PRP vs. whole blood injection in the treatment of hamstring tendinopathy

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Dr. Peter J. Moley discusses the use of ultrasound-guided intratendinous injections with platelet-rich plasma or autologous whole blood for treatment of proximal hamstring tendinopathy.
17 patients with chronic hamstring tendinopathy were randomly assigned to receive either a platelet-rich plasma (PRP) injection or a whole blood (WB) injection. Follow-up was performed for 6 months post-injection. The results of Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: The department Research and Education fund
Conflicts: None disclosed
Why was this study needed now?
Chronic hamstring tendinopathy is an overuse injury in physically active individuals. It typically occurs as a result of repetitive jumping, kicking or frequent running. Chronic hamstring tendinopathy is commonly associated with posterior thigh pain or lower gluteal pain, that is usually aggravated by exercise or prolonged sitting. Both platelet-rich plasma (PRP) and whole blood (WB) injections have been suggested as possible methods of treatment for chronic hamstring tendinopathy. However, uncertainty regarding the optimal method of treatment exists, as limited evidence exists comparing the effects of PRP and WB injections on pain and disability, thus warranting the present study.
What was the principal research question?
Is there a significant difference between ultrasound-guided platelet-rich plasma and whole blood injections in terms of functional outcomes and pain in patients with chronic hamstring tendinopathy, as evaluated 6 months following treatment?
Population: 17 patients (19 hips) with a clinical or MRI diagnosis of proximal hamstring tendinopathy, and who failed to respond to 6 weeks of conservative treatment were included. All individuals were 18 years of age or older. Individuals who had previously received any corticosteroid injection within 6 months prior to study, or received any past PRP or WB injection into the affected area were excluded. Prior to ultrasound examination, 20mL of blood was withdrawn from each patient and placed in a centrifuge for extraction of the platelet-rich component. Under ultrasound guidance, all patients received an injection of 1% lidococaine (Hospira, Inc, Lake Forest, IL) over the subcutaneous tissue using a 22-gauge, 3.5 inch needle positioned into the hamstring tendon origin. 5mL of whole blood were also withdrawn immediately before injection (15 patients, 17 hips, completed).
Intervention: PRP group: 3mL of platelet-rich-plasma was injected via ultra sound guidance. PRP was not activated prior to injection (n=11, 10 patients and 11 hips completed; Mean age=46.6, 3M/8F).
Comparison: Whole blood injection group: 5mL of whole blood was injected into the tendon via ultra sound guidance. (n=6, 7 hips, Completed=5, 6 hips, Mean age=45.4, 1M/5F).
Outcomes: The primary outcome measure was disability, measured via the Modified Harris Hip score (MHHS) at all time points. Secondary outcome measures included activities of daily living (ADL) and sport-specific function (SPORT), measured via The Hip Outcome Score at all assessment time points. Quality of life was also assessed at all assessment time points, measured by the International Hip Outcome Tool 33 (IHOT-33). Ultrasound images prior to injection and at 6 months following treatment were collected and compared in order to investigate the effect of each treatment method on tendon appearance and calcification.
Methods: RCT: prospective, double-blinded, single-centered
Time: 6 months (assessments were made immediately before injection, at 2, 6, and 12 weeks and 6 months following injection)
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.