Abstract
Biological interventions, such as ultrasound guided platelet rich plasma (PRP) injections, are a second line treatment worth considering for recalcitrant tendinopathy, but efficacy and effectiveness have not been established yet. The use of PRP has been most commonly studied in lateral epicondylitis, with nine randomized controlled trials and seven prospective controlled studies in the medical literature. Corticosteroid injection was used as the comparator in six studies, autologous blood in three, and local anesthetic agents in two studies. Recent meta-analyses showed that PRP and autologous blood are superior to corticosteroids in pain reduction and ameliorating functionality in epicondylitis. PRP efficacy on supraspinatus tears are controversial, and PRP is better than controls in two out of five studies, when compared with corticosteroids and dry needling. Patellar tendinopathy is examined in four controlled studies, and eight case series, PRP ameliorated outcomes but not in all cases. Whether more than one injection should be given is under discussion. Achilles tendinopathy was examined in three prospective controlled studies (a single injection), and six case series. Patients showed improvements regarding baseline values, but two controlled studies failed to reveal differences with controls. Pooling data across studies is challenging because of heterogeneity in outcome scores and comparators. Tendinopathy progression and outcomes are poorly monitored with self-reported questionnaires that are not sensitive enough to discriminate local changes. Molecular indicators of tendon health and disease can help to assess whether the condition progress or heal after biological interventions. The international consensus about the design of clinical studies should be pursued.
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