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The effects of repeated intra-articular PRP injections on clinical outcomes of early osteoarthritis of the knee Autologous platelet gel and platelet-poor plasma reduce pain with total shoulder arthroplasty. Platelet-rich plasma injections for chronic plantar fasciitis Application of Platelet-Rich Plasma to Disorders of the Knee Joint Comparison of magnetic resonance imaging findings in anterior cruciate ligament grafts with and without autologous platelet-derived growth factors. Platelet-Rich Plasma versus Corticosteroid Injection for Recalcitrant Lateral Epicondylitis: Clinical and Ultrasonographic Evaluation Platelet-Rich Plasma Versus Autologous Whole Blood for the Treatment of Chronic Lateral Elbow Epicondylitis Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. 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Ultrasound guided injections of platelets rich plasma for muscle injury in professional athletes. Comparative study. A Pilot Study Evaluating the Effectiveness of Platelet-Rich Plasma Therapy for Treating Degenerative Tendinopathies: A Randomized Control Trial with Synchronous Observational Cohort Application of rhBMP-7 and platelet-rich plasma in the treatment of long bone non-unions: a prospective randomised clinical study on 120 patients. Platelet-Rich Plasma Versus Focused Shock Waves in the Treatment of Jumper’s Knee in Athletes Treatment of Knee Joint Osteoarthritis with Autologous Platelet-Rich Plasma in Comparison with Hyaluronic Acid 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 Plasma rich in growth factors in arthroscopic rotator cuff repair: a randomized, double-blind, controlled clinical trial. Treatment of Partial Ulnar Collateral Ligament Tears in the Elbow With Platelet-Rich Plasma Double-blind, Randomized, Placebo-controlled Study Evaluating the Use of Platelet-rich Plasma Therapy (PRP) for Acute Ankle Sprains in the Emergency Department. Treatment of Lateral Epicondylitis With Platelet-Rich Plasma, Glucocorticoid, or Saline A side-effect induced by the combination of a demineralized freeze-dried bone allograft and leucocyte and platelet-rich plasma during treatment for large bone cysts: a 4-year follow-up clinical study. Has platelet-rich plasma any role in anterior cruciate ligament allograft healing? Platelet-rich plasma (PRP) injections as an effective treatment for early osteoarthritis Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: a randomized trial. [Platelet rich plasma versus oral paracetamol for the treatment of early knee osteoarthritis. Preliminary study]. Leukocyte-Poor Platelet-Rich Plasma versus Bupivacaine for Recalcitrant Lateral Epicondylar Tendinopathy Is platelet-rich plasma able to enhance the results of arthroscopic microfracture in early osteoarthritis and cartilage lesion over 40 years of age? Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis. Use of platelet-leukocyte membrane in arthroscopic repair of large rotator cuff tears: a prospective randomized study. Comparison between two different platelet-rich plasma preparations and control applied during anterior cruciate ligament reconstruction. Is there any evidence to support their use? Efficacy of Platelet-Rich Plasma for Chronic Tennis Elbow Platelet-Rich Plasma as a Treatment for Patellar Tendinopathy Platelet-rich plasma prevents blood loss and pain and enhances early functional outcome after total knee arthroplasty: a prospective randomised controlled study Inefficacy of ultrasound-guided local injections of autologous conditioned plasma for recent epicondylitis: results of a double-blind placebo-controlled randomized clinical trial with one-year follow-up. One-Year Follow-up of Platelet-Rich Plasma Treatment in Chronic Achilles Tendinopathy No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achilles tendinopathy Platelet-rich plasma injections for the treatment of refractory Achilles tendinopathy: results at 4 years. The Effect of Platelet-Rich Fibrin Matrix on Rotator Cuff Tendon Healing 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 Magnetic Resonance Imaging Evaluation of Patellar Tendon Graft Remodelling after Anterior Cruciate Ligament Reconstruction with or without Platelet-Rich Plasma Injection of Platelet-Rich Plasma in Patients with Primary and Secondary Knee Osteoarthritis: A Pilot Study Clinical Effects of Platelet-Rich Plasma and Hyaluronic Acid as an Additional Therapy for Talar Osteochondral Lesions Treated with Microfracture Surgery IMpact of Platelet Rich plasma OVer alternative therapies in patients with lateral Epicondylitis (IMPROVE): protocol for a multicenter randomized controlled study: a multicenter, randomized trial comparing autologous platelet-rich plasma, autologous whole blood, dry needle tendon fenestration, and p Rationale, secondary outcome scores and 1-year follow-up of a randomised trial of platelet-rich plasma injections in acute hamstring muscle injury: the Dutch Hamstring Injection Therapy study Bone Marrow Aspirate Concentrate and Platelet-rich Plasma Enhanced Bone Healing in Distraction Osteogenesis of the Tibia Platelet-rich fibrin in arthroscopic repair of massive rotator cuff tears: a prospective randomized pilot clinical trial. Rotator cuff repair healing influenced by platelet-rich plasma construct augmentation. Platelet Gel Supplementation in Long Bone Nonunions Treated by External Fixation Ultrasound-Guided Intratendinous Injections With Platelet-Rich Plasma or Autologous Whole Blood for Treatment of Proximal Hamstring Tendinopathy: A Double-Blind Randomized Controlled Trial. Platelet-rich plasma injection reduces pain in patients with recalcitrant epicondylitis. Stem cell-based therapy for prevention of delayed fracture union: a randomized and prospective preliminary study. Intraoperative platelet-rich plasma does not improve outcomes of total knee arthroplasty. Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial Treatment With Platelet-Rich Plasma Is More Effective Than Placebo for Knee Osteoarthritis The Tendon Structure Returns to Asymptomatic Values in Nonoperatively Treated Achilles Tendinopathy but Is Not Associated With Symptoms Platelet-Rich Plasma Efficacy Versus Corticosteroid Injection Treatment for Chronic Severe Plantar Fasciitis
