PRP-Therapy for Tendinopathies of Rotator Cuff and Long Head of Biceps

Cover Page


Cite item

Full Text

Abstract

Relevance. Owing to its controlling action on the inflammatory process, pain-relieving and reparative effects the RPR-therapy became quite demanded for treatment of certain types of tendinopathies specified by prevalence of degenerative process and poor reparative potential. Purpose of the study — to evaluate the efficiency of PRP-therapy in patients with tendinopathies of rotator cuff (RC) long head of biceps (LHB) tendons. Material and Methods. The paper presents the results of two-center prospective study for application of autologous platelet rich plasma in treatment of 122 patients: 53 men and 69 women aging 46.8±6.8 years who suffered RC tendinopathy (66%), subacromial impingement syndrome and RC tendinopathy (17%) and LHB tendinopathy (17%). Treatment outcomes were evaluated in 1, 3 and 6 months after PRP-therapy using various scales — VAS, UCLA , DASH, — and instrumental examination methods (US, MRI). Results. The authors observed statistically significant improvement in pain and functional scores in all three groups as compared to reported scores prior to PRP-therapy during 6 months follow up. During this period of evaluation, the scores of UCLA and DASH in patients with RC tendinopathy improved at 8.6 and 36.4 points, with subacromial impingement syndrome and RC tendinopathy — at 9.6 and 38.8 points, with LHB tendinopathy — at 11.5 and 44.1 point, respectively. The most notable reduction of pain syndrome by VAS was achieved in treatment of LHB tendinopathy (at 5.4 points) and RC tendinopathy (at 5.2 point). The highest average scores of satisfaction with treatment outcomes were reported in patients with RC tendinopathy (2.3) and LHB tendinopathy (2.2). MRI and ultrasound examinations after PRP-therapy demonstrated improved structure of RC and LHB tendons — decreased or eliminated swelling, areas of hypoechoic signal. Conclusion. PRP-therapy in patients with RC and LHB tendons and with subacromial impingement syndrome with RC tendinopathy significantly reduces severity of pain and improved the shoulder joint function with positive dynamics during 6 months follow up.

About the authors

D. A. Malanin

Volgograd State Medical University;
Volgograd Medical Research Center

Email: fake@neicon.ru

Dr. Sci. (Med.), Professor, Head of Department for Traumatology, Orthopaedics and Field Surgery; Head of Laboratory for Clinical and Experimental Orthopaedics

Volgograd

Russian Federation

A. I. Norkin

Razumovsky Saratov State Medical University

Email: fake@neicon.ru

Cand. Sci. (Med.), orthopaediс Surgeon

Saratov

Russian Federation

A. S. Tregubov

Volgograd State Medical University;
Volgograd Medical Research Center

Author for correspondence.
Email: megacargando@gmail.com

Assistant Professor, Department of Traumatology, Orthopaedics and Field Surgery; Research Fellow

Volgograd

Russian Federation

M. V. Demeshchenko

Volgograd State Medical University,
Volgograd Medical Research Center

Email: fake@neicon.ru

Assistant Professor, Department of Traumatology, Orthopaedics and Field Surgery; Research Fellow

Volgograd 

Russian Federation

L. L. Cherezov

Volgograd State Medical University

Email: fake@neicon.ru

Cand. Sci. (Med.), Associated Professor, Department of Traumatology, Orthopaedics and Field Surgery

