Platelet-rich plasma PRP for Jumpers Knee

Introduction: What is Patellar Tendinopathy, Jumper’s Knee?

Jumper’s knee, also known as patellar tendinopathy, is a chronic overuse injury affecting the patellar tendon, typically at its proximal insertion on the inferior pole of the patella. This condition is prevalent among athletes involved in sports that require repetitive jumping and explosive movements, such as volleyball and basketball.[1-3] This comprehensive review focuses on the efficacy and safety of platelet-rich plasma, PRP for Jumpers knee, along with important factors to consider for the best results.

What causes Patellar Tendinopathy, Jumper’s Knee?

The etiology of jumper’s knee involves repetitive microtrauma and overload of the extensor mechanism of the knee, leading to degenerative changes rather than inflammatory processes. Histopathological findings include collagen disorganization, mucoid degeneration, and neovascularization.[1][3] Risk factors include intrinsic factors such as ligamentous laxity, increased Q-angle, and patella alta, as well as extrinsic factors like training frequency, surface hardness, and level of performance.[1][4]

How is Jumper’s Knee diagnosed?

Clinically, jumper’s knee presents with anterior knee pain localized to the patellar tendon, which is exacerbated by activities involving knee extension, such as jumping or squatting. Diagnosis is primarily clinical, supported by imaging modalities like ultrasound and MRI to assess tendon structure and rule out differential diagnoses.[1-2]

What are typical treatment options for Jumper’s Knee?

Management for Jumper’s Knee may include:

Conservative measures, including activity modification, eccentric strengthening exercises,
Cryotherapy,
Nonsteroidal anti-inflammatory drugs (NSAIDs).

What are some advanced treatments for Jumper’s Knee?

Extracorporeal shockwave therapy (ESWT),
Platelet-rich plasma (PRP) injections,
Dry needling.[2-3][5]
Surgical intervention is considered for recalcitrant cases and involves debridement of the degenerative tissue, with both open and arthroscopic techniques showing similar efficacy.[1][6-7]

Can PRP injections help with Patellar Tendinopathy, Jumper’s Knee?

Platelet-rich plasma (PRP) therapy has emerged as a potential treatment for jumper’s knee. PRP is an autologous blood product enriched with platelets, which release growth factors that may enhance tendon healing. The preparation involves centrifugation of the patient’s blood to concentrate platelets, which are then injected into the affected tendon.[3]

Ultrasound guided PRP knee injection by Dr. Yam PRPclinic.ca — PRP for Jumper’s Knee can be a very effective Treatment Option

What does the research say about using PRP for patellar tendinopathy, Jumper’s knee?

Clinical studies have shown mixed but generally promising results for PRP in treating chronic patellar tendinopathy:

A study by Kaux demonstrated that a single PRP injection combined with a submaximal eccentric rehabilitation protocol significantly reduced pain in patients with chronic jumper’s knee, although functional improvements were not statistically significant.[1]
Another study by Filardo et al. reported that multiple PRP injections led to significant improvements in pain and functional scores in patients with refractory patellar tendinopathy, with further benefits observed after the addition of physiotherapy.[2]
Charousset et al. conducted a prospective study on athletes with chronic patellar tendinopathy and found that three consecutive ultrasound-guided PRP injections significantly improved VISA-P, VAS, and Lysholm scores at a two-year follow-up. Additionally, MRI assessments showed improved tendon structural integrity in a majority of patients.[3]
A randomized controlled trial comparing PRP injections to extracorporeal shock-wave therapy (ESWT) found that PRP led to greater improvements in pain and functional scores at 6 and 12 months.[Smith, 4]
A systematic review by Liddle and Rodríguez-Merchán concluded that PRP is a safe and promising therapy for recalcitrant patellar tendinopathy, although its superiority over other treatments such as physical therapy remains unproven.[4]

Risks and side effects of PRP injections

The use of platelet-rich plasma (PRP) for patellar tendinopathy, or jumper’s knee, is generally considered safe, but it is not without risks and potential side effects. The most commonly reported adverse effects include:

1. Inflammatory Reactions: An local inflammatory response is expected after most PRP treatments. This usually lasts for 3-5 days after a treatment, although it may be longer and more severe after tendon treatments with PRP. This is usually managed with rest, ice, and sometimes prescription pain medications. There are also case reports of more severe reaction, as documented in a case involving a type 1 diabetic patient. This reaction may manifest as increased pain, swelling, and redness at the injection site.[1]

2. Symptom Exacerbation: There have been reports of worsening patellar tendinitis following PRP treatment. Patients may experience increased pain, tendon thickening, and even osteolysis of the distal pole of the patella.[2]

3. Tendon Rupture: Although rare, there is a documented case of patellar tendon rupture following a series of PRP injections. This case involved a 40-year-old male soccer player who experienced a complete tendon rupture with severe degenerative changes.[3] Although, it should be remembered that this is a single case report, and the patient had returned to playing sports soon after the treatment with considerably lower amounts of painful symptoms as reported by the authors in a later update. It should be noted that there is a much higher risk of tendon rupture with steroid (cortisone) injections near tendons.