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 OBJECTIVE To determine the efficacy of autologous platelet-rich plasma ( PRP ) compared with dextrose prolotherapy ( DP ) in patients with chronic recalcitrant plantar fasciitis ( PF ) DESIGN : A single-blinded , r and omized , controlled study . SETTING Department of Physical Medicine and Rehabilitation of a university hospital . PARTICIPANTS Twenty-one patients with a clinical diagnosis of chronic PF confirmed by diagnostic ultrasound ( plantar fascia thickness > 4 mm ) were r and omly assigned to the  PRP group ( n = 10 ) or the DP group ( n = 11 ) . INTERVENTIONS Each patient received 2 injections into the plantar fascia through a peppering technique under ultrasound guidance at an interval of 2 weeks , either with 2 mL of autologous PRP or 2 mL of 15 % dextrose/lidocaine solution . MAIN OUTCOME MEASUREMENTS The outcome measures included the pain , disability , and activity limitation subscales , measured by means of the Foot Functional Index . Data were collected before the first injection , at 2 weeks ( before the second injection ) , and at the 2- and 6-month follow-ups . RESULTS All patients completed the follow-ups , with the exception of 1 patient in the PRP group . The mean Foot Functional Index total and subcategory score improvements were greater in the PRP group compared with the DP group ( improvement with PRP vs DP , total : 30.4 % vs 15.1 % , pain : 29.7 % vs 17.1 % , disability : 26.6 % vs 14.5 % , activity limitation : 28.0 % vs 12.4 % ) . However , no statistically significant difference was noted at any follow-up . In the pain and disability subcategories , both groups showed significant improvements at the last re-evaluation . The PRP group also showed significant improvements in the disability and activity limitation subscales at the second re-evaluation . CONCLUSIONS Each treatment seems to be effective for chronic recalcitrant PF , exp and ing the treatment options for patients in whom conservative care has failed . PRP treatment also may lead to a better initial improvement in function compared with DP treatment ABSTRACT Activated blood platelets play a critical , early role in the wound healing response by releasing several types of growth factors at the site of injury which mediate the initial stages of tissue repair . Autologously derived platelet-rich plasma has been applied during surgery as a healing aid and some studies have shown benefit with total joint arthroplasty procedures such as in the knee . However , little has been published regarding the use of platelet-rich plasma during total hip arthroplasty . The hip is especially prone to develop isl and s of heterotopic bone following arthroplasty which can lead to pain , limited motion , and even ankylosis of the joint . If this condition is exacerbated by platelet-rich plasma , this could present a barrier to the use of this adjuvant in total hip arthroplasty . This retrospective , controlled clinical study examined the effect of platelet rich plasma application during closure following total hip arthroplasty on heterotopic ossification . By one year , 21.3 % of the control patients developed heterotopic bone ( 91 patients , 94 hips , Brooker grade s I – III ) compared to 12.9 % of the treatment patients ( 76 patients , 85 hips , Brooker grade s I – II ) . These differences were not significant ( p = 0.478 , power = 0.90 ) . Thus , the use of platelet-rich plasma in this procedure does not appear to influence the incidence or severity of heterotopic ossification which should help to justify further clinical research to more fully underst and whether this autologous blood product has a role in total hip arthroplasty Purpose Syndesmotic sprains are uncommon injuries that require prolonged recovery . The influence of ultrasound-guided injections of platelet-rich plasma ( PRP ) into the injured antero-inferior tibio-fibular ligaments ( AITFL ) in athletes on return to play ( RTP ) and dynamic stability was studied . Methods Sixteen elite athletes with AITFL tears were r and omized to a treatment group receiving injections of PRP or to a control group . All patients followed an identical rehabilitation protocol and RTP criteria . Patients were prospect ively evaluated for clinical ability to return to full activity and residual pain .  Dynamic ultrasound examinations were performed at initial examination and at 6 weeks post-injury to demonstrate re-stabilization of the syndesmosis joint and correlation with subjective outcome . Results All patients presented with a tear to the AITFL with dynamic syndesmosis instability in dorsiflexion – external rotation , and larger neutral tibia – fibula distance on ultrasound . Early diagnosis and treatment lead to shorter RTP , with 40.8 ( ±8.9 ) and 59.6 ( ±12.0 ) days for the PRP and control groups , respectively ( p = 0.006 ) . Significantly less residual pain upon return to activity was found in the PRP group ; five patients ( 62.5 % ) in the control group returned to play with minor discomfort versus one patient in the treatment group ( 12.5 % ) . One patient in the control group had continuous pain and disability and subsequently underwent syndesmosis reconstruction . Conclusions Athletes suffering from high ankle sprains benefit from ultrasound-guided PRP injections with a shorter RTP , re-stabilization of the syndesmosis joint and less long-term residual pain . Level of evidence II Purpose The aim of this study was to evaluate the outcome of patients with patellar tendinopathy treated with platelet-rich plasma injections ( PRP ) .  Additionally , this study examined whether certain characteristics , such as activity level or previous treatment affected the results . Methods Patients ( n = 36 ) were asked to fill in the Victorian Institute of  Sports Assessment – Patellar question naire ( VISA-P ) and visual analogue scales ( VAS ) , assessing pain in activities of daily life ( ADL ) , during work and sports , before and after treatment with PRP . Of these patients , 14 had been treated before with cortisone , ethoxysclerol , and /or surgical treatment ( group 1 ) , while the remaining patients had not been treated before ( group 2 ) . Results Overall , group 1 and group 2 improved significantly on the VAS scales ( p < .0.05 ) . However , group 2 also improved on VISA-P ( p = .0.003 ) , while group 1 showed less healing potential ( p = 0.060 ) . Although the difference between group 1 and group 2 at follow-up was not considered clinical ly meaningful , over time both groups showed a clinical ly significant improvement . Conclusion After PRP treatment , patients with patellar tendinopathy showed a statistically significant improvement . In addition , these improvements can also be considered clinical ly meaningful . However , patients who were not treated before with ethoxysclerol , cortisone , and /or surgical treatment showed the improvement Autologous mesenchymal stromal cell (MSC)-based therapies offer one of the most promising and safe methods for regeneration or reconstruction of tissues and organs . Routine procedures to obtain adequate amount of autologous stem cells need their expansion through culture , with risks of contamination and cell differentiation , leading to the loss of cell ability for therapies . We suggest the use of human bone marrow ( BM ) as a physiological bioreactor to produce autologous MSC by injection of autologous platelet-rich plasma activated by recombinant human soluble tissue factor ( rhsTF ) in iliac crest . A trial on 13 healthy volunteers showed the feasibility and harmlessness of the procedure . The phenotype and cellularity of BM cells were not modified , on day 3 after injection . Endothelial progenitor cells ( EPC ) were mobilized to the bloodstream , without stimulation of hematopoietic stem cells ( HSC ) . MSC level in BM increased with