Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy Comparison of magnetic resonance imaging findings in anterior cruciate ligament grafts with and without autologous platelet-derived growth factors. Platelet-Rich Plasma Versus Autologous Whole Blood for the Treatment of Chronic Lateral Elbow Epicondylitis Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. Patellar Tendon Healing With Platelet-Rich Plasma Effects of platelet concentrate and a bone plug on the healing of hamstring tendons in a bone tunnel. Platelet-rich plasma: does it help reduce tunnel widening after ACL reconstruction? Platelet-Rich Plasma Augmentation for Arthroscopic Rotator Cuff Repair Validation of the WHO Quality of Life assessment instrument (WHOQOL-100) in a population of Dutch adult psychiatric outpatients. Positive Effect of an Autologous Platelet Concentrate in Lateral Epicondylitis in a Double-Blind Randomized Controlled Trial The reliability of a linear analogue for evaluating pain Anatomic ACL reconstruction: does the platelet-rich plasma accelerate tendon healing? Platelet-rich plasma: Growth factor enhancement for bone grafts. Autologous platelet-rich plasma gel to reduce donor-site morbidity after patellar tendon graft harvesting for anterior cruciate ligament reconstruction: a randomized, controlled clinical study Use of platelet-rich plasma for the treatment of refractory jumper’s knee Treatment of Lateral Epicondylitis With Platelet-Rich Plasma, Glucocorticoid, or Saline Has platelet-rich plasma any role in anterior cruciate ligament allograft healing? Autologous Platelets Have No Effect on the Healing of Human Achilles Tendon Ruptures Comparison of injection modalities in the treatment of plantar heel pain: a randomized controlled trial. Use of platelet-leukocyte membrane in arthroscopic repair of large rotator cuff tears: a prospective randomized study. Platelet-Rich Plasma as a Treatment for Patellar Tendinopathy One-Year Follow-up of Platelet-Rich Plasma Treatment in Chronic Achilles Tendinopathy Magnetic resonance imaging evaluation of the integration and maturation of semitendinosus-gracilis graft in anterior cruciate ligament reconstruction using autologous platelet concentrate. No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achilles tendinopathy The epidemiology of musculoskeletal tendinous and ligamentous injuries. The Effect of Platelet-Rich Fibrin Matrix on Rotator Cuff Tendon Healing Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy. Platelet-Rich Plasma in Rotator Cuff Repair Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections Platelet-rich fibrin in arthroscopic repair of massive rotator cuff tears: a prospective randomized pilot clinical trial. Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery.
HYPOTHESIS Local application of autologous platelet rich plasma ( PRP ) improves tendon healing in patients undergoing arthroscopic rotator cuff repair . STUDY DESIGN Prospect i ve , r and omized , controlled , double blind study ; considering an alpha level of 5 % , a power of 80 % , 22 patients for group are needed . MATERIAL S AND METHODS Fifty-three patients who underwent shoulder arthroscopy for the repair of a complete rotator cuff tear were r and omly divided into 2 groups , using a block r and omization procedure . A treatment group ( N = 26 ) consisted of those who received an intraoperative application of PRP in combination with an autologous thrombin component . A control group ( N = 27 ) consisted of those who did not receive that treatment . Patients were evaluated with vali date d outcome scores . A magnetic resonance image ( MRI ) was performed in all cases at more than 1 year post-op . All patients had the same accelerated rehabilitation protocol . RESULTS The 2 groups were homogeneous . The pain score in the treatment group was lower than the control group at 3 , 7 , 14 , and 30 days after surgery ( P < .05 ) . On the Simple Shoulder Test ( SST ) , University of California ( UCLA ) , and Constant scores , strength in external rotation , as measured by a dynamometer , were significantly higher in the treatment group than the control group at 3 months after surgery ( strength in external rotation [ SER ] : 3 ± 1.6 vs 2.1 ± 1.3 kg ; SST : 8.9 ± 2.2 vs 7.1 ± 2.7 ; UCLA : 26.9 ± 3 vs 24.2 ± 4.9 ; Constant : 65 ± 9 vs 57.8 ± 11 ; P < .05 ) . There was no difference between the 2 groups after 6 , 12 , and 24 months . The follow-up MRI showed no significant difference in the healing rate of the rotator cuff tear . In the subgroup of grade 1 and 2 tears , with less retraction , SER in the PRP group was significant higher at 3 , 6 , 12 , and 24 months postoperative ( P < .05 ) . CONCLUSION The results of our study showed autologous PRP  reduced pain in the first postoperative months . The long-term results of subgroups of grade 1 and 2 tears suggest that PRP positively affected cuff rotator healing Background —There is no disease specific , reliable , and valid clinical measure of Achilles tendinopathy . Objective —To develop and test a question naire based instrument that would serve as an index of severity of Achilles tendinopathy . Methods —Item generation , item reduction , item scaling , and pretesting were used to develop a question naire to assess the severity of Achilles tendinopathy . The final version consisted of eight questions that measured the domains of pain , function in daily living , and sporting activity . Results range from 0 to 100 , where 100 represents the perfect score . Its validity and reliability were then tested in a population of non-surgical patients with Achilles tendinopathy ( n = 45 ) , presurgical patients with Achilles tendinopathy ( n = 14 ) , and two normal control population s ( total n = 87 ) . Results —The VISA-A question naire had good test-retest ( r = 0.93 ) , intrarater ( three tests , r = 0.90 ) , and interrater ( r = 0.90 ) reliability as well as good stability when compared one week apart ( r = 0.81 ) . The mean ( 95 % confidence interval ) VISA-A score in the non-surgical patients was 64 ( 59–69 ) , in presurgical patients 44 ( 28–60 ) , and in control subjects it exceeded 96 ( 94–99 ) . Thus the VISA-A score was higher in non-surgical than presurgical patients ( p = 0.02 ) and higher in control subjects than in both patient population s ( p<0.001 ) . Conclusions —The VISA-A question naire is reliable and displayed construct validity when means were compared in patients with a range of severity of Achilles tendinopathy and control subjects . The continuous numerical result of the VISA-A question naire has the potential to provide utility in both the clinical setting and research . The test is not design ed to be diagnostic . Further studies are needed to determine whether the VISA-A score predicts prognosis PURPOSE To determine whether the use of platelet-rich plasma gel ( PRPG ) affects magnetic resonance imaging ( MRI ) findings in the anterior cruciate ligament ( ACL ) graft during the first year after reconstruction . METHODS A prospect i ve single-blinded study of 50 ACL reconstructions in 50 patients was performed . In group A ( study group ) PRPG was added to the graft with a st and ardized technique , and in group B ( control group ) no PRPG was added . An  MRI study  was performed postoperatively between 3 and 9 months in group A and between 3 and 12 months in group B. The imaging analysis was performed in a blind protocol by the same radiologist . RESULTS The mean heterogeneity score value at the time of MRI , assigned by the radiologist , was 1.14 in group A and 3.25 in group B. Both groups were comparable in terms of sex and age ( P < .05 ) . The mean time to obtain a completely homogeneous intra-articular segment in group A ( PRPG added ) was 177 days after surgery , and it was 369 days in group B. Using the quadratic predictive model , these findings show that group A ( PRPG added ) needed only 48 % of the time group B required to achieve the same MRI image ( P < .001 ) . CONCLUSIONS ACL reconstruction with the use of PRPG achieves complete homogeneous grafts assessed by MRI , in 179 days compared with 369 days for ACL reconstruction without PRPG . This represents a time shortening of 48 % with respect to ACL reconstruction without PRPG Background : Chronic lateral elbow epicondylitis is a tendinosis with angiofibrolastic degeneration of the wrist extensors ’ origin . Healing of this lesion is reported with the use of autologous blood as well as with platelet-rich plasma ( PRP ) . Purpose : A comparative study of these 2 treatments was conducted in an effort to investigate the possible advantages of PRP . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Twenty-eight patients were divided equally into 2 groups , after blocked r and omization . Group A was treated with a single injection of 3 mL of autologous blood and group B with 3 mL of PRP under ultrasound guidance . A st and ardized program of eccentric muscle strengthening was followed by all patients in both groups . Evaluation using a pain visual analog scale ( VAS ) and Liverpool elbow score was performed at 6 weeks , 3 months , and 6 months . Results : The VAS score improvement was larger in group B at every follow-up interval but the difference was statistically significant only at 6 weeks , when mean improvement was 3.8 points ( 95 % confidence interval [ CI ] , 3.1 - 4.5 ) in group B ( 61.47 % improvement ) and 2.5 points ( 95 % CI , 1.9 - 3.1 ) in group A ( 41.6 % improvement ) ( P < .05 ) . No statistically significant difference was noted between groups regarding Liverpool elbow score . Conclusion : Regarding pain reduction ,  PRP treatment seems to be an effective treatment for chronic lateral elbow epicondylitis and superior to autologous blood in the short term . Defining details of indications , best PRP concentration , number and time of injections , as well as rehabilitation protocol might increase the method ’s effectiveness . Additionally , the possibility of cost reduction of the method might justify the use of PRP over autologous whole blood for chronic or refractory tennis elbow CONTEXT Tendon disorders comprise 30 % to 50 % of all activity-related injuries ; chronic degenerative tendon disorders ( tendinopathy ) occur frequently and are difficult to treat . Tendon regeneration might be improved by injecting platelet-rich plasma ( PRP ) , an increasingly used treatment for releasing growth factors into the degenerative tendon . OBJECTIVE To examine whether a PRP injection would improve outcome in chronic midportion Achilles tendinopathy . DESIGN , SETTING , AND PATIENTS A stratified , block-r and omized , double-blind , placebo-controlled trial at a single center ( The Hague Medical Center , Leidschendam , The Netherl and s ) of 54 r and omized patients aged 18 to 70 years with chronic tendinopathy 2 to 7 cm above the Achilles tendon insertion . The trial was conducted between August 28 , 2008 , and January 29 , 2009 , with follow-up until July 16 , 2009 . INTERVENTION Eccentric exercises ( usual care ) with either a PRP injection ( PRP group ) or saline injection ( placebo group ) . R and omization was stratified by activity level . MAIN OUTCOME MEASURES The vali date d Victorian Institute of Sports Assessment -Achilles ( VISA-A ) question naire , which evaluated pain score and activity level , was completed at baseline and 6 , 12 , and 24 weeks . The VISA-A score ranged from 0 to 100 , with higher scores corresponding with less pain and increased activity . Treatment group effects were evaluated using general linear models on the basis of intention-to-treat . RESULTS After r and omization into the PRP group ( n = 27 ) or placebo group ( n = 27 ) , there was complete follow-up of all patients . The mean VISA-A score improved significantly after 24 weeks in the PRP group by 21.7 points ( 95 % confidence interval [ CI ] , 13.0 - 30.5 ) and in the placebo group by 20.5 points ( 95 % CI , 11.6 - 29.4 ) . The increase was not significantly different between both groups ( adjusted between-group difference from baseline to 24 weeks , -0.9 ; 95 % CI , -12.4 to 10.6 ) . This CI did not include the predefined relevant difference of 12 points in favor of PRP treatment . CONCLUSION Among patients with chronic Achilles tendinopathy who were treated with eccentric exercises , a PRP injection compared with a saline injection did not result in greater improvement in pain and activity . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00761423 Background : The patellar tendon has limited ability to heal after harvesting its central third . Platelet-rich plasma ( PRP ) could improve patellar tendon healing . Hypothesis : Adding PRP to the patellar tendon harvest site would improve donor site healing and improve clinical outcome at 6 months after anterior cruciate ligament ( ACL ) reconstruction with a patellar tendon graft . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Twenty-seven patients were r and omly divided to receive ( n = 12 ) or not receive ( n = 15 ) PRP in the patellar tendon harvest site during ACL reconstruction . The primary outcome was magnetic resonance imaging ( MRI ) assessment of patellar tendon healing ( gap area ) after 6 months . Secondary outcomes were question naires and isokinetic testing of ACL reconstruction with a patellar tendon graft comparing both groups . Results : Patellar tendon gap area was significantly smaller in the PRP group ( 4.9 ± 5.3 mm2 ; 95 % confidence interval [ CI ] , 1.1 - 8.8 ) than in the control group ( 9.4 ± 4.4 mm2 ; 95 % CI , 6.6 - 12.2 ; P = .046 ) . Visual analog scale score for pain was lower in the PRP group immediately postoperatively ( 3.8 ± 1.0 ; 95 % CI , 3.18 - 4.49 ) than in the control group ( 5.1 ± 1.4 ; 95 % CI , 4.24 - 5.90 ; P = .02 ) . There were no differences after 6 months in question naire and isokinetic testing results comparing both groups . Conclusion : We showed that PRP had a positive effect on patellar tendon harvest site healing on MRI after 6 months and also reduced pain in the immediate postoperative period . Question naire and isokinetic testing results were not different between the groups at 6 months PURPOSE The purpose of this study was to determine if the use of platelet concentrate ( PC ) and bone plug ( BP ) does accelerate the healing process in anterior cruciate ligament ( ACL ) reconstruction . METHODS One hundred and eight patients requiring ACL reconstruction were prospect ively r and omized into 4 groups :  control  ( 27 patients ) , PC ( 26 patients ) , BP ( 28 patients ) , and a combination of PC and BP ( 27 patients ) . Magnetic resonance imaging ( MRI ) studies were carried out at both 3 and 6 months postsurgery . Maturation of the graft was evaluated at the femoral tunnel using MRI maturation criteria defined by a low-intensity signal , absence of osteoligamentous interface , and no widening of the femoral tunnel . RESULTS Three months after surgery , no differences were found among the groups regarding MRI maturation criteria . Six months postsurgery , 78 % of the patients in the control group had a low-intensity signal , while in the PC group the low-intensity signal was present in 100 % of the patients ( P = .036 ) . No statistical differences were observed regarding the osteoligamentous interface between the various groups . Finally , tunnel widening was seen in 11 % of the patients of the BP group versus 41 % of the patients in the control group ( P = .047 ) , but no statistical difference was seen with the other groups . CONCLUSIONS The use of PC had an enhancing effect on the graft maturation process evaluated only by MRI signal intensity , without showing any significant effect in the osteoligamentous interface or tunnel widening evolution . The use of a BP effectively prevented