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Platelet-Rich Plasma as an Effective Treatment for Proximal Hamstring Injuries
2013 ISAKOS ABSTRACTS
ethoxysclerol, and/or surgical treatment (Group 1), while the remaining patients were not treated before (Group 2). Results: Overall, Group 1 and Group 2 improved significantly on the VAS scales (p<.05). However, Group 2 also improved on VISA-P (p¼.003), while Group 1 showed less healing potential (p¼.060). Although the difference between Group 1 and Group 2 at follow-up was not considered clinically meaningful, over time both groups showed a clinically meaningful improvement. Conclusion: After PRP treatment, patients with patellar tendinopathy showed a statistically significant improvement. In addition, these improvements can also be considered clinically meaningful. However, patients who were not treated before with ethoxysclerol, cortisone, and/ or surgical treatment showed the largest improvement. Keywords: Patellar tendon, Jumpers’ knee, Platelet-rich plasma, Tendinopathy, Pain, Disability Paper #114: Platelet-Rich Plasma as an Effective Treatment for Proximal Hamstring Injuries RONAK PATEL, MD, USA PRESENTING AUTHOR ROBERT JOSEPH WETZEL, MD, USA MICHAEL TERRY, MD, USA $ McGaw Medical Center at Northwestern, Chicago, IL, USA
SUMMARY A platelet-rich plasma (PRP) injection at the muscle origin is an effective treatment for proximal hamstring injuries by effectively reducing pain and increasing functional outcomes scores in both primary and recalcitrant injuries. ABSTRACT DATA Introduction: Proximal hamstring injuries can be disabling, and several traditional conservative treatments (TCT), including physiotherapy and non-steroidal antiinflammatory drugs, have been inconsistently successful. Corticosteroid injections have demonstrated success, but can exhibit adverse effects on local tissue. Open repair has shown good to excellent results, but carries inherent surgical risk. Platelet-rich plasma (PRP) has emerged as a safe, effective treatment for several orthopaedic pathologies. We propose a PRP injection at the muscle origin as a novel treatment for proximal hamstring injuries. Materials and Methods: An Institutional Review Board approved retrospective review yielded fifteen patients with seventeen proximal hamstring injuries. Twelve injuries failed TCT initially and were ultimately treated with a PRP injection at the hamstrings origin. Five patients were successfully treated with TCT alone. Analysis included pre- and post-treatment visual analog scores (VAS), Nirschl Phase Rating Scale (NPRS), and return to sport. Results: There was no significant difference between the groups’ pre-treatment VAS (p¼0.17) and NPRS (p¼0.06) nor their post-treatment VAS (p¼0.40) and NPRS (p¼0.21). Both the TCT (p¼0.01, p¼0.01) and the PRP (p¼<0.01, p¼<0.01) groups demonstrated significant
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reduction in VAS and NPRS. All athletes returned to desired activity level without major complications. Conclusion and Discussion: Treatment for proximal hamstring injuries can be challenging, especially cases refractory to TCT. In these instances, surgical repair has been previously advocated. We feel that in both refractory and primary cases, PRP is a safe, effective treatment and a viable alternative to operative intervention. Both our groups had significant reductions in VAS and NPRS, and all our athletes returned to sport without complications. Paper #115: Posterior Cruciate Ligament (PCL) Injuries in Children: Long Term Follow Up of 20 Cases of Reconstruction and Repair NISHITH V. SHAH, MD, INDIA PRESENTING AUTHOR $ Rajasthan Hospitals, Ahmedabad, Gujarat, INDIA
SUMMARY Outcome study of long term follow-up of PCL reconstrcution with auto and allograft in Children
ABSTRACT DATA PCL injuries in children are becoming more and more common. Usually they are brought late for treatment of their medial side pain, repeated synovitis, effusion & not able to perform daily activities due to tiredness. Except 2 cases of PCL tibial avulsion injury, all the patients came to us between 6 months to 9 years after their original injury. All of them had adequate conservative treatment that failed. Most of our patients came from poor socioeconomical class. For all these patients, sitting on the ground in cross legged position(to eat and to do household activities) was most difficult. Literature regarding the treatment for posterior cruciate ligament (PCL) injuries in paediatric and adolescent patients is almost not available. We have treated 21 knees of PCL injuries in 20 knees. Out of these, only 2 cases are of PCL avulsion; the rest all are of PCL reconstruction. Our youngest patient of PCL reconstruction is 3.5 years old who sustained flexion injury in home and came to us after almost 4 months of injury. Cricket & Football injury (Flexion or hyperextension) & Road accidents (Dashboard or flexion) had same number of patients. 4 patients injured themselves at home and 3 sustained fall in the school (no sports). All patients had posterior drawer test positive to grade 2 to 3. PLC injury of grade 1-2 was present in 7 patients but only in one patient we did PLC reconstruction with PCL reconstruction. 3 of them had previous surgery for PVNS, fracture fixation as well as biopsy for repeated synovitis. Stress X-rays were more reliable then MRI studies especially in prepubescent age group. According to Tanner scoring our 4 patients are in Stage 1 (below 10 years),4 in stage 2(10-11 yrs.),6 in Stage 3 (1214 years),2 in Stage 4(13 -15 yrs.) and 5 are in Stage 5 (More than 16 yrs). So ‘physes at risk’ group makes 80% of our cases of PCL reconstruction.
