sprains, strains and muscular gains - get relief with platelet rich plasma therapy

Advances in the Treatment of Tendon InjuriesRishi Sharma, MD, Sports Medicine

www.SpringfieldClinic.comwww.SpringfieldClinic.com

Common Tendon Problems

• Shoulder

• Elbow

• Wrist

• Hip

• Knee

• Ankle & Foot

Tendon: What is it?

• Fibrous connective tissue that connects muscle to bone

Tendon: What is the function?

• Acts as a spring to collect and release force

Common Names for Tendinopathy

• Tendonitis

• Peritendonitis

• Tendinopathy

• Tenosynovitis

• Apophysitis

• Insertitis

• Bursitis

• Enthesopathy

How is it injured?

• Tendinopathy– Degeneration of

the tendon

• Tendinitis– Overuse

• Tendon Tears– Injury

Microscopic Tendon

RUPTURED TENDON

ACHILLES TENDINOPATHY

NORMAL TENDON

ROTATOR CUFF TENDINOPATHY

Can the tendon heal itself?

• Depends– Full-thickness

• usually no

– Tendinopathy• usually yes

How does tendinopathy heal?

• Inflammation

• Repair

• Remodeling

How does tendinopathy heal?

• Inflammation

• Repair

• Remodeling

How does tendinopathy heal?

• Inflammation

• Repair

• Remodeling

What is the problem with the tendon?

• Tendinopathy

• Full-thickness tear

Etiology of Tendon Disorders

• Repetitive and prolonged exertion

• Sudden increase in training

• Pre-existing tendinosis

• Acute trauma

Shoulder

• Rotator Cuff Tendon– Continuum from:

• Tendinopathy to Full-thickness Rotator Cuff Tear

• Biceps Tendon

Rotator Cuff Pain

• Insidious onset of pain

• Middle aged

• Increasing pain with activity

• Can have decreased range of motion or weakness

Elbow

Elbow

• Tennis Elbow– Lateral Epicondylitis

• Golfer’s Elbow– Medial Epicondylitis

Tennis Elbow

Tennis Elbow

• Common extensor tendon

Golfer’s Elbow

Wrist

• DeQuervain’s tenosynovitis

Hip

• Trochanteric Bursitis

Hip

• Hamstring

• Hip Flexors

Knee

• Quadriceps tendon

• Patellar tendon

Foot & Ankle

• Achilles tendon

• Peroneal tendon

• Tibialis posterior tendon

• Tibialis anterior tendon

Medications

Bracing

Physical Rehabilitation

Corticosteroid Injections

Topaz - Radiocoblation

Surgical Treatment

• Achilles Tendinopathy

Emerging Treatments

• Topical Glycerol Trinitrate

• Proliferation Therapy

• Botulinium Toxin A

• Acupuncture

• Low Level Laser Therapy

• Platelet Rich Plasma

Platelet-Rich Plasma

• Sample of blood with a platelet concentration of at least 1,000,000 platelets/micromLin 5 mL of plasma

Platelet-Rich Plasma

Types of Platelet Rich Plasma

• Tier One– Arteriocyte Magellan– Harvest SmartPRep– Biomet GPS II

• 4-5 x’s baseline platelet concentration

• Tier Two– Arthrex– Cascade

• 2-3 x’s baseline concentration

Tier One: PRP

• Arteriocyte Magellan

Tier Two

• Arthrex

Platelet-Rich Plasma

• What do platelets contain?– alpha granules

• PDGF • VEGF• EGF• IGF-1

How do we know where to inject?

Ultrasound

• Patellar tendinopathy

Ultrasound

• Achilles tendinopathy

Rotator Cuff Disorders

• Diagnostic Ultrasound– Partial and Full thickness tears– Tendinopathy

Evidence of PRP

• Double blind randomized study showed PRP better than corticosteroid at 26 and 52 weeks

– AJSM Feb 2010

PRP Evidence

• Mishra, et. al; in a pilot study; has had success in the management of chronic elbow tendinosis with PRP

• Scarpone, et. al; showed statistical significance in pain scores for the management of rotator cuff tendonipathy with PRP

• Barret, et. al. had found significant symptom relief in patients with plantar facciitis who underwent PRP therapy.

May not work for everyone