tunnel widening . The BP and PC combination did not show a synergic effect as compared to PC or BP individually . LEVEL OF EVIDENCE Level II , lesser quality r and omized controlled trial Purpose The purpose of this study was to evaluate the efficacy of platelet-rich plasma ( PRP ) in reducing femoral and tibial tunnel enlargement in patients operated on for anterior cruciate ligament reconstruction with hamstrings . Methods Forty male patients , in which both femoral and tibial 9-mm tunnels were performed because of the graft size , were enrolled in this prospect i ve study . They were r and omly assigned to group A ( 20 patients , PRP group ) and group B ( 20 patients , control group ) . All patients were followed up at a median of 14.7 months ( range 10–16 months ) , with a physical examination , the Tegner , Lysholm and objective IKDC scoring scales , and with the KT-1000 arthrometer . Moreover , they underwent a  CT evaluation in order to assess the amount of tunnel enlargement . Results Femoral tunnel diameter increased from 9.0 ± 0.1 mm to 9.8 ± 0.3 mm in group A ( p = 0.032 ) and from 9.0 ± 0.1 mm to 9.4 ± 0.5 mm in group B ( p = 0.043 ) . Tibial tunnel diameter increased from 9.0 ± 0.2 mm to 10.9 ± 0.2 mm in group A ( p = 0.029 ) and from 9.1 ± 0.1 mm to 10.1 ± 0.4 mm in group B ( p = 0.028 ) . Physical examination as well as the evaluation scales used showed no differences between the two groups . Conclusions The use of PRP does not seem to be effective in preventing tunnel enlargement . Level of evidence Therapeutic study , Level II Background : After reinsertion on the humerus , the rotator cuff has limited ability to heal . Growth factor augmentation has been proposed to enhance healing in such procedure . Purpose : This study was conducted to assess the efficacy and safety of growth factor augmentation during rotator cuff repair . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Eighty-eight patients with a rotator cuff tear were r and omly assigned by a computer-generated sequence to receive arthroscopic rotator cuff repair without ( n = 45 ) or with ( n = 43 ) augmentation with autologous platelet-rich fibrin matrix ( PRFM ) . The primary end point was the postoperative difference in the Constant score between the 2 groups . The secondary end point was the integrity of the repaired rotator cuff , as evaluated by magnetic resonance imaging . Analysis was on an intention-to-treat basis . Results : All the patients completed follow-up at 16 months . There was no statistically significant difference in total Constant score when comparing the results of arthroscopic repair of the 2 groups ( 95 % confidence interval , −3.43 to 3.9 ) ( P = .44 ) . There was no statistically significant difference in magnetic resonance imaging tendon score when comparing arthroscopic repair with or without PRFM ( P = .07 ) . Conclusion : Our study does not support the use of autologous PRFM for augmentation of a double-row repair of a small or medium rotator cuff tear to improve the healing of the rotator cuff . Our results are applicable to small and medium rotator cuff tears ; it is possible that PRFM may be beneficial for large and massive rotator cuff tears . Also , given the heterogeneity of PRFM preparation products available on the market , it is possible that other preparations may be more effective BACKGROUND Research concerning the psychometric properties of the  WHO Quality of Life Assessment Instrument ( WHOQOL-100 ) in general population s of psychiatric out patients has not been performed systematic ally . AIMS To examine the content validity , construct validity , and reliability of the WHOQOL-100 in a general population of Dutch adult psychiatric out patients . METHOD A total of 533 psychiatric out patients entered the study ( 438 r and omly selected , 85 internally referred ) . Participants completed self-administered question naires for measuring quality of life ( WHOQOL-100 ) , psychopathological symptoms ( SCL-90 ) , and perceived social support ( PSSS ) .  In addition , they underwent two semi-structured interviews in order to obtain Axis-I and Axis-II diagnoses , according to DSM-IV . RESULTS The drop-out percentage was low ( 7.1 % ) . Of the 24 facets of the WHOQOL-100 , 22 had a good distribution of scores , leaving out the facets physical environment and transport . Exploratory factor analysis revealed a four-factor structure , which was similar to earlier findings in patients with specific somatic diseases and depressive disorders . Various-a priori expected-positive and negative correlations were found between facets and domains of the WHOQOL-100 , and dimensions of the SCL-90 and the PSSS-score , indicating good construct validity of the WHOQOL-100 . The internal consistency of all facets and the four domains of the WHOQOL-100 was good ( Cronbach 's alpha 's ranging from 0.62 to 0.93 and 0.64 to 0.84 , respectively ) . Sparse and relatively low correlations were found between demographic characteristics ( age and sex ) and WHOQOL-100 scores . CONCLUSIONS Content validity , construct validity , and reliability of the WHOQOL-100 in a population of adult Dutch psychiatric out patients are good . The WHOQOL-100 appears to be a suitable instrument for measuring quality of life in adult psychiatric out patients Background Platelet-rich plasma ( PRP ) has shown to be a general stimulation for repair . Purpose To determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis . Study Design R and omized controlled trial ; Level of evidence , 1 . Patients The trial was conducted in 2 teaching hospitals in the Netherl and s. One hundred patients with chronic lateral epicondylitis were r and omly assigned in the PRP group ( n = 51 ) or the corticosteroid group ( n = 49 ) . A central computer system carried out r and omization and allocation to the trial group . Patients were r and omized to receive either a corticosteroid injection or an autologous platelet concentrate injection through a peppering technique . The primary analysis included visual analog scores and DASH Outcome Measure scores ( DASH : Disabilities of the Arm , Shoulder , and H and ) . Results Successful treatment was defined as more than a 25 % reduction in visual analog score or DASH score without a reintervention after 1 year . The results showed that , according to the visual analog scores , 24 of the 49 patients ( 49 % ) in the corticosteroid group and 37 of the 51 patients ( 73 % ) in the PRP group were successful , which was significantly different ( P < .001 ) . Furthermore , according to the DASH scores , 25 of the 49 patients ( 51 % ) in the corticosteroid group and 37 of the 51 patients ( 73 % ) in the PRP group were successful , which was also significantly different ( P = .005 ) . The corticosteroid group was better initially and then declined , whereas the PRP group progressively improved . Conclusion Treatment of patients with chronic lateral epicondylitis with PRP reduces pain and significantly increases function , exceeding the effect of corticosteroid injection . Future decisions for application of the PRP for lateral epicondylitis should be confirmed by further follow-up from this trial and should take into account possible costs and harms as well as benefits A linear analogue for rating  pain with 10 , 15 and 20 cm lines is significantly less variable than a 5 cm line ( mean error of 15 cm line is 0 - 19 % , 95 % confidence limits for the group + /- 2 % and an inood correlation between repeated ratins of a recalled pain distant in time . The variance of the rating is significantly less than the repeated rating of a r and om mark . The linear analogue rating of a constant pain stimulus is reproducible and changes in rating are likely to be real changes of opinion . Pethidine 150 mg intramuscularly had no significant effect , tested 30 minutes after the administration , on the accuracy