations successives. Le but de notre étude était donc de comparer l’efficacité d’une et de 2 infiltrations (rapprochées) de PRP dans le cade de tendinopathies patellaires chroniques, rebelles aux traitements conservateurs. Matériel et méthode : Vingt sportifs souffrant de tendinopathie patellaire depuis plus de 3 mois ont été inclus et randomisés en 2 groupes, respectivement 1 ou 2 infiltrations de PRP (15 jours d’intervalle). Le PRP a été obtenu à l’aide d’une machine d’aphérèse permettant d’obtenir une concentration plaquettaire identique pour tous les sujets. Ils ont bénéficié ensuite d’une rééducation excentrique sous-maximale standardisée. Le suivi a été réalisé à l’aide d’une échelle visuelle analogique de la douleur, de scores algo-fonctionnels (IKDC et VISA-P), ainsi qu’un questionnaire « mode de vie » avant l’infiltration, 3 et 12 mois post-infiltration. Résultats: La concentration de PRP employée était la même au sein des 2 groupes (9x106/µL), et ne contenait pas d’érythrocyte ni de leucocyte. Au terme du suivi (1 an), les résultats montrent une amélioration des scores EVA dans les deux groupes et significative pour le groupe 1 (p=0,005). Les scores VISA-P et IKDC ont tous deux augmentés, significativement dans les deux groupes. Un sujet par groupe n’a pas repris d’activité physique tandis 67% ont repris le sport au niveau antérieur dans le groupe 1 et 78% dans le groupe 2. Conclusion: La comparaison entre 1 et 2 infiltrations rapprochées de PRP n’a pas permis de mettre en évidence de différence entre les 2 groupes sur un suivi d’un an. Une seconde infiltration rapprochée ne semble donc pas indiquée pour améliorer l’efficacité de ce traitement. Cependant, un suivi à plus long terme serait nécessaire. De même l’évaluation d’une seconde infiltration plus à distance (3 mois) de la première mériterait d’être explorée. [less ▲]

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