ethoxysclerol, and/or surgical treatment (Group 1), while the remaining patients were not treated before (Group 2). Results: Overall, Group 1 and Group 2 improved significantly on the VAS scales (p<.05). However, Group 2 also improved on VISA-P (p¼.003), while Group 1 showed less healing potential (p¼.060). Although the difference between Group 1 and Group 2 at follow-up was not considered clinically meaningful, over time both groups showed a clinically meaningful improvement. Conclusion: After PRP treatment, patients with patellar tendinopathy showed a statistically significant improvement. In addition, these improvements can also be considered clinically meaningful. However, patients who were not treated before with ethoxysclerol, cortisone, and/ or surgical treatment showed the largest improvement. Keywords: Patellar tendon, Jumpers’ knee, Platelet-rich plasma, Tendinopathy, Pain, Disability Paper #114: Platelet-Rich Plasma as an Effective Treatment for Proximal Hamstring Injuries RONAK PATEL, MD, USA PRESENTING AUTHOR ROBERT JOSEPH WETZEL, MD, USA MICHAEL TERRY, MD, USA $ McGaw Medical Center at Northwestern, Chicago, IL, USA
SUMMARY A platelet-rich plasma (PRP) injection at the muscle origin is an effective treatment for proximal hamstring injuries by effectively reducing pain and increasing functional outcomes scores in both primary and recalcitrant injuries. ABSTRACT DATA Introduction: Proximal hamstring injuries can be disabling, and several traditional conservative treatments (TCT), including physiotherapy and non-steroidal antiinflammatory drugs, have been inconsistently successful. Corticosteroid injections have demonstrated success, but can exhibit adverse effects on local tissue. Open repair has shown good to excellent results, but carries inherent surgical risk. Platelet-rich plasma (PRP) has emerged as a safe, effective treatment for several orthopaedic pathologies. We propose a PRP injection at the muscle origin as a novel treatment for proximal hamstring injuries. Materials and Methods: An Institutional Review Board approved retrospective review yielded fifteen patients with seventeen proximal hamstring injuries. Twelve injuries failed TCT initially and were ultimately treated with a PRP injection at the hamstrings origin. Five patients were successfully treated with TCT alone. Analysis included pre- and post-treatment visual analog scores (VAS), Nirschl Phase Rating Scale (NPRS), and return to sport. Results: There was no significant difference between the groups’ pre-treatment VAS (p¼0.17) and NPRS (p¼0.06) nor their post-treatment VAS (p¼0.40) and NPRS (p¼0.21). Both the TCT (p¼0.01, p¼0.01) and the PRP (p¼<0.01, p¼<0.01) groups demonstrated significant
e103
reduction in VAS and NPRS. All athletes returned to desired activity level without major complications. Conclusion and Discussion: Treatment for proximal hamstring injuries can be challenging, especially cases refractory to TCT. In these instances, surgical repair has been previously advocated. We feel that in both refractory and primary cases, PRP is a safe, effective treatment and a viable alternative to operative intervention. Both our groups had significant reductions in VAS and NPRS, and all our athletes returned to sport without complications. Paper #115: Posterior Cruciate Ligament (PCL) Injuries in Children: Long Term Follow Up of 20 Cases of Reconstruction and Repair NISHITH V. SHAH, MD, INDIA PRESENTING AUTHOR $ Rajasthan Hospitals, Ahmedabad, Gujarat, INDIA
SUMMARY Outcome study of long term follow-up of PCL reconstrcution with auto and allograft in Children
ABSTRACT DATA PCL injuries in children are becoming more and more common. Usually they are brought late for treatment of their medial side pain, repeated synovitis, effusion & not able to perform daily activities due to tiredness. Except 2 cases of PCL tibial avulsion injury, all the patients came to us between 6 months to 9 years after their original injury. All of them had adequate conservative treatment that failed. Most of our patients came from poor socioeconomical class. For all these patients, sitting on the ground in cross legged position(to eat and to do household activities) was most difficult. Literature regarding the treatment for posterior cruciate ligament (PCL) injuries in paediatric and adolescent patients is almost not available. We have treated 21 knees of PCL injuries in 20 knees. Out of these, only 2 cases are of PCL avulsion; the rest all are of PCL reconstruction. Our youngest patient of PCL reconstruction is 3.5 years old who sustained flexion injury in home and came to us after almost 4 months of injury. Cricket & Football injury (Flexion or hyperextension) & Road accidents (Dashboard or flexion) had same number of patients. 4 patients injured themselves at home and 3 sustained fall in the school (no sports). All patients had posterior drawer test positive to grade 2 to 3. PLC injury of grade 1-2 was present in 7 patients but only in one patient we did PLC reconstruction with PCL reconstruction. 3 of them had previous surgery for PVNS, fracture fixation as well as biopsy for repeated synovitis. Stress X-rays were more reliable then MRI studies especially in prepubescent age group. According to Tanner scoring our 4 patients are in Stage 1 (below 10 years),4 in stage 2(10-11 yrs.),6 in Stage 3 (1214 years),2 in Stage 4(13 -15 yrs.) and 5 are in Stage 5 (More than 16 yrs). So ‘physes at risk’ group makes 80% of our cases of PCL reconstruction.