or reproducibility of the analogue rating . A linear analogue seems a suitable method of recording the patient 's opion of a severe pain such as that of labour Recently , the use of hamstring tendons in anterior cruciate ligament repair has been increasing . However , tendon-to-bone healing occurs slowly , which can be a problem to an early return to sport activities . The use of growth factors from platelets seems to improve tissue healing . We enrolled 40 patients in a prospect i ve study that were su bmi tted to an anatomic reconstruction of the anterior cruciate ligament . Patients were sequentially enrolled into four groups : group A without platelet-rich plasma ( PRP ) ; group B with PRP in femoral tunnels at the end of surgery ; group C with PRP in femoral tunnels at the end of surgery and intra-articular at 2- and 4 weeks after surgery ; group D with PRP activated with thrombin in the femoral tunnels . All patients underwent magnetic resonance imaging of the knee 3 months after surgery to evaluate the signal intensity of the fibrous interzone ( FIZ ) in the femoral tunnels . We did not find any difference among the groups when comparing the signal intensity of the FIZ on magnetic resonance imaging Platelet-rich plasma is an autologous source of platelet-derived growth factor and transforming growth factor beta that is obtained by sequestering and concentrating platelets by gradient density centrifugation . This technique produced a concentration of human platelets of 338 % and identified platelet-derived growth factor and transforming growth factor beta within them . Monoclonal antibody assessment of cancellous cellular marrow grafts demonstrated cells that were capable of responding to the growth factors by bearing cell membrane receptors . The additional amounts of these growth factors obtained by adding platelet-rich plasma to grafts evidence d a radiographic maturation rate 1.62 to 2.16 times that of grafts without platelet-rich plasma . As assessed by histomorphometry , there was also a greater bone density in grafts in which platelet-rich plasma was added ( 74.0 % + /- 11 % ) than in grafts in which platelet-rich plasma was not added ( 55.1 % + /- 8 % ; p = 0.005 ) Purpose Bone-patellar tendon – bone technique ( BPTB ) for anterior cruciate ligament injuries is associated with a higher risk of donor-site morbidity . To evaluate whether platelet-rich plasma ( PRP ) , due to its anti-inflammatory properties and capacity to stimulate tissue regeneration , was able to reduce the anterior knee pain , the kneeling pain , and donor-site morbidity , as evidence d by evaluation of VISA and VAS scoring scales and MRI analysis of the tendon and bone defect , we performed a clinical r and omized controlled study where PRP gel was applied to donor site after ACL reconstruction with BPTB . Methods Forty young athletes with the indication of ACL reconstruction with patellar tendon grafts were r and omly assigned to group A ( n = 20 patients , control group ) or group B ( n = 20 patients , PRP group ) . The autologous PRP gel was applied to both the patellar and tendon bone plug harvest site and stabilized by the peritenon suture . At 12-month follow-up , all patients underwent clinical examination and VAS and VISA question naires , respectively , evaluating the average daily pain of the knee and the pain during particular activities involving the knee , were filled . MRI at the same time point was also performed . Results VISA scores were significantly higher in the patients treated with PRP ( 84.5 ± 11.8 and 97.8 ± 2.5 for group A and for group B ; P = 0.041 ) , whereas no significant difference in postoperative VAS scores between the two groups was observed ( 1 ± 1.4 and 0.6 ± 0.9 for group A and group B , n.s . ) . In 85 % of PRP group patients , the tibial and patellar bone defect was satisfactorily filled by new bony tissue ( > 70 % of bone gap filled ) , whereas this percentage was just of 60 % in control group patients , but this difference was not statistically significant . Conclusions The study shows the usefulness of PRP in reducing subjective pain at the donor-site level after ACL reconstruction with BPTB . However , this approach deserves further investigations to confirm PRP efficacy and to eluci date its mechanism of action . Level of evidence Prospect i ve r and omized controlled study , Level The aim of this study was to evaluate the efficacy of multiple platelet-rich plasma ( PRP ) injections on the healing of chronic refractory patellar tendinopathy after previous classical treatments have failed . We treated 15 patients affected by chronic jumper ’s knee , who had failed previous nonsurgical or surgical treatments , with multiple PRP injections and physiotherapy .  We also compared the clinical outcome with a homogeneous group of 16 patients primarily treated exclusively with the physiotherapy approach .  Multiple PRP injections were performed on three occasions two weeks apart into the site of patellar tendinopathy . Tegner , EQ VAS and pain level were used for clinical evaluation before , at the end of the treatment and at six months follow-up . Complications , functional recovery and patient satisfaction were also recorded . A statistically significant improvement in all scores was observed at the end of the PRP injections in patients with chronic refractory patellar tendinopathy and a further improvement was noted at six months , after physiotherapy was added . Moreover , comparable results were obtained with respect to the less severe cases in the EQ VAS score and pain level evaluation , as in time to recover and patient satisfaction , with an even higher improvement in the sport activity level achieved in the PRP group . The clinical results are encouraging , indicating that PRP injections have the potential to promote the achievement of a satisfactory clinical outcome , even in difficult cases with chronic refractory tendinopathy after previous classical treatments have failed Background : Lateral epicondylitis ( LE ) is a common musculoskeletal disorder for which an effective treatment strategy remains unknown . Purpose : To examine whether a single injection of platelet-rich plasma ( PRP ) is more effective than placebo ( saline ) or glucocorticoid in reducing pain in adults with LE after 3 months . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : A total of 60 patients with chronic LE were r and omized ( 1:1:1 ) to receive either a blinded injection of PRP , saline , or glucocorticoid . The primary end point was a change in pain using the Patient-Rated Tennis Elbow Evaluation ( PRTEE ) question naire at 3 months . Secondary outcomes were ultrasonographic changes in tendon thickness and color Doppler activity . Results : Pain reduction at 3 months ( primary end point ) was observed in all 3 groups , with no statistically significant difference between the groups ; mean differences were the following : glucocorticoid versus saline : −3.8 ( 95 % CI , −9.9 to 2.4 ) ; PRP versus saline : −2.7 ( 95 % CI , −8.8 to 3.5 ) ; and glucocorticoid versus PRP : −1.1 ( 95 % CI , −7.2 to 5.0 ) . At 1 month , however , glucocorticoid  reduced pain more effectively than did both saline and PRP ; mean differences were the following : glucocorticoid versus saline : −8.1 ( 95 % CI , −14.3 to −1.9 ) ; and glucocorticoid versus PRP : −9.3 ( 95 % CI , −15.4 to −3.2 ) . Among the secondary outcomes , at 3 months , glucocorticoid was more effective than PRP and saline in reducing color Doppler activity and tendon thickness . For color Doppler activity , mean differences were the following : glucocorticoid versus PRP : −2.6 ( 95 % CI , −3.1 to −2.2 ) ; and glucocorticoid versus saline : −2.0 ( 95 % CI , −2.5 to −1.6 ) . For tendon thickness , mean differences were the following : glucocorticoid versus PRP : −0.5 ( 95 % CI , −0.8 to −0.2 ) ; and glucocorticoid versus saline : −0.8 ( 95 % CI , −1.2 to −0.5 ) . Conclusion : Neither injection of PRP nor glucocorticoid was superior to saline with regard to pain reduction in LE at the primary end point at 3 months . However , injection of glucocorticoid had a short-term pain-reducing effect at 1 month in contrast to the other therapies . Injection of glucocorticoid in LE reduces both color Doppler activity and tendon thickness compared with PRP and saline PURPOSE The aim of this study was to evaluate and compare the clinical and inflammatory parameters with the addition of platelet-derived growth factor ( PDGF ) in primary anterior cruciate ligament ( ACL ) reconstruction with bone-patellar tendon-bone allograft .  