Volgograd

Russian Federation

References

  1. Werner R.A., Franzblau A., Gell N., Ulin S.S., Armstrong T.J. A longitudinal study of industrial and clerical workers: predictors of upper extremity tendonitis. J Occup Rehabil. 2005;15:37-46. doi: 10.1007/s10926-005-0872-1.
  2. Maffulli N., Wong, J., Almekinders L.C. Types and epi-demiology of tendinopathy. Clin Sports Med. 2003;22(4):675-692. doi: 10.1016/s0278-5919(03)00004-8.
  3. Scarpone M., Rabago D., Snell E., Demeo P., Ruppert K., Pritchard P. et al. Effectiveness of platelet-rich plasma injection for rotator cuff tendinopathy: A prospective open-label study. Glob Adv Health Med. 2013;2(2):26-31. doi: 10.7453/gahmj.2012.054.
  4. Kaux J.F., Drion P., Croisier J.L., Crielaard J.M. Tendinopathies and platelet-rich plasma (PRP): from pre-clinical experiments to therapeutic use. J Stem Cells Regen Med. 2015;11(1):7-17.
  5. Sharma P., Maffulli N. Biology of tendon injury: healing, modeling and remodeling. J Musculoskelet Neuronal Interact. 2006;6(2):181-190.
  6. Riley G.P., Curry V., DeGroot J., van El B., Verzijl N., Hazleman B.L., Bank R.A. Matrix metalloproteinase activities and their relationship with collagen remodelling in tendon pathology. Matrix Biol. 2002;21(2):185-195. doi: 10.1016/s0945-053x(01)00196-2.
  7. Goodship A.E., Birch H.L., Wilson A.M. The pathobiology and repair of tendon and ligament injury. Vet Clin North Am Equine Pract. 1994;10(2):323-349. doi: 10.1016/s0749-0739(17)30359-0.
  8. Yuan J., Wang M.X., Murrell G.A. Cell death and tendinopathy. Clin Sports Med. 2003;22(4):693-701. doi: 10.1016/s0278-5919(03)00049-8.
  9. Bestwick C.S., Maffulli N. Reactive oxygen species and tendon problems: review and hypothesis. Sports Med Arthroscopy Rev. 2000;8:6-16.
  10. Jozsa L., Kannus P. Histopathological findings in spontaneous tendon ruptures. Scand J Med Sci Sports. 1997;7(2): 113-118. doi: 10.1111/j.1600-0838.1997.tb00127.x.
  11. Khan K.M., Cook J.L., Bonar F., Harcourt P., Astrom M. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med. 1999;27(6):393-408. doi: 10.2165/00007256-199927060-00004.
  12. Alfredson H., Bjur D., Thorsen K., Lorentzon R., Sandström P. High intratendinous lactate level in painful chronic Achilles tendinosis. An investigation using microdialysis technique. J Orthop Res. 2002;20(5):934-938. doi: 10.1016/s0736-0266(02)00021-9.
  13. Foster T.E., Puskas B.L., Mandelbaum B.R., Gerhardt M.B., Rodeo S.A. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37(11): 2259-2272. doi: 10.1177/0363546509349921.
  14. Zhang J., Wang J.H. Platelet-rich plasma releasate promotes differentiation of tendon stem cells into active tenocytes. Am J Sports Med. 2010;38(12):2477-2486. doi: 10.1177/0363546510376750.
  15. Kaux J.F., Forthomme B., Goff C.L., Crielaard J.M., Croisier J.L. Current opinions on tendinopathy. J Sports Sci Med. 2011;10(2):238-253.
  16. Andia I., Sánchez M., Maffulli N. Joint pathology and platelet-rich plasma therapies. Expert Opin Biol Ther. 2012;12(1):7-22. doi: 10.1517/14712598.2012.632765.
  17. Kesikburun S., Tan A.K., Yilmaz B., Yaşar E., Yazicioğlu K. Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. Am J Sports Med. 2013;41(11):2609-2616. doi: 10.1177/0363546513496542.
  18. Rha D.W., Park C.Y., Kim Y.K., Kim M.T., Lee S.C. Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial. Clin Rehabil. 2013;27(2):113-122. doi: 10.1177/0269215512448388
  19. von Wehren L., Blanke F., Todorov A., Heisterbach P., Sailer J., Majewski M. The effect of subacromial injections of autologous conditioned plasma versus cortisone for the treatment of symptomatic partial rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. 2016;24:3787-3792. doi: 10.1007/s00167-015-3651-3.
  20. Маланин Д.А., Новочадов В.В., Демкин С.А., Демещенко М.В., Данилов Д.И. Обогащенная тромбоцитами аутологичная плазма в лечении пациентов с гонартрозом III стадии. Травматология и ортопедия России. 2014;(3):52-59. doi: 10.21823/2311-2905-2014-0-3-52-59.
  21. Brokelman R.B.G., Haverkamp D., van Loon C. et al. The validation of the visual analogue scale for patient satisfaction after total hip arthroplasty. Eur Orthop Traumatol. 2012 Jun; 3(2):101-105. doi: 10.1007/s12570-012-0100-3.
  22. Dolkart O., Chechik O., Zarfati Y., Brosh T., Alhajajra F., Maman E. A single dose of platelet-rich plasma improves the organization and strength of a surgically repaired rotator cuff tendon in rats. Arch Orthop Trauma Surg. 2014;134(9):1271-1277. doi: 10.1007/s00402-014-2026-4.
  23. Tsicopoluos К., Tsicopoluos I., Simeonidis E., Papathanasiou E., Haidich A.B., Anastasopoulos N., Natsis K. et al. The clinical impact of platelet-rich plasma on tendinopathy compared to placebo or dry needling injections: a meta-analysis. Phys Ther Sports. 2016;17:87-94. doi: 10.1016/j.ptsp.2015.06.003.
  24. Choi B.H., Zhu S.J., Kim B.Y., Huh J.Y., Lee S.H., Jung J.-H. Effect of platelet-rich plasma (PRP) concentration on the viability and proliferation of alveolar bone cells: an in vitro study. Int J Oral Maxillofac Surg. 2005.34(4):420-424. doi: 10.1016/j.ijom.2004.10.018.
  25. Sundman E.A., Cole B.J., Karas V., Della Valle C., Tetreault M.W., Mohammed H.O., Fortier L.A. The antiinflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med. 2014;42(1):35-41. doi: 10.1177/0363546513507766.
  26. Dragoo J.L., Wasterlain A.S., Braun H.J., Nead K.T. Plateletrich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am J Sports Med. 2014;42(3);610-618. doi: 10.1177/0363546513518416.
  27. Giovanini A.F., Gonzaga C.C., Zielak J.C., Deliberador T.M., Kuczera J., Göringher I. et al. Platelet-rich plasma (PRP) impairs the craniofacial bone repair associated with its elevated TGF-β levels and modulates the co-expression between collagen III and α-smooth muscle actin. J Orthop Res. 2011;29(3):457-463. doi: 10.1002/jor.21263.
  28. Fitzpatrick J., Bulsara M., Zheng M.H. The Effectiveness of platelet-rich plasma in the treatment of tendinopathy: a meta-analysis of randomized controlled clinical trials. Am J Sports Med. 2017;45(1):226-233. doi: 10.1177/0363546516643716.
  29. Filardo G., Di Matteo B., Kon E., Merli G, Marcacci M. Platelet-rich plasma in tendon-related disorders: results and indication. Knee Surg Sports Traumatol Arthrosc. 2018;26(7):1984-1999. doi: 10.1007/s00167-016-4261-4.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c)


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies