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Treatment of chronic tendinopathy with ultrasound-guided needle tenotomy and platelet-rich plasma injection.

Abstract

OBJECTIVE

To determine whether ultrasound (US)-guided percutaneous needle tenotomy followed by a platelet-rich plasma (PRP) injection would result in pain reduction, functional improvement, or structural alterations in patients with chronic, recalcitrant tendinopathy.

DESIGN

Part A was a retrospective observational study. Part B was a prospective observational study.

SETTING

Outpatient academic sports medicine center.

PARTICIPANTS

Patients were required to have chronic (>3 months), recalcitrant tendinopathy treated with US-guided percutaneous tenotomy and PRP injection between January 2007 and October 2009. Fifty-one subjects met the inclusion criteria. Forty-one (80%) participated in part A of the study, whereas 34 subjects (67%) participated in part B.

METHODS

In part A, subjects completed a survey obtaining anthropomorphic, demographic, pain, and functional data. Subjects' platelet, hemoglobin, and white blood cell concentrations from their whole-blood and PRP samples were also obtained. In part B, subjects returned to the clinic after US-guided percutaneous needle tenotomy and PRP injection for a diagnostic US, which was compared with their preprocedure diagnostic US.

MAIN OUTCOME MEASURES

The main outcome measures included changes in pain, function, and tendon characteristics.

RESULTS

The tendinopathy location was in the upper extremity in 10 subjects (24.4%), was in the lower extremity in 31 subjects (75.6%), and had been present for a mean of 40 months. The mean postprocedure follow-up was 14 months, and the maximum benefits occurred 4 months postprocedure. There were mean functional and worst-pain improvements of 68% and 58%, respectively. Eighty-three percent of subjects were satisfied with their outcomes and would recommend the procedure to a friend. Although no tendons demonstrated a normal sonographic appearance after the procedure, 84% of subjects had an improvement in echotexture, 64% had a resolution of intratendinous calcifications, and 82% had a decrease in intratendinous neovascularity. None of the variables analyzed in this study demonstrated a significant correlation with pain or functional outcome measures.

CONCLUSIONS

In this case series, we found US-guided percutaneous needle tenotomy followed by PRP injection to be a safe and effective treatment for chronic, recalcitrant tendinopathy, and this treatment was associated with sonographically apparent improvements in tendon morphology. However, because of the intrinsic limitations of the study design and the heterogeneity of treated tendons, further research is required to corroborate our findings.

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  • Authors+Show Affiliations

    ,

    Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, MN, USA. finnoff.jonathan@mayo.edu

    , , , , ,

    Source

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Chronic Disease
    Female
    Follow-Up Studies
    Humans
    Injections
    Male
    Middle Aged
    Needles
    Outpatients
    Pain Measurement
    Platelet-Rich Plasma
    Prospective Studies
    Retrospective Studies
    Tendinopathy
    Tendons
    Tenotomy
    Treatment Outcome
    Young Adult

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    21872551

    Citation

    TY - JOUR T1 - Treatment of chronic tendinopathy with ultrasound-guided needle tenotomy and platelet-rich plasma injection. AU - Finnoff,Jonathan T, AU - Fowler,Steven P, AU - Lai,Jim K, AU - Santrach,Paula J, AU - Willis,Elaine A, AU - Sayeed,Yusef A, AU - Smith,Jay, Y1 - 2011/08/26/ PY - 2010/12/2/received PY - 2011/5/2/revised PY - 2011/5/12/accepted PY - 2011/8/26/aheadofprint PY - 2011/8/30/entrez PY - 2011/8/30/pubmed PY - 2012/3/1/medline SP - 900 EP - 11 JF - PM & R : the journal of injury, function, and rehabilitation JO - PM R VL - 3 IS - 10 N2 - OBJECTIVE: To determine whether ultrasound (US)-guided percutaneous needle tenotomy followed by a platelet-rich plasma (PRP) injection would result in pain reduction, functional improvement, or structural alterations in patients with chronic, recalcitrant tendinopathy. DESIGN: Part A was a retrospective observational study. Part B was a prospective observational study. SETTING: Outpatient academic sports medicine center. PARTICIPANTS: Patients were required to have chronic (>3 months), recalcitrant tendinopathy treated with US-guided percutaneous tenotomy and PRP injection between January 2007 and October 2009. Fifty-one subjects met the inclusion criteria. Forty-one (80%) participated in part A of the study, whereas 34 subjects (67%) participated in part B. METHODS: In part A, subjects completed a survey obtaining anthropomorphic, demographic, pain, and functional data. Subjects' platelet, hemoglobin, and white blood cell concentrations from their whole-blood and PRP samples were also obtained. In part B, subjects returned to the clinic after US-guided percutaneous needle tenotomy and PRP injection for a diagnostic US, which was compared with their preprocedure diagnostic US. MAIN OUTCOME MEASURES: The main outcome measures included changes in pain, function, and tendon characteristics. RESULTS: The tendinopathy location was in the upper extremity in 10 subjects (24.4%), was in the lower extremity in 31 subjects (75.6%), and had been present for a mean of 40 months. The mean postprocedure follow-up was 14 months, and the maximum benefits occurred 4 months postprocedure. There were mean functional and worst-pain improvements of 68% and 58%, respectively. Eighty-three percent of subjects were satisfied with their outcomes and would recommend the procedure to a friend. Although no tendons demonstrated a normal sonographic appearance after the procedure, 84% of subjects had an improvement in echotexture, 64% had a resolution of intratendinous calcifications, and 82% had a decrease in intratendinous neovascularity. None of the variables analyzed in this study demonstrated a significant correlation with pain or functional outcome measures. CONCLUSIONS: In this case series, we found US-guided percutaneous needle tenotomy followed by PRP injection to be a safe and effective treatment for chronic, recalcitrant tendinopathy, and this treatment was associated with sonographically apparent improvements in tendon morphology. However, because of the intrinsic limitations of the study design and the heterogeneity of treated tendons, further research is required to corroborate our findings. SN - 1934-1563 UR - https://www.unboundmedicine.com/medline/citation/21872551/abstract/Treatment_of_chronic_tendinopathy_with_ultrasound_guided_needle_tenotomy_and_platelet_rich_plasma_injection_ L2 - http://linkinghub.elsevier.com/retrieve/pii/S1934-1482(11)00363-7 ER -