a specific commitment to preosteoblastic cell population both in vivo and in vitro . This self-stimulation system of BM seems thus to be a promising feasible process 3 days before clinical cell therapy applications Purpose To assess the outcome of intra-articular platelet-rich plasma ( PRP ) injections into the knee in patients with early stages of osteoarthritis ( OA ) and to determine whether cyclical dosing would affect the end result . Methods This is a prospect i ve , r and omized study in which 93 patients ( 119 knees ) were followed up for a minimum of 2 years . Fifty knees were r and omly selected prior to the first injection , to receive a second cycle at the completion of 1 year . A cycle consisted of three injections , each given at a monthly interval . The outcome was assessed using Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , Visual Analogue Scale ( VAS ) , Tegner and Marx scoring systems , recorded prior to the first injection and then at 12 , 18 and 24 months . Results There was a significant improvement in all scores over time compared to the pre-treatment value ( p < 0.001 ) . At 12 months , both groups showed similar and significant improvement . At 18 months , except for KOOS ( Symptoms ) and Tegner score , all other parameters showed a significant difference between the two groups in favour of the patients who had received the second cycle ( p < 0.001 ) . At 2 years , the scores declined in both groups but remained above the pre-treatment value with no significant difference between the groups despite the patients with two cycles showing higher mean values for all the scores . Conclusion Intra-articular PRP injections into the knee for symptomatic early stages of OA are a valid treatment option . There is a significant reduction in pain and improvement in function after 12 months , which can be further improved at 18 months by annual repetition of the treatment . Although the beneficial effects are ill sustained at 2 years , the results are encouraging when compared to the pre-treatment function . Level of evidence II The recovery of patients undergoing total shoulder arthroplasty ( TSA ) can be adversely affected by a number of complications . Autologous platelet gel ( APG ) , produced by activating platelet-rich plasma ( PRP ) , has been shown to improve hemostasis and wound healing and reduce infections in some surgical procedures . Activated platelet-poor plasma ( PPP ) has also been used as a hemostatic agent . This study examines the effects of APG and PPP treatment on TSA patients postoperatively . After Institutional Review Board ( IRB ) approval , 40 patients undergoing TSA at our institution were prospect ively enrolled in our study . They were r and omized into either a control ( n = 20 ) or study ( n = 20 ) group , with the study group receiving APG and PPP treatment .  Preoperative demographic data , pre- and postoperative laboratory data , pain scores , pain medication , complications , pre- and postoperative range of motion measurements , and postoperative lengths of stay were recorded for each group . The preoperative internal rotation index was significantly higher in the control group compared with treatment patients ( 4.64 + /- 4.46 vs. 1.88 + /- 2.44 , p < .05 ) . The percent hemoglobin retained postoperatively was higher in the treatment group at 24 ( 84.54 + /- 5.32 vs. 79.87 + /- 8.73 ) and 72 hours ( 87.46 + /- 16.03 vs. 76.70 vs. 5.96 ) , but neither difference reached statistical significance . The treatment group had significantly lower pain scores ( p = .007 ) and total fentanyl requirements ( p < .05 ) compared with control patients . The internal rotation index improvement factor ( postoperative internal rotation index/preoperative internal rotation index ) was significantly higher in the treatment group vs. the control group ( p < .05 ) . Although it did not reach statistical significance , the treatment group was discharged almost 9 hours earlier than the control group ( 64.44 + /- 15.23 vs. 73.39 + /- 15.37 ) . APG and PPP treatment decreased pain and provided a greater increase in internal rotation measurements postoperatively Purpose The purpose of this study was to assess the safety and preliminary clinical results of platelet-rich plasma ( PRP ) injections for treating chronic plantar fasciitis . Methods Fourteen consecutive patients with chronic plantar fasciitis receiving three injections of PRP into the plantar fascia were assessed 12 months after the procedure . The modified Roles and Maudsley score and a visual analogue scale ( VAS ) for pain were used to evaluate the clinical results . Results According to criteria of the Roles and Maudsley score , at 12 months of follow-up , results were rated as excellent in nine ( 64.3 % ) , good in two ( 14.3 % ) , acceptable in two ( 14.3 % ) and poor in one ( 7.1 % ) patient . VAS for pain was significantly decreased from 7.1 ± 1.1 before treatment to 1.9 ± 1.5 at the last follow-up ( p < 0.01 ) . Conclusions In this single-centre , uncontrolled , prospect i ve , preliminary study , results indicate that treating chronic plantar fasciitis with PRP injections is safe and has the potential to reduce pain Importance : The promising therapeutic potential and regenerative properties of platelet-rich plasma ( PRP ) have rapidly led to its widespread clinical use in musculoskeletal injury and disease . Although the basic scientific rationale surrounding PRP products is compelling , the clinical application has outpaced the research . Objective : The purpose of this article is to examine the current concepts around the basic science of PRP application , different preparation systems , and clinical application of PRP in disorders in the knee . Evidence Acquisition : A systematic search of PubMed for studies that evaluated the basic science , preparation and clinical application of platelet concentrates was performed . The search used terms , including platelet-rich plasma or PRP preparation , activation , use in the knee , cartilage , ligament , and meniscus . Studies found in the initial search and related studies were review ed . Results : A comprehensive review of the literature supports the potential use of PRP  both nonoperatively and intraoperatively , but highlights the absence of large clinical studies and the lack of st and ardization between method , product , and clinical efficacy . Conclusions and Relevance . In addition to the call for more r and omized , controlled clinical studies to assess the clinical effect of PRP , at this point , it is necessary to investigate PRP product composition and eventually have the ability to tailor the therapeutic product for specific indications 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 Purpose . To evaluate the clinical and ultrasonographic changes in the morphology and vascularity of the common extensor tendon after injecting platelet-rich plasma ( PRP ) or corticosteroid ( CS ) for recalcitrant lateral epicondylitis ( LE ) . Methods . 30 patients aged 18 to 60 years with recalcitrant ( > 6 months ) LE not responsive to oral medication or non-invasive treatment were r and omised to receive PRP ( n=15 ) or CS ( n=15 ) injection . Patients were assessed using the visual analogue scale ( VAS ) for pain , Disabilities of the Arm , Shoulder and H and Scale ( DASH ) score , Oxford Elbow Score , modified Mayo Clinic performance index for the elbow ( modified Mayo score ) , and h and grip strength . Ultrasonography was performed by a musculoskeletal ultrasonologist to evaluate for tear at the common extensor origin , oedema at the common extensor origin , cortical erosion , probe-induced tenderness , and thickness of the tendon . Results . The VAS for pain , DASH score , Oxford Elbow Score , modified Mayo score , and h and grip strength all improved significantly from pre-injection to the 6-month follow-up in the PRP and CS groups . However , in the CS group , the scores generally peaked at 3 months and then deteriorated slightly at 6 months indicating recurrence of symptoms , which involved 46.7 % of the CS patients . At 6 months , the number of patients positive for various ulrasonographic findings generally decreased . However , in the CS group , the number of patients with reduced thickness of the common extensor tendon increased from 2 to 12 , and the number of patients with cortical erosion at the lateral epicondyle increased from 9 to 11 . Conclusion . PRP appeared to enable biological healing of the lesion , whereas CS appeared to provide short-term , symptomatic relief but result ed in tendon degeneration 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 PURPOSE The aim of our study is to compare the efficacy of platelet-rich plasma ( PRP ) and viscosupplementation ( hyaluronic acid [ HA ] ) intra-articular injections for the treatment of knee cartilage degenerative lesions and osteoarthritis ( OA ) . METHODS The study involved 150 patients affected by cartilage degenerative lesions and early and severe OA . Fifty symptomatic patients were treated with 3 autologous PRP intra-articular injections and were evaluated prospect ively at enrollment and at 2- and 6-month follow-up . The results obtained were compared with 2 homogeneous groups of patients treated with HA injections . One group was treated with injections of high-molecular weight HA ; the other group was treated with low-molecular weight ( LW ) HA .  International Knee Documentation Committee and EQ VAS scores were used for clinical evaluation ; adverse events and patient satisfaction were also recorded . RESULTS At 2 months ' follow-up , the PRP and LW HA groups showed a similar improvement , with higher results compared with the high-molecular weight HA group ( P < .005 ) . At 6 months ' follow-up , better results were observed in the PRP group ( P < .005 ) . PRP and LW HA treatments offered similar results in patients aged over 50 years and in the treatment of advanced OA . PRP showed a better performance compared with HA in younger patients affected by cartilage lesions or early OA . CONCLUSIONS Autologous PRP injections showed more and longer efficacy than HA injections in reducing pain and symptoms and recovering articular function . Better results were achieved in younger and more active patients with a low degree of cartilage degeneration , whereas a worse outcome was obtained in more degenerated joints and in older patients , in whom results similar to those of viscosupplementation have been observed . LEVEL OF EVIDENCE Level II , prospect i ve comparative study Background Tendinopathy is a difficult problem to manage and can result in significant patient morbidity . Currently , the clinical use of platelet-rich plasma ( PRP ) in painful tendons is widespread but its efficacy remains controversial . Methods / Design This study is a single-center , r and omized double-blind controlled trial . Eighty patients will be allocated to have ultrasound (US)-guided needling combined with a leukocyte-depleted ( that is , pure ) PRP or lidocaine each alternate week for a total of two interventions . Outcome data will be collected before intervention , and at 6 weeks , 3 , 6 , and 12 months after intervention . Main outcome measure : Changes in pain and activity levels , as assessed by Disabilities of the Arm , Shoulder and H and ( DASH-E , Spanish version ) score , at 6 months . We will compare the percentage of patients in each group that achieve a successful treatment defined as a reduction of at least 25 % in the DASH-E score . Secondary outcome measures include changes in DASH-E at 3 and 12 months , changes in pain as assessed by the visual analogue scale ( VAS ) at the 6-week , 3- , 6- , and 12-month follow-up , changes in sonographic features and neovascularity , and percentage of patients in each group with adverse reactions at 3 , 6 , and 12 months . Discussion The results of this study will provide insights into the effect of pure PRP in tendon and may contribute to identifying the best protocol for PRP application in tendinopathies . Trial registration Clinical Trials.gov : NCT01945528 Background Platelet-rich plasma ( PRP ) is an autologous platelet concentrate . It is prepared by separating the platelet fraction of whole blood from patients and mixing it with an agent to activate the platelets . In a clinical setting , PRP may be reapplied to the patient to improve and hasten the healing of tissue . The therapeutic effect is based on the presence of growth factors stored in the platelets . Current evidence in orthopedics shows that PRP applications can be used to accelerate bone and soft tissue regeneration following tendon injuries and arthroplasty . Outcomes include decreased inflammation , reduced blood loss and post-treatment pain relief . Recent shoulder research indicates there is poor vascularization present in the area around tendinopathies and this possibly prevents full healing capacity post surgery ( Am J Sports Med36(6):1171–1178 , 2008 ) . Although it is becoming popular in other areas of orthopedics there is little evidence regarding the use of PRP for shoulder pathologies . The application of PRP may help to revascularize the area and consequently promote tendon healing . Such evidence highlights an opportunity to explore the efficacy of PRP use during arthroscopic shoulder surgery for rotator cuff pathologies . Methods / Design PARot is a single center , blinded superiority-type r and omized controlled trial assessing the clinical outcomes of PRP applications in patients who undergo shoulder surgery for rotator cuff disease . Patients will be r and omized to one of the following treatment groups : arthroscopic subacromial decompression surgery or arthroscopic subacromial decompression surgery with application of PRP.The  study will run for 3 years and aims to r and omize 40 patients . Recruitment will be for 24 months with final follow-up at 1 year post surgery . The third year will also involve collation and analysis of the data . This study will be funded through the NIHR Biomedical Research Unit at the Oxford University Hospitals NHS Trust . Trial registration Current Controlled Trials : IS RCT The use of platelet-rich plasma ( PRP ) as an adjuvant to tissue repair is gaining favour in orthopaedic surgery . Tunnel widening after anterior cruciate ligament ( ACL ) reconstruction is a recognised phenomenon that could compromise revision surgery . The purpose of this study was to determine whether PRP might prevent tunnel widening in ACL reconstruction . Patients undergoing ACL reconstruction using a hamstring graft were r and omly allocated either to have PRP introduced into the tunnels peri-operatively or not . CT scanning of the knees was carried out on the day after surgery and at three months post-operatively and the width of the tunnels was measured . Patients were also evaluated clinical ly at three months , when laxity was also measured . Each group comprised 25 patients , and at three months post-operatively all were pain-free with stable knees , a negative Lachman test and a good range of movement . Arthrometric results had improved significantly in both groups ( p < 0.001 ) . Despite slightly less tunnel widening in the PRP group , there was no significant difference between the groups at the femoral opening or the mid-tunnel ( p = 0.370 and p = 0.363 , respectively ) nor at the tibial opening or mid-tunnel ( p = 0.333 and p = 0.177 , respectively).We conclude that PRP has no significant effect in preventing tunnel widening after ACL reconstruction Background : Platelet-rich plasma ( PRP ) has been proposed to augment tendon healing through improving tissue structure during the initial repair phase . Purpose : To investigate both the clinical and tissue effects of the coapplication of PRP injection with arthroscopic acromioplasty ( AA ) in patients with chronic rotator cuff tendinopathy . Design : R and omized controlled trial ; Level of evidence , 1 . Methods : The study comprised 60 r and omized patients diagnosed with rotator cuff tendinopathy ( 55 % women ) aged between 35 and 75 years . Patients were r and omized to AA alone or in combination with an injection of autologous PRP into the subacromial bursa ( AA + PRP ) .  Efficacy of treatment was assessed by analysis of patient-reported outcomes up to 2 years after treatment ( Oxford Shoulder Score [ OSS ] ) and by analysis of tendon biopsy specimens taken 12 weeks after treatment . Results : There was no significant difference in the OSS between AA alone and AA + PRP at any time point in the study . From 12 weeks onward , there was a significant increase in the OSS for both groups compared with their baseline scores ( P < .001 ) . Bonar scoring determined no significant change in tissue structure with the coapplication of PRP compared with surgery alone . The number of blood vessels and tendon cellularity were significantly decreased in tissue biopsy specimens taken from PRP-treated patients . The expression of p53-positive apoptotic cells increased after AA + PRP but decreased after AA alone . Conclusion : Arthroscopic acromioplasty significantly improves long-term clinical outcomes up to 2 years . The coapplication of PRP did not affect clinical outcomes . PRP significantly alters the tissue characteristics in tendons after surgery with reduced cellularity and vascularity and increased levels of apoptosis . Clinical Relevance : The coapplication of PRP did not improve clinical outcomes and may have potential deleterious effects on healing tendons . Registry Number : IS RCT N Background Platelet Rich Plasma ( PRP ) , a blood-derived product rich in growth factors , is a promising treatment for cartilage defects but there is still a lack of clinical evidence . The aim of this study is to show , through a r and omized double blind prospect i ve trial , the efficacy of this procedure , by comparing PRP to Hyaluronic Acid ( HA ) injections for the treatment of knee chondropathy or osteoarthritis ( OA ) . Methods 109 patients ( 55 treated with HA and 54 with PRP )  were treated and evaluated at 12 months of follow-up . The patients were enrolled according to the following inclusion criteria : age > 18 years , history of chronic ( at least 4 months ) pain or swelling of the knee and imaging findings of degenerative changes of the joint ( Kellgren-Lawrence Score up to 3 ) . A cycle of 3 weekly injections was administered blindly . All patients were prospect ively evaluated before and at 2 , 6 , and 12 months after the treatment by : IKDC , EQ-VAS , TEGNER , and KOOS scores . Range of motion and knee circumference changes were measured over time . Adverse events and patient satisfaction were also recorded . Results Only minor adverse events were detected in some patients , such as mild pain and effusion after the injections , in particular in the PRP group , where a significantly higher post-injective pain reaction was observed ( p=0.039 ) . At the follow-up evaluations , both groups presented a clinical improvement but the comparison between the two groups showed a not statistically significant difference in all scores evaluated . A trend favorable for the PRP group was only found in patients with low grade articular degeneration ( Kellgren-Lawrence score up to 2 ) . Conclusions Results suggest that PRP injections offer a significant clinical improvement up to one year of follow-up . However , conversely to what was shown by the current literature , for middle-aged patients with moderate signs of OA , PRP results were not better than those obtained with HA injections , and thus it should not be considered as first line treatment . More promising results are shown for its use in low grade degeneration , but they still have to be confirmed Intra-articular injections of platelet-rich plasma ( PRP ) and hyaluronic acid ( HA ) represent efficacious medical treatments for osteoarthritis ( OA ) , although no comparative study on long-term efficacy in hip OA exists . The goals of the current study were to compare the clinical efficacy of PRP vs HA at 12 months of follow-up in patients with hip OA and evaluate the influence of the type of infiltration and patient age , sex , body mass index , and degree of OA on temporal clinical evolution . One hundred patients with chronic unilateral symptomatic hip OA were consecutively enrolled and r and omly assigned to 1 of 2 groups : group A received PRP and group B received HA administered via intra-articular ultrasound-guided injections . Patients were evaluated at baseline and after 1 , 3 , 6 , and 12 months using the Harris Hip Score ( HHS ) and visual analog scale ( VAS ) . An overall improvement was detected in both groups between 1- and 3-month follow-up . Despite a slightly progressive worsening between 6- and 12-month follow-up , the final clinical scores remained higher compared with baseline ( P<.0005 ) , with no significant differences between PRP and HA . Regarding clinical temporal evolution , multivariate analysis showed that HHS was not influenced by the type of infiltration , patient age , sex , body mass index , or degree of OA , whereas a significant association was detected between OA grade IV and VAS evolution ( P<.0005 ) . Intra-articular