Shock wave therapy, platelet-richplasma or pharmaceutical treatments?

Johannes Tol

• 2006-2019

• 11 single-arm case series

• 1 prospective non-randomised cohort

• 3 RCTs

Liddle AD, Rodriguez-Merchan EC. Platelet-Rich Plasma in the Treatment of Patellar Tendinopathy: A Systematic Review. Am J Sp Med 2014

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PRP in patellar Tendinopathy

• 2009 Kon et al. – FU 6 mnths–PRP group (n=20): 3 PRP injections→16/20 (80%) satisfied

• 2012 Gosens et al. – FU 18.4 mnths–PRP group (n=36): 1 PRP injection–Significant improvement in VISA-P

• 2014 Bellaiche et al. – FU 24 mnths–PRP group (n=28): 3 PRP injections→Significant improvement in VISA-P (39 to 94)

Prospective case series

In my hands PRP works !!

• 2013 Vetrano et al. - AJSM– FU 2, 6, 12 m–PRP group (n=23), 2 injections leucocyte-rich–ESWT group (N=23)

• PRP superior to ESWT (VISA-P):• at 6-months (86 ± 14. vs 74 ± 20;P = .014) • and 12-months (91 ± 10 vs 78 ± 20; P =.026)

• Not superior at 2 months

PRP vs Shock wave: Non-blinded RCT

• 2014 Dragoo et al. - AJSM– FU 2, 6 m

–PRP group (n=10): 1 PRP injection leucocyte-rich

–Dry needling group (N=13)

• PRP NOT superior at 6-months

• PRP superior at 2 months (87 ± 14 vs 74 ± 20;P = .014)

RCT PRP vs Dry Needling: Non-blinded

• 2019 Scott et al. - AJSM– FU 3, 6, 12 m– LR-PRP group (n=19): 1 PRP injection leucocyte-rich + Rehab– LP-PRP (N=19): 1 PRP injection leucocyte-poor + Rehab–Saline (N=19) + Rehab

• Clinical relevant effect of 13 on VISA-P at 12 weeks:- LR-PRP: 35% improved- LP-PRP: 72%- Saline: 71%

RCT placebo controlled

Short-term (2m): no strong evidence to support the use of PRP

Mid-term (6, 12 m): no evidence to support the use of PRP

Best evidence synthesis PRP

• Until 2018

• 6 prospective non-randomised cohort study

• 5 RCTs

ESWT in patellar Tendinopathy

ESWT in patellar Tendinopathy

Focused vs PLACEBO ESWT (VISA-P, VAS pain)

2 RCTs

Moderate level of evidence:

No difference

Focused vs Conservative therapy (VISA-P, VAS pain)

1 RCT (no blinding, 2-3 yrs FU)

Conservative: NSAIDs+PT+knee strap+exercise

Superior results for focused

Summary ESWT: Low level of evidence for ..

NSAIDs in patellar Tendinopathy

Conflicting evidence

Short-term positive effect (1 week)

No strong/moderate evidence

to support the use of

PRP injections

ESWT

NSAIDs

Take home message