METHODS We prospect ively r and omized 100 patients undergoing arthroscopic patellar tendon allograft ACL reconstruction  to a group in whom platelet-enriched gel was used ( n = 50 ) and a non-gel group ( n = 50 ) . The platelet concentration was 837 x 10(3)/mm(3 ) , and the gel was introduced inside the graft and the tibial tunnel . Demographic data were comparable between groups . The mean follow-up was 24 months for both groups and included a history , clinical evaluation with the International Knee Documentation Committee score , radiographs , and magnetic resonance imaging . RESULTS There were no differences in the number of associated injuries . The results did not show any statistically significant differences between the groups for inflammatory parameters ( perimeters of the knee and C-reactive protein level ) , magnetic resonance imaging appearance of the graft , and clinical evaluation scores ( visual analog scale , International Knee Documentation Committee , and KT-1000 arthrometer [ MEDmetric , San Diego , CA ] ) . CONCLUSIONS At this time , the therapeutic role of PDGF in ACL reconstruction remains unclear . The use of PDGF , on the graft and inside the tibial tunnel , in patients treated with bone-patellar tendon-bone allografts has no discernable clinical or biomechanical effect at 2 years ' follow-up . More clinical studies will be needed to show the efficacy and use of these factors in daily practice in ACL reconstruction . LEVEL OF EVIDENCE Level I , prospect i ve , r and omized , double-blind study Background : Animal studies have shown that local application of platelet-rich plasma ( PRP ) stimulates tendon repair . Preliminary results from a retrospective case series have shown faster return to sports . Hypothesis : Autologous PRP stimulates healing of acute Achilles tendon ruptures . Study Design : R and omized controlled trial ; Level of evidence , 2 . Methods : Thirty patients were recruited consecutively . During surgery , tantalum beads were implanted in the Achilles tendon proximal and distal to the rupture . Before skin suture , r and omization was performed , and 16 patients were injected with 10mL PRP ( 10 times higher platelet concentration than peripheral blood ) whereas 14 were not . With 3-dimensional radiographs ( roentgen stereophotogrammetric analysis ; RSA ) , the distance between the beads was measured at 7 , 19 , and 52 weeks while the patient resisted different dorsal flexion moments over the ankle joint , thereby estimating tendon strain per load . An estimate of elasticity modulus was calculated using callus dimensions from computed tomography . At 1 year , functional outcome was evaluated , including the heel raise index and Achilles Tendon Total Rupture Score . The primary effect variables were elasticity modulus at 7 weeks and heel raise index at 1 year . Results : The mechanical variables showed a large degree of variation between patients that could not be explained by measuring error . No significant group differences in elasticity modulus could be shown . There was no significant difference in heel raise index . The Achilles Tendon Total Rupture Score was lower in the PRP group , suggesting a detrimental effect . There was a correlation between the elasticity modulus at 7 and 19 weeks and the heel raise index at 52 weeks . Conclusion : The results suggest that PRP is not useful for treatment of Achilles tendon ruptures . The variation in elasticity modulus provides biologically relevant information , although it is unclear how early biomechanics is connected to late clinical results In a prospect i ve r and omized study of plantar heel pain , 44 patients were treated with injection of 1 mL of 2 % prilocaine using the peppering technique , 1 mL of 2 % prilocaine combined with 2 mL of autologous blood , or 1 mL of 2 % prilocaine mixed with 40 mg of methylprednisolone acetate . At 6-month follow-up , clinical improvement was evaluated by using a 10-cm visual analog scale and the rearfoot score of the American Orthopaedic Foot and Ankle Society . Results were analyzed using sample t-tests within groups and repeated- measures analyses of variance between groups . Mean + /- SD visual analog scale scores in the peppering technique , autologous blood injection , and corticosteroid injection groups improved from 6.4 + /- 1.1 , 7.6 + /- 1.3 , and 7.28 + /- 1.2 to 2.0 + /- 2.2 ( P < .001 ) , 2.4 + /- 1.8 ( P < .001 ) , and 2.57 + /- 2.9 ( P < .001 ) , respectively . Mean + /- SD rearfoot scores in the same groups improved from 64.1 + /- 15.1 , 71.6 + /- 1 , and 65.7 + /- 12.7 to 78.2 + /- 12.4 ( P = .018 ) , 80.9 + /- 13.9 ( P = .025 ) , and 80.07 + /- 17.5 ( P = .030 ) , respectively . There were no statistically significant differences among the groups . Good outcomes have been documented using the  peppering technique and autologous blood injection  for the treatment of lateral epicondylitis . Although the curative mechanisms of both injection modalities are based on a hypothesis , they seem to be good alternatives to corticosteroid injection for the treatment of plantar heel pain BACKGROUND Arthroscopic rotator cuff repair  generally provides satisfactory results including decreased shoulder pain and improved shoulder motion . Unfortunately , imaging studies demonstrate that the retear rate associated with the available arthroscopic techniques may be high . The purpose of this study was to evaluate the clinical and magnetic resonance imaging ( MRI ) results of arthroscopic rotator cuff repair with and without the use of platelet-leukocyte membrane in patients with a large posterosuperior rotator cuff tear . METHODS Eighty consecutive patients with a large full-thickness posterosuperior rotator cuff tear were enrolled . All tears were repaired using an arthroscopic single-row technique .  Patients were r and omized to treatment either with or without a platelet-leukocyte membrane inserted between the rotator cuff tendon and its footprint . In patients treated with this membrane , one membrane was utilized for each suture anchor . The primary outcomes were the difference between the preoperative and postoperative Constant scores and the repair integrity assessed by MRI according to the Sugaya classification . The secondary outcome was the difference between the preoperative and postoperative Simple Shoulder Test ( SST ) scores . RESULTS The only significant differences between the two groups involved the patient age and the preoperative and postoperative Constant scores ; the differences in the Constant score were due to differences in the shoulder pain subscore . At a mean of thirteen months of follow-up , rotator cuff retears were observed only in the group of patients in whom the membrane had not been used , and a thin but intact tendon was observed more frequently in this group as well . The use of the membrane was associated with significantly better repair integrity ( p = 0.04 ) . CONCLUSIONS The use of the platelet-leukocyte membrane in the treatment of rotator cuff tears improved repair integrity compared with repair without membrane . However , the improvement in repair integrity was not associated with greater improvement in the functional outcome . In fact , the Constant scores of the two groups would have been similar if the shoulder pain component ( which had differed preoperatively ) had been excluded Background : Previous studies have shown improvement in patellar tendinopathy symptoms after platelet-rich plasma ( PRP ) injections , but no r and omized controlled trial has compared PRP with dry needling ( DN ) for this condition . Purpose : To compare clinical outcomes in patellar tendinopathy after a single ultrasound-guided , leukocyte-rich PRP injection versus DN . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : A total of 23 patients with patellar tendinopathy on examination and MRI who had failed nonoperative treatment were enrolled and r and omized to receive ultrasound-guided DN alone ( DN group ; n = 13 ) or with injection of leukocyte-rich PRP ( PRP group ; n = 10 ) , along with st and ardized eccentric exercises . Patients and the physician providing follow-up care were blinded . Participants completed patient-reported outcome surveys before and at 3 , 6 , 9 , 12 , and ≥26 weeks after treatment during follow-up visits . The primary outcome measure was the Victorian Institute of Sports Assessment ( VISA ) score for patellar tendinopathy at 12 weeks , and secondary measures included the visual analog scale ( VAS ) for pain , Tegner activity scale , Lysholm knee scale , and Short Form ( SF-12 ) question naire at 12 and ≥26 weeks . Results were analyzed using 2-tailed paired and unpaired t tests . Patients who were dissatisfied at 12 weeks were allowed to cross over into a separate unblinded arm . Results : At 12 weeks after treatment , VISA scores improved by a mean ± st and ard deviation of 5.2 ± 12.5 points ( P = .20 ) in the DN group ( n = 12 ) and by 25.4 ± 23.2 points ( P = .01 ) in the PRP group ( n = 9 ) ; at ≥26 weeks , the scores improved by 33.2 ± 14.0 points ( P = .001 ) in the DN group ( n = 9 ) and by 28.9 ± 25.2 points ( P = .01 ) in the PRP group ( n = 7 ) . The PRP group had improved significantly more than the DN group at 12 weeks ( P = .02 ) , but the difference between groups was not significant at ≥26 weeks ( P = .66 ) . Lysholm scores were not significantly different between groups at 12 weeks ( P = .81 ) , but the DN group had improved significantly more than the PRP group at ≥26 weeks ( P = .006 ) . At 12 weeks , 3 patients in the DN group failed treatment and subsequently crossed over into the PRP group . These patients were excluded from the primary ≥26-week analysis . There were no treatment failures in the PRP group . No adverse events were reported . Recruitment was stopped because interim analysis demonstrated statistically significant and clinical ly important results . Conclusion : A therapeutic regimen of st and ardized eccentric exercise and ultrasound-guided leukocyte-rich PRP injection with DN accelerates the recovery from patellar tendinopathy relative to exercise and ultrasound-guided DN alone , but the apparent benefit of PRP dissipates over time Background Achilles tendinopathy is a common disease among both athletes and in the general population in which the use of platelet-rich plasma has recently been increasing . Good evidence for the use of this autologous product in tendinopathy is limited , and data on longer-term results are lacking . Purpose To study the effects of a platelet-rich plasma injection in patients with chronic midportion Achilles tendinopathy at 1-year follow-up . Study Design R and omized controlled trial ; Level of evidence , 1 . Methods Fifty-four patients , aged 18 to 70 years , with chronic tendinopathy 2 to 7 cm proximal to the Achilles tendon insertion were r and omized to receive either a blinded injection containing platelet-rich plasma or saline ( placebo group ) in addition to an eccentric training program . The main outcome was the vali date d Victorian Institute of Sports Assessment –Achilles score . Patient satisfaction was recorded and ultrasound examination performed at baseline and follow-up . Results The mean Victorian Institute of Sports Assessment –Achilles score improved in both the platelet-rich plasma group and the placebo group after 1 year . There was no significant difference in increase between both groups ( adjusted between-group difference , 5.5 ; 95 % confidence interval , –4.9 to 15.8 , P = .292 ) . In both groups , 59 % of the patients were satisfied with the received treatment . Ultrasonographic tendon structure improved significantly in both groups but was not significantly different between groups ( adjusted between-group difference , 1.2 % ; 95 % confidence interval , –4.1 to 6.6 , P = .647 ) . Conclusion This r and omized controlled trial showed no clinical and ultrasonographic superiority of platelet-rich plasma injection over a placebo injection in chronic Achilles tendinopathy at 1 year combined with an eccentric training program PURPOSE To evaluate integration and maturation of semitendinosus-gracilis ( STG ) grafts in anterior cruciate ligament ( ACL ) reconstruction with magnetic resonance imaging ( MRI ) in patients who underwent ACL reconstruction with STG with and without autologous platelet concentrate ( APC ) .  METHODS A r and omized single-blinded evaluator prospect i ve study was performed in 2 consecutive series of patients who underwent reconstruction over a 14-month period : 30 with APC use ( group A ) and 20 as control subjects ( group B ) . At 6 months , an  MRI evaluation was performed , with observation of the graft 's maturation and presence or absence of synovial fluid at the tunnel-graft interface . To facilitate interpretation , a scoring scale was design ed to evaluate graft integration and maturation . RESULTS Regarding the presence of synovial fluid at the bone-graft interface , the test was negative in 86.84 % of patients in group A and 94.74 % in group B. A disorganized autograft signal pattern was found in 2.63 % in group A and 5.26 % in group B. Signal intensity was considered hypointense in 63.16 % in group A and 42.11 % in group B , isointense in 34.21 % in group A and 52.63 % in group B , and hyperintense in 0 % in both groups . The final mean score was 4.45 points in group A and 4.2 points in group B ( P ≥ .05 ) . Poor integration was found in 2.63 % in group A and 5.26 % in group B ( P = .214 ) . Good integration was found in 97.37 % in group A and 94.74 % in group B ( P = .784 ) . CONCLUSIONS In our consecutive series of patients who underwent ACL reconstruction with STG grafts , 1 group with intraoperative APC use versus a control group , followed up by MRI at 6 months after reconstruction , we did not find any statistically significant benefit in the APC group in terms of integration assessment and graft maturation ( ligamentization ) . LEVEL OF EVIDENCE Level III , case-control study Objective To assess whether a platelet-rich plasma ( PRP ) injection leads to an enhanced tendon structure and neovascularisation , measured with ultrasonographic techniques , in chronic midportion Achilles tendinopathy . Design Double-blind , r and omised , placebo-controlled clinical trial . Setting Sports medical department of The Hague medical centre . Patients 54 patients with chronic midportion Achilles tendinopathy were included . Interventions Patients were r and omised to eccentric exercise therapy  with either a PRP injection ( PRP group ) or a saline injection ( placebo group ) . Main outcome measurements Tendon structure was evaluated by ultrasonographic tissue characterisation , a novel technique which quantifies tendon structure into four echo-types : echo-types I+II represent organised tendon bundles , whereas echo-types III+IV represent a disorganised tendon structure . Colour Doppler ultrasonography was used to measure the degree of neovascularisation . Follow-up was at 6 , 12 and 24 weeks . Results A significant improvement in echo-types I+II was found