injections of PRP are efficacious in terms of functional improvement and pain reduction but are not superior to HA in patients with symptomatic hip OA at 12-month follow-up PURPOSE The objective of this study is to evaluate the clinical and immunologic effects of intra-articular doses of platelet-rich plasma ( PRP ) in arthroscopic hip surgery for femoroacetabular impingement . METHODS Preoperatively , patients were r and omized either to receive an intra-articular injection of PRP ( group I , n = 30 ) or not to receive PRP ( group  II , n = 27 ) at the end of hip arthroscopic surgery . To evaluate the clinical outcome and follow-up , we used the modified Harris Hip Score ( mHHS ) 3 , 6 , and 24 months after surgery . Pain was evaluated using a visual analog scale 24 hours , 48 hours , 3 months , and 6 months after surgery . The radiologic outcome was analyzed using radiographs and magnetic resonance imaging ( MRI ) obtained before surgery and 6 months after surgery . Labral integration and joint effusion were evaluated with MRI at 6 months . For statistical analysis , an independent t test and the Wilcoxon rank sum test were used ( P < .05 was considered statistically significant ) . RESULTS The visual analog scale score 48 hours after surgery was 3.04 in group I compared with 5.28 in group II ( P < .05 ) . At the 3-month follow-up , the mHHS was 91.79 in group I versus 90.97 in group II ( P = .65 ) . At the 24-month follow-up , the mHHS was 93.41 in group I ( P = .56 ) versus 92.32 in group II ( P = .52 ) . At the 6-month follow-up , MRI showed no effusion in 36.7 % of patients in group I versus 21.1 % of patients in group II ( P = .013 ) . Regarding labral integration , no statistical differences were observed between the groups ( P = .76 ) . CONCLUSIONS In this r and omized study , PRP result ed in lower postoperative pain scores at 48 hours and fewer joint effusions at 6 months . These findings suggest that PRP may have a benefit regarding postoperative inflammation ; however , the long-term clinical benefit is unclear . LEVEL OF EVIDENCE Level II , lesser- quality r and omized controlled trial Introduction We aim ed to identify the effects of intraoperative applied leukocyte-poor platelet-rich plasma ( LP-PRP ) during knee arthroscopy for degenerative lesions involving pain , function and quality of life . Methods We performed a r and omized controlled , double-blind trial ( RCT ) including 58 patients for arthroscopic knee surgery for cartilage or meniscal degeneration with allocation into the LP-PRP ( n = 24 ) or control group ( n = 34 ) . During arthroscopy , LP-PRP was injected intra-articular in the intervention group . At baseline , 6 weeks , 6 months and 12 months pain , function , and life quality were assessed . Results 91 % of enrolled patients were available for 12 months follow-up . Pain was significantly lower in the LP-PRP group ( VAS 0.9 . vs. 2.3 ) at 6 ( p = 0.008 ) but not at 12 months ( VAS 1.0 vs. 1.6 , p = 0.063 ) . LP-PRP application improved the Lysholm Score at 6 ( 77.5 vs. 65.6 , p = 0.033 ) and 12 months ( 83.2 vs.70.0 , p = 0.007 ) . Assessment of life quality ( SF-36 ) concerning the physical component summary was significantly higher at 6 weeks ( 33.9 vs. 25.6 , p = 0.001 ) and 6 months ( 29.9 vs. 27.1 , p = 0.027 ) in the LP-PRP group but equal at 1 year ( 31.4 vs. 30.1 , p = 0.438 ) . Conclusions Intraoperative application of LP-PRP may enhance pain reduction and gain of knee function within 6–12 months compared to arthroscopy alone . Level of evidence II , r and omized controlled clinical trial with reduced power . Clinical Trials.gov identifierNCT02189408 Background Elbow epicondylar tendinosis is a common problem that usually resolves with nonoperative treatments . When these measures fail , however , patients are interested in an alternative to surgical intervention . Hypothesis Treatment of chronic severe elbow tendinosis with buffered platelet-rich plasma will reduce pain and increase function in patients considering surgery for their problem . Study Design Cohort study ; Level of evidence , 2 . Methods One hundred forty patients with elbow epicondylar pain were evaluated in this study . All these patients were initially given a st and ardized physical therapy protocol and a variety of other nonoperative treatments .  Twenty of these patients had significant persistent pain for a mean of 15 months ( mean , 82 of 100 ; range , 60 - 100 of 100 on a visual analog pain scale ) , despite these interventions . All patients were considering surgery . This cohort of patients who had failed nonoperative treatment was then given either a single percutaneous injection of platelet-rich plasma ( active group , n = 15 ) or bupivacaine ( control group , n = 5 ) . Results Eight weeks after the treatment , the platelet-rich plasma patients noted 60 % improvement in their visual analog pain scores versus 16 % improvement in control patients ( P = . 001 ) . Sixty percent ( 3 of 5 ) of the control subjects withdrew or sought other treatments after the 8-week period , preventing further direct analysis . Therefore , only the patients treated with platelet-rich plasma were available for continued evaluation . At 6 months , the patients treated with platelet-rich plasma noted 81 % improvement in their visual analog pain scores ( P = . 0001 ) . At final follow-up ( mean , 25.6 months ; range , 12 - 38 months ) , the platelet-rich plasma patients reported 93 % reduction in pain compared with before the treatment ( P < . 0001 ) . Conclusion Treatment of patients with chronic elbow tendinosis with buffered platelet-rich plasma reduced pain significantly in this pilot investigation . Further evaluation of this novel treatment is warranted . Finally , platelet-rich plasma should be considered before surgical intervention BACKGROUND One of the most challenging aspects of a revision knee arthroplasty is the management of bone loss . The OBJECTIVE of the study is to show the capability to augment bone mineral density in areas with bone loss with platelet-derived growth factors . METHODS R and omized , prospect i ve , blinded study in patients who underwent a total knee replacement revision with tibial-damaged metaphyseal bone were r and omly allocated to have a  revision total knee arthroplasty  and to fill the bone defects with lyophilized bone allograft mixed with platelet growth factors ( experimental group , n= 9 ) or with lyophilized bone allograft alone ( control group , n= 7 ) . To evaluate bone mineral density between groups , dual-energy X-ray absorptiometry ( DEXA ) was performed preoperatively , at 1 month , 6 months and 1 year after surgery . RESULTS The study was comprised of a total of 16 patients . We found no significant differences observed during the follow-up between groups in mineral bone density . CONCLUSIONS Use of platelet-derived growth factors does not improve bone mineral density in patients with revision knee arthroplasty 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 Background : Nonoperative options for osteochondral lesions ( OCLs ) of the talar dome are limited , and currently , there is a lack of scientific evidence to guide management . Purpose : To evaluate the short-term efficacy and safety of platelet-rich plasma ( PRP ) compared with hyaluronic acid ( HA ) in reducing pain and disability caused by OCLs of the ankle . Study Design : R and omized controlled trial ; Level of evidence , 2 . Methods : Thirty-two patients aged 18 to 60 years were allocated to a treatment by intra-articular injections of either HA ( group 1 ) or PRP ( plasma rich in growth factors [ PRGF ] technique , group 2 ) for OCLs of the talus . Thirty OCLs , 15 per arm , received 3 consecutive intra-articular therapeutic injections and were followed for 28 weeks . The efficacy of the injections in reducing pain and improving function was assessed at each visit using the American Orthopaedic Foot and Ankle Society ( AOFAS ) Ankle-Hindfoot Scale ( AHFS ) ; a visual analog scale ( VAS ) for pain , stiffness , and function ; and the subjective global function score . Results : The majority of patients were men ( n = 23 ; 79 % ) . The AHFS score improved from 66 and 68 to 78 and 92 in groups 1 and 2 , respectively , from baseline to week 28 ( P < .0001 ) , favoring PRP ( P < .05 ) . Mean VAS scores ( 1 = asymptomatic , 10 = severe symptoms ) decreased for pain ( group 1 : 5.6 to 3.1 ; group 2 : 4.1 to 0.9 ) , stiffness ( group 1 : 5.1 to 2.9 ; group 2 : 5.0 to 0.8 ) , and function ( group 1 : 5.8 to 3.5 ; group 2 : 4.7 to 0.8 ) from baseline to week 28 ( P < .0001 ) , favoring PRP ( P < .05 for stiffness , P < .01 for function , P > .05 for pain ) . Subjective global function scores , reported on a scale from 0 to 100 ( with 100 representing healthy , preinjury function ) improved from 56 and 58 at baseline to 73 and 91 by week 28 for groups 1 and 2 , respectively ( P < .01 in favor of PRP ) . Conclusion : Osteochondral lesions of the ankle treated with intra-articular injections of PRP and HA result ed in a decrease in pain scores and an increase in function for at least 6 months , with minimal adverse events .  Platelet-rich plasma treatment led to a significantly better outcome than HA Background : Rotator cuff tendinopathy ( RCT ) is a significant source of disability and loss of work .  Platelet-rich plasma ( PRP ) has been suggested to be beneficial in the treatment of RCT . Purpose : To investigate the effect of PRP injections on pain and shoulder functions in patients with chronic RCT . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : A total of 40 patients , 18 to 70 years of age , with ( 1 ) a history of shoulder pain for > 3 months during overhead-throwing activities , ( 2 ) MRI findings of RCT or partial tendon ruptures , and ( 3 ) a minimum 50 % reduction in shoulder pain with subacromial injections of an anesthetic  were included in this placebo-controlled , double-blind r and omized clinical trial . Patients were r and omized into a PRP group ( n = 20 ) or placebo group ( n = 20 ) . Patients received an ultrasound-guided injection into the subacromial space that contained either 5 mL of PRP prepared from autologous venous blood or 5 mL of saline solution . All patients underwent a 6-week st and ard exercise program . Outcome measures ( Western Ontario Rotator Cuff Index [ WORC ] , Shoulder Pain and Disability Index [ SPADI ] , 100-mm visual analog scale [ VAS ] of shoulder pain with the Neer test , and shoulder range of motion ) were assessed at baseline and at 3 , 6 , 12 , and 24 weeks and 1 year after injection . Results : Comparison of the patients revealed no significant difference between the groups in WORC , SPADI , and VAS scores at 1-year follow-up ( P = .174 , P = .314 , and P = .904 , respectively ) . Similar results were found at other assessment points . Within each group , the WORC , SPADI , and VAS scores showed significant improvements compared with baseline at all time points ( P < .001 ) . In the range of motion measures , there were no significant group × time interactions . Conclusion : At 1-year follow-up , a PRP injection was found to be no more effective in improving quality of life , pain , disability , and shoulder range of motion than placebo in patients with chronic RCT who were treated with an exercise program 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 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 Background : Platelet-rich plasma ( PRP ) is expected to have a biological augmentation potential in the healing of various diseases and injuries , including rotator cuff tears . However , few evaluations have been performed specifically for large to massive tears . Purpose : To assess the efficacy of PRP augmentation in patients undergoing arthroscopic repair for large to massive rotator cuff tears . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : A total of 48 patients scheduled for arthroscopic repair of large to massive rotator cuff tears were r and omly assigned to receive either PRP-augmented ( PRP group ) or conventional treatment ( conventional group ) . In the PRP group , 3 PRP gels ( 3 × 3 mL ) were applied to each patient between the torn end and the greater tuberosity . The primary outcome measure was the retear rate assessed by magnetic resonance imaging ( MRI ) or computed tomographic arthrography ( CTA ) at a minimum of 9 months after surgery . Secondary outcome measures included pain , range of motion , muscle strength , overall satisfaction , functional scores , and the change in cross-sectional area ( CSA ) of the supraspinatus . Results : The retear rate of the PRP group ( 20.0 % ) was significantly lower than that of the conventional group ( 55.6 % ) ( P = .023 ) . Clinical outcomes showed no statistical difference between the 2 groups ( all P > .05 ) except for the overall function ( P = .043 ) . The change in 1-year postoperative and immediately postoperative CSA was significantly different between the 2 groups : –15.54 ± 94.34 mm2 in the PRP group versus −85.62 ± 103.57 mm2 in the conventional group ( P = .047 ) . Conclusion : The application of PRP for large to massive rotator cuff repairs significantly improved structural outcomes , as evidence d by a decreased retear rate and increased CSA of the supraspinatus compared with repairs without PRP augmentation . While there was no significant difference in clinical outcomes except the overall shoulder function after 1-year follow-up , better structural outcomes in the PRP group might suggest improved clinical outcomes at longer term follow-up Background To evaluate the efficacy of a single platelet-rich plasma ( PRP ) injection in reducing the return to sport duration in male athletes , following an acute hamstring injury . Methods A r and omised , three-arm ( double-blind for the injection arms ) , parallel-group trial , in which 90 professional athletes with MRI positive hamstring injuries were r and omised to injection with PRP-intervention , platelet-poor plasma ( PPP-control ) or no injection . All received an intensive st and ardised rehabilitation programme . The primary outcome measure