4. General Adverse Events: While PRP is generally considered to have a favorable side effect profile, minor complications such as pain at the injection site, infection, and local tissue damage can occur. However, these are relatively uncommon and usually mild.[4]

PRP Concentration, Dose and Composition greatly influences success or failure of any PRP treatment

It is important to remember that not all PRP is the same, and the dose of platelets in one type of PRP preparation may be over 200x lower or higher than another type of PRP preparation. Although this fact is seldom addressed at most PRP clinics, it is very important and the main reason why so many patients see no effect from their PRP treatments.

Additionally, the composition of PRP can vary, which may influence the risk of adverse effects. For instance, leukocyte-rich PRP (L-PRP) has been shown to induce more inflammatory and catabolic changes compared to pure PRP (P-PRP).[5]

The only way to be sure of the concentration, dose, and composition of PRP is to analyze the PRP before use before each treatment. This requires the use of a hematology analyzer which is unfortunately quite rare. Without hematology analysis of the PRP, there is no guarantee of the type of PRP treatment you are getting. This type of analysis is especially important for any PRP treatments of the musculoskeletal system, including for osteoarthritis, or shoulder pain including rotator cuff injuries.

The Best type of PRP for Knee Treatments

The best type of PRP for jumpers knee will have very high concentration, dose and purity. In addition, testing of the sample must be done each time to know for certain what is being given to the patient for each treatment. It’s important to remember that every sample can be different, even when processed in exactly the same way.

In summary, while PRP therapy for patellar tendinopathy is generally safe, it carries risks such as inflammatory reactions, symptom exacerbation, and, in rare cases, tendon rupture. Careful patient selection and excellent PRP preparation protocols are essential to minimize these risks.

Who is the best Candidate for PRP for Patellar Tendinopathy?

The best candidate for PRP therapy for patellar tendinopathy is typically a patient who has not responded well to conservative treatments such as physical therapy, rest, and anti-inflammatory medications. Additionally, younger patients seem to respond better to PRP therapy compared to older individuals due to their potentially higher baseline regenerative capacity and healing potential. Furthermore, individuals with chronic patellar tendinopathy who have persistent pain and functional limitations despite conservative treatments may also benefit from PRP therapy as it can stimulate tissue repair and regeneration in the affected tendon.

Will PRP work for you?

To find out if PRP might be a viable option for you, we invite you to book a consultation with our doctor. During the consultation, our doctor will review your medical history, symptoms and treatment goals to help decide if PRP therapy is a suitable course of action for your individual needs. Additional lab tests or imaging studies may be ordered, including X-rays, ultrasound, or MRI to help assess your specific condition. Based on the results of these tests, our doctor will be able to provide you with a personalized treatment plan tailored to address your unique situation and optimize the potential benefits of PRP therapy.

Summary: PRP Therapy for Patellar Tedinopathy (Jumperʼs Knee) can be effective

But only if the PRP is prepared properly and analyzed for quality and concentration before use. While PRP therapy for patellar tendinopathy is generally safe, it carries risks such as inflammatory reactions, symptom exacerbation, and, in rare cases, tendon rupture. Careful patient selection and standardized PRP preparation protocols are essential to minimize these risks.

References

1. Exuberant Inflammatory Reaction as a Side Effect of Platelet-Rich Plasma Injection in Treating One Case of Tendinopathy. Kaux JF, Croisier JL, Léonard P, Le Goff C, Crielaard JM.

Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2014;24(2):150-2. doi:10.1097/JSM.0b013e31829aa410.

2. Progression of Patellar Tendinitis Following Treatment With Platelet-Rich Plasma: Case Reports. Bowman KF, Muller B, Middleton K, et al.

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA. 2013;21(9):2035-9. doi:10.1007/s00167-013-2549-1.

3. Rupture of the Patellar Tendon After Platelet-Rich Plasma Treatment: A Case Report. Redler A, Proietti L, Mazza D, et al.

Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2020;30(1):e20-e22. doi:10.1097/JSM.0000000000000703.

4. Treatment of Tendinopathies With Platelet-Rich Plasma. Mautner K, Kneer L.

Physical Medicine and Rehabilitation Clinics of North America. 2014;25(4):865-80. doi:10.1016/j.pmr.2014.06.008.

5. The Differential Effects of Leukocyte-Containing and Pure Platelet-Rich Plasma (PRP) on Tendon Stem/Progenitor Cells – Implications of PRP Application for the Clinical Treatment of Tendon Injuries. Zhou Y, Zhang J, Wu H, Hogan MV, Wang JH.