after 24 weeks within both the PRP group ( n=27 ) and the placebo group ( n=27 ) , but there was no significant between-group difference ( 95 % CI −1.6 to 7.8 , p=0.169 ) . After 6 weeks , the neovascularisation score increased within the PRP group ( p=0.001 ) and the placebo group ( p=0.002 ) , but there was no significant between-group difference in change in neovascularisation score at any point in time . Conclusion Injecting PRP for the treatment of chronic midportion Achilles tendinopathy does not contribute to an increased tendon structure or alter the degree of neovascularisation , compared with placebo . Funding Biomet Biologics LLC , Warsaw , Indiana This study describes the epidemiology of a range of adult musculoskeletal soft tissue injuries . Our institution is the only hospital treating adults with musculoskeletal trauma in a well-defined catchment population of about 535,000 . Demographic details over 5 years were recorded prospect ively . Eighteen injury types were studied including anterior cruciate ligament ( ACL ) rupture , acromioclavicular joint ( ACJ ) injury , Achilles , patellar and quadriceps tendon ruptures , h and tendon injuries and mallet finger . 2794 patients presented with ligamentous or tedinous injuries over 5 years . 74.2 % of patients were male , giving an incidence of 166.6/100,000 per year for males and 52.1/100,000 per year for females . The mean age was 36.3 years : 33.1 in males , 43.6 in females . 1040 ( 37.2 % ) were knee injuries : 75.6 % were male with mean age 32.9 , compared with 35.3 in females . 947 cases were h and tendon injuries ( 33.9 % ) : 72.1 % were male , with mean age 34.5 compared with 42.0 in females . Meniscal injury of the knee was the commonest injury with an incidence of 23.8/100,000 per year . Other common injuries were h and extensor tendons ( 18/100,000 per year ) , ACJ injury ( 14.5/100,000 per year ) , Achilles tendon rupture ( 11.3/100,000 per year ) , mallet finger ( 9.9/100,000 per year ) and ACL rupture ( 8.1/100,000 per year ) . Achilles , patellar and quadriceps tendon rupture and mallet finger were injuries of middle age ; rotator cuff tears and biceps tendon rupture were commoner in the elderly but all other injuries predominated in young patients . All injuries were commoner in males . Most soft tissue injuries follow distribution curves previously described for fracture epidemiology but three new distribution curves are presented for the injuries which predominate in middle age Background : There is a strong need for methods to improve the biological potential of rotator cuff tendon healing . Platelet-rich fibrin matrix ( PRFM ) allows delivery of autologous cytokines to healing tissue , and limited evidence suggests a positive effect of platelet-rich plasma on tendon biology . Purpose : To evaluate the effect of platelet-rich fibrin matrix on rotator cuff tendon healing . Study Design : R and omized controlled trial ; Level of evidence , 2 . Methods : Seventy-nine patients undergoing arthroscopic rotator cuff tendon repair were r and omized intraoperatively to either receive  PRFM at the tendon-bone interface ( n = 40 ) or  st and ard repair with no PRFM ( n = 39 ) . St and ardized repair techniques were used for all patients . The postoperative rehabilitation protocol was the same in both groups . The primary outcome was tendon healing evaluated by ultrasound ( intact vs defect at repair site ) at 6 and 12 weeks . Power Doppler ultrasound was also used to evaluate vascularity in the peribursal , peritendinous , and musculotendinous and insertion site areas of the tendon and bone anchor site . Secondary outcomes included st and ardized shoulder outcome scales ( American Shoulder and Elbow Surgeons [ ASES ] and L’Insalata ) and strength measurements using a h and held dynamometer . Patients and the evaluator were blinded to treatment group . All patients were evaluated at minimum 1-year follow-up . A logistic regression model was used to predict outcome ( healed vs defect ) based on tear severity , repair type , treatment type ( PRFM or control ) , and platelet count . Results : Overall , there were no differences in tendon-to-bone healing between the PRFM and control groups . Complete tendon-to-bone healing ( intact repair ) was found in 24 of 36 ( 67 % ) in the PRFM group and 25 of 31 ( 81 % ) in the control group ( P = .20 ) . There were no significant differences in healing by ultrasound between 6 and 12 weeks . There were gradual increases in ASES and L’Insalata scores over time in both groups , but there were no differences in scores between the groups . We also found no difference in vascularity in the peribursal , peritendinous , and musculotendinous areas of the tendon between groups . There were no differences in strength between groups . Platelet count had no effect on healing . Logistic regression analysis demonstrated that PRFM was a significant predictor ( P = .037 ) for a tendon defect at 12 weeks , with an odds ratio of 5.8 . Conclusion : Platelet-rich fibrin matrix applied to the tendon-bone interface at the time of rotator cuff repair had no demonstrable effect on tendon healing , tendon vascularity , manual muscle strength , or clinical rating scales . In fact , the regression analysis suggests that PRFM may have a negative effect on healing . Further study is required to evaluate the role of PRFM in rotator cuff repair PURPOSE The efficacy of platelet-rich plasma ( PRP ) in the treatment and healing of chronic tendinopathy through stimulation of cell proliferation and total collagen production has been demonstrated by both in vitro and in vivo studies . The aim of this study is to evaluate the effectiveness of ultrasound (US)-guided autologous PRP injections in patellar and Achilles tendinopathy . MATERIAL S AND METHODS Autologous PRP was injected under US-guidance into the Achilles and patellar tendons ( 30 Achilles tendons , 28 patellar tendons ) in 48 prospect ively selected patients ( 30 males , 18 females , mean age 38 ± 16 years , range 20 - 61 years ) . All patients were previously evaluated according to the Victoria Institute of Sport Assessment ( VISA ) scale  , which assessed pain and activity level , and they all underwent US of the tendon before treatment and at follow-up after 20 days and 6 months . Statistical analysis was performed with Chi-square and Wilcoxon tests . RESULTS 20 days after PRP injection the patients presented a non-significant improvement of clinical symptoms . At the 6-month follow-up VISA score increased from a mean value of 57 - 75.5 ( p < .01 ) . US evaluation revealed a reduction of hypoechoic areas in 26 tendons ( p < .01 ) associated with a widespread improvement of fibrillar echotexture of the tendon and reduced hypervascularity at power Doppler . CONCLUSION PRP injection in patellar and Achilles tendinopathy results in a significant and lasting improvement of clinical symptoms and leads to recovery of the tendon matrix potentially helping to prevent degenerative lesions . US-guidance allows PRP injection into the tendon with great accuracy Background : Although platelet-rich plasma ( PRP ) has been used in rotator cuff repair , most authors have been unable to report the advantages of this method in clinical trials . Hypothesis : The use of PRP promotes better functional and structural results in arthroscopic rotator cuff repair . