Evidence for Patellar Tendinopathy:


Patellar tendinopathy:

In the largest study of its kind, the American Journal of Sports Medicine recently published a meta-analysis incorporating 70 studies and 2530 patients(1). The conclusions from this analysis were that in comparison to eccentric exercises and shock-wave therapy, Ultrasound guided PRP injection treatment for chronic patellar tendinopathy, offered satisfactory results in the long term. PRP was considered as a good non-surgical option in the management of patellar tendinopathy.

Dupley et al published the only meta-analysis of randomised control trials in 2017 (2). This level 1 paper compared the outcomes of PRP with other non-surgical modalities including Shockwave therapy and Dry Needling for patients who have had chronic patellar tendinopathy. The findings concluded that PRP was superior to other non-surgical treatments in its outcomes and long-term benefits.

A similar level 1 study performed by Dragoo et al in 2009, carried out a double-blind, randomised controlled trial comparing Ultrasound guided PRP and dry needling (3). The outcomes of PRP were superior compared to dry needling alone with no treatment failures in the PRP group up to 3 months after injection.

In 2015, Kaux et al published on their 1 year results in using PRP for Chronic Patellar Tendinopathy (4). They found that the efficacy of PRP remains good at improving pain and function when combined with eccentric rehab.

The internationally renowned Lyon group, lead by Betrand Sonnery Cottet, published their experience of using PRP in the management of patellar tendinopathy and the frequency of injections (5). The compared two groups, one which had had a single injection and the other which had two. The results looked at functional outcomes and pain with a follow-up time of 2 years. While there were significant improvements in both groups, there was a better improvement in the group undergoing two injections.

In 2014, Charousset published their findings in the American Journal of Sports Medicine on the use of PRP in chronic patella tendinopathy, specifically in professional and semi-professional athletes(6). The sports included basketball, football and gymnastics. Of the group, 66% were able to get back their respective sports at their pre-symptoms sporting level. Interestingly, MRI scans were performed after their treatment and 57% of tendons appeared to have completely healed and the rest had partially healed.

Ferrero et al specifically looked at the effectiveness of ultrasound guided PRP injections in patellar tendinopathy (7). This study confirmed an improvement in the tendon structure at 3 and 6 months on repeat Ultrasound with a significant improvement in the patient symptoms. Interestingly, it was also noted that there was an increase in vascularity around the tendon, suggestive of increased healing.

In 2009, a group of surgeons led by Filardo et al (8) looked at patients who had undergone failed treatment for chronic patellar tendinopathy. All of these patients had been treated extensively with surgical and non-surgical methods with no benefit. Following a course of treatment with PRP injections, a significant benefit was noted in patient satisfaction, a reduction in pain symptoms and a significant improvement in the time to return to sporting activity.

  1. Andriolo L, Altamura SA, Reale D, Candrian C, Zaffagnini S, Filardo G. Nonsurgical Treatments of Patellar Tendinopathy: Multiple Injections of Platelet-Rich Plasma Are a Suitable Option: A Systematic Review and Meta-analysis. Am J Sports Med. 2018 Mar 1;4(2):363546518759674.
  2. Dupley L, Charalambous CP. Platelet-Rich Plasma Injections as a Treatment for Refractory Patellar Tendinosis: A Meta-Analysis of Randomised Trials. Knee Surg Relat Res. 2017 Sep 1;29(3):165–71.
  3. Dragoo JL, Wasterlain AS, Braun HJ, Nead KT. Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am J Sports Med. 2014 Mar;42(3):610–8.
  4. Kaux J-F, Bruyere O, Croisier J-L, Forthomme B, Le Goff C, Crielaard J-M. One-year follow-up of platelet-rich plasma infiltration to treat chronic proximal patellar tendinopathies. Acta Orthop Belg. 2015 Jun;81(2):251–6.
  5. Zayni R, Thaunat M, Fayard J-M, Hager J-P, Carrillon Y, Clechet J, et al. Platelet-rich plasma as a treatment for chronic patellar tendinopathy: comparison of a single versus two consecutive injections. Muscles Ligaments Tendons J. CIC Edizioni Internazionali; 2015 Apr;5(2):92–8.
  6. Charousset C, Zaoui A, Bellaiche L, Bouyer B. Are multiple platelet-rich plasma injections useful for treatment of chronic patellar tendinopathy in athletes? a prospective study. Am J Sports Med. 2014 Apr;42(4):906–11.
  7. Ferrero G, Fabbro E, Orlandi D, Martini C, Lacelli F, Serafini G, et al. Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy. Journal of Ultrasound. 2012 Dec;15(4):260–6.
  8. Filardo G, Kon E, Villa Della S, Vincentelli F, Fornasari PM, Marcacci M. Use of platelet-rich plasma for the treatment of refractory jumper’s knee. Int Orthop. Springer-Verlag; 2009 Jul 31;34(6):909–15.