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : This was a prospect i ve , r and omized , double-blind study with 2 groups of 27 patients each ( PRP group and control group ) . Complete supraspinatus tears with retraction of less than 3 cm were subjected to arthroscopic single-row repair ;  at the end of the surgical procedure , liquid PRP prepared by apheresis was given to the patients in the PRP group with autologous thrombin . The outcomes were assessed by the University of California at Los Angeles ( UCLA ) and Constant scales , visual analog scale ( VAS ) for pain , and magnetic resonance imaging ( MRI ) before and 3 , 6 , 12 , and 24 months after surgery . The significance level was 5 % . Results : The 2 groups of patients exhibited significant clinical improvement ( P < .001 ) . Between the preoperative assessment and 24-month follow-up , the mean UCLA score increased from 13.63 ± 3.639 to 32.70 ± 3.635 and from 13.93 ± 4.649 to 32.44 ± 4.318 in the control and PRP groups , respectively ( P = .916 ) . The mean Constant score increased from 47.37 ± 11.088 to 85.15 ± 9.879 in the control group and from 46.96 ± 11.937 to 84.78 ± 14.048 in the PRP group ( P = .498 ) . The mean VAS score varied from 7.00 ± 1.939 and 6.67 ± 1.617 before surgery to 1.15 ± 1.916 and 0.96 ± 2.244 at the 24-month assessment in the control and PRP groups , respectively ( P = .418 ) . The only difference was in the mean UCLA score at 12 months , with 30.04 ± 4.528 in the control group and 32.30 ± 3.506 in the PRP group ( P = .046 ) . The control group exhibited 1 case of a complete retear and 4 partial retears , and the PRP group exhibited 2 cases of partial retears ( P = .42 ) . Conclusion : Platelet-rich plasma prepared by apheresis and applied in the liquid state with thrombin did not promote better clinical results at 24-month follow-up . Given the numbers available for analysis , the retear rate also did not change Background Growth factor technologies are increasingly used to enhance healing in musculoskeletal injuries , particularly in sports medicine . Two such products ; platelet-rich plasma ( PRP ) and autologous blood , have a growing body of supporting evidence . No previous trial has directly compared the efficacy of these two methods . Hypothesis Growth factor administration improves tissue regeneration in patients who have failed to respond to conservative therapy . Study design A prospect i ve , double-blind , r and omised trial . Methods Elbow tendinopathy patients who had failed conservative physical therapy were divided into two patient groups : PRP injection ( N=80 ) and  autologous blood injection ( ABI ) ( N=70 ) . Each patient received two injections at 0 and 1 month . Patient-related tennis elbow evaluation ( PRTEE ) was recorded by a blinded investigator at 0 , 1 , 3 and 6 months . The main outcome measure was PRTEE , a vali date d composite outcome for pain , activities of daily living and physical function , utilising a 0–100 scale . Results At 6 months the authors observed a 66 % success rate in the PRP group versus 72 % in the ABI group , p = NS . There was a higher rate of conversion to surgery in the ABI group ( 20 % ) versus the PRP group ( 10 % ) . Conclusion In patients who are resistant to first-line physical therapy such as eccentric loading , ABI or PRP injections are useful second-line therapies to improve clinical outcomes . In this study , up to seven out of 10 additional patients in this difficult to treat cohort benefit from a surgery-sparing intervention The objective of this study was to prospect ively evaluate the feasibility of a large- scale project on the influence of local application of Platelet Rich Fibrin ( PRF ) on the functional outcome and integrity of the arthroscopically repaired tendons in patients with massive tears of the rotator cuff . A prospect i ve , r and omized pilot clinical trial was performed on 28 patients ( 22 females , 6 males ) with an average age of 65 years ( range : 53 to 77 ) undergoing complete arthroscopic repair of a massive rotator cuff tear . After the repair was completed , 6 ml PRF ( Vivostat ) was locally applied to the repair site in 14 patients ; no similar action was done in the other 14 patients . All patients underwent a clinical examination and an arthro-MRI to evaluate the integrity of the repair , one year after the operation . They were followed clinical ly for a minimum of 2 years . Functional outcome was evaluated with the Constant and DASH scores . There were no reported complications in either group . None of the patients was lost to follow-up . Globally , the Constant score improved from 45 preoperatively ( range : 25 to 65 ) to 64 at one year ( range : 20 to 79 ) ( p < 0.001 ) , with no significant change at two years ( mean 63 , range : 20 to 77 ) . The VAS for pain improved from 5.6/10 preoperatively to 1.7/10 at the most recent examination ( p < 0.001 ) . All but two patients were satisfied . With the numbers of patients available , we could not detect a significant difference in the preoperative ( 46 vs. 43 ; p = 037 ) or postoperative Constant score ( 61 vs. 68 ; p = 0.125 ) between the control group and the PRF group . On arthro-MRI , 19 of the 28 patients ( 68 % ) were found to have a large re-tear : 10/14 in the PRF group and 9/14 in the control group . Local application of autologous PRF to the repair site of massive rotator cuffs fully reconstructed arthroscopically failed to improve the clinical outcome and the healing rate , compared with a st and ard repair . However , a large-scale study would be necessary to confirm these results BACKGROUND The minimal clinical ly important difference ( MCID ) is increasingly used to evaluate treatment effectiveness . The MCID for the Constant score has not been previously reported . MATERIAL S AND METHODS A prospect ively collected cohort of 802 consecutive shoulders with arthroscopically treated partial- or full-thickness rotator cuff tears was analyzed . The Constant score was measured preoperatively and at 3 months and 1 year postoperatively . At follow-up visits , the patients were asked a simple 2-stage question : Is the shoulder better or worse after the operation compared with the preoperative state ? This single 2-level question was used as an indicator of patient satisfaction and as an anchor to calculate the  MCID  for the Constant score . RESULTS At 1 year , 781 ( 97.4 % ) patients ( 474 men , 307 women ) were available for follow-up . The preoperative Constant score was 53.1 ( SD 17.2 ) in all patients , 56.2 ( SD 17.4 ) in male patients , and 48.2 ( SD 15.6 ) in female patients . Postoperatively at 3 months , the scores were 61.7 ( SD 16.4 ) in all patients , 65.1 ( SD 16.1 ) in male patients , and 56.8 ( SD 15.5 ) in female patients . At 1 year , the scores were 75.9 ( SD 15.2 ) in all patients , 79.0 ( SD 14.9 ) in male patients , and 71.0 ( SD 14.3 ) in female patients . At 3 months postoperatively , 92.2 % of male patients and 87.2 % of female patients were satisfied with the outcome ( P = .027 ) ; at 1 year , the satisfaction was 93.2 % and 89.5 % , respectively ( P = .067 ) . Five different statistical approaches yielded 5 different MCID estimates ( range , 2 - 16 ) . The 3-month mean change estimate of MCID was 10.4 points . CONCLUSION Our study demonstrates an MCID estimate of 10.4 points as the threshold for the Constant score in patients with rotator cuff tear . LEVEL OF EVIDENCE Basic science study , validation of outcomes instruments/classification systems
BACKGROUND Platelet-rich therapies are being used increasingly in the treatment of musculoskeletal soft tissue injuries such as ligament , muscle and tendon tears and tendinopathies .
These therapies can be used as the principal treatment or as an augmentation procedure ( application after surgical repair or reconstruction ) .
Platelet-rich therapies are produced by centrifuging a quantity of the patient 's own blood and extracting the active , platelet-rich , fraction .
The platelet-rich fraction is applied to the injured tissue ; for example , by injection .
Platelets have the ability to produce several growth factors , so these therapies should enhance tissue healing .
There is a need to assess whether this translates into clinical benefit .
OBJECTIVES To assess the effects ( benefits and harms ) of platelet-rich therapies for treating musculoskeletal soft tissue injuries .