was time to return to play , with secondary measures including reinjury rate after 2 and 6 months . Results The adjusted HR for the PRP group compared with the PPP group was 2.29 ( 95 % CI 1.30 to 4.04 ) p=0.004 ; for the PRP group compared with the no injection group 1.48 ( 95 % CI 0.869 to 2.520 ) p=0.15 , and for the PPP group compared with the no injection group 1.57 ( 95 % CI 0.88 to −2.80 ) p=0.13 . The adjusted difference for time to return to sports between the PRP and PPP groups was −5.7 days ( 95 % CI −10.1 to −1.4 ) p=0.01 ; between the PRP and no injection groups −2.9 days ( 95 % CI −7.2 to 1.4 ) p=0.189 and between the PPP and no injection groups 2.8 days ( 95 % CI −1.6 to 7.2 ) p=0.210 . There was no significant difference for the secondary outcome measures . No adverse effects were reported . Conclusions Our findings indicate that there is no benefit of a single PRP injection over intensive rehabilitation in athletes who have sustained acute , MRI positive hamstring injuries . Intensive physiotherapy led rehabilitation remains the primary means of ensuring an optimal return to sport following muscle injury . Trial registration number Clinical Trials.gov Identifier : NCT01812564 BACKGROUND Plantar fasciitis is one of the commonest , and most frustrating , foot ailments seen in a regular orthopaedic clinic . There are a number of modalities available to treat this condition , of which corticosteroid injection is , perhaps , the most popular . However , recent years have seen an increased interest in the use of platelet-rich plasma ( PRP ) injections in various clinical situations such as plantar fasciitis . METHODS We undertook a prospect i ve non-r and omized study to compare the efficacy of traditional corticosteroid injection ( Steroid group ) to PRP injection ( PRP group ) , in a cohort of patients . RESULTS We studied both groups of patients before and after the injections using Visual Analogue Score ( VAS ) , the Foot & Ankle Disability Index ( FADI ) and American Foot and Ankle Score ( AFAS ) . Our study confirms that there is significant clinical improvement in PRP group at three months after the injection . CONCLUSION The use of PRP injection can be an attractive alternative in the treatment of disabling , recalcitrant plantar fasciitis .  STUDY DESIGN Cohort study . LEVEL OF CLINICAL EVIDENCE Level 3 Background : Platelet-rich plasma ( PRP ) has been shown to be a general stimulation for repair and 1-year results showed promising success percentages . Purpose : This trial was undertaken to determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis with a 2-year follow-up . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : The trial was conducted in 2 Dutch teaching hospitals . One hundred patients with chronic lateral epicondylitis were r and omly assigned to a leukocyte-enriched PRP group ( n = 51 ) or the corticosteroid group ( n = 49 ) . R and omization and allocation to the trial group were carried out by a central computer system . Patients received either a corticosteroid injection or an autologous platelet concentrate injection through a peppering needling technique . The primary analysis included visual analog scale ( VAS ) pain scores and Disabilities of the Arm , Shoulder and H and ( DASH ) outcome scores . Results : The PRP group was more often successfully treated than the corticosteroid group ( P < .0001 ) . Success was defined as a reduction of 25 % on VAS or DASH scores without a reintervention after 2 years . When baseline VAS and DASH scores were compared with the scores at 2-year follow-up , both groups significantly improved across time ( intention-to-treat principle ) . However , the DASH scores of the corticosteroid group returned to baseline levels , while those of the PRP group significantly improved ( as-treated principle ) . There were no complications related to the use of PRP . Conclusion : Treatment of patients with chronic lateral epicondylitis with PRP  reduces pain and increases function significantly , exceeding the effect of corticosteroid injection even after a follow-up of 2 years . Future decisions for application of 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 To investigate whether platelet-rich plasma ( PRP ) when used with allograft bone improves the management outcome of displaced intra-articular calcaneal fractures . Over a 7-year period , all displaced type III calcaneal fractures admitted in our department ( 276 fractures in 254 patients ) were r and omly divided into three groups according to the plan of management : autograft alone ( n = 101 ) , allograft combined with PRP ( n = 85 ) , or allograft alone ( n = 90 ) . Radiographic imaging and three-dimensional computed tomography were used to assess the thalamic portion , Bohler 's angle , the crucial angle of Gissane , and the height , width and length of the calcaneum . The American Orthopedic Foot and Ankle Society ( AOFAS ) ankle-hind-foot scoring system was used to evaluate the hind foot function at 12 , 24 , and 72 months postsurgery . At 12 months no significant difference existed in outcome amongst the treatment groups ( p > 0.05 ) . However , at 24 and 72 months the results of the  autograft  , and the  allograft combined with PRP  , were similar and both were significantly better than that of the allograft alone ( p < 0.05 ) . PRP augmented the favorable outcome of allografts  in the management of displaced calcaneal fractures , and matched that of autograft used alone . The findings of this study thus support the clinical use of PRP in conjunction with allograft in the treatment of displaced intra-articular calcaneal fractures Purpose To compare the safety and efficacy of two different approaches of platelet-rich plasma ( PRP ) production methods as intra-articular injection treatment for knee cartilage degenerative lesions and osteoarthritis ( OA ) . Methods The study involved 144 symptomatic patients affected by cartilage degenerative lesions and OA . Seventy-two patients were treated with 3  injections of platelet concentrate prepared with a single-spinning procedure ( PRGF ) , the other 72 with 3 injections of PRP obtained with a double-spinning approach . The patients were evaluated prospect ively at the enrollment and at 2 , 6 , and 12 months ’ follow-up with IKDC , EQ-VAS and Tegner scores ; adverse events and patient satisfaction were also recorded . Results Both treatment groups presented a statistically significant improvement in all the scores evaluated at all the follow-up times . Better results were achieved in both groups in younger patients with a lower degree of cartilage degeneration . The comparative analysis showed similar improvements with the two procedures : in particular , IKDC subjective evaluation increased from 45.0 ± 10.1 to 59.0 ± 16.2 , 61.3 ± 16.3 , and 61.6 ± 16.2 at 2 , 6 , and 12 months in the PRGF group , and from 42.1 ± 13.5 to 60.8 ± 16.6 , 62.5 ± 19.9 , and 59.9 ± 20.0 at 2 , 6 , and 12 months in the PRP group , respectively . Concerning adverse events , more swelling ( P = 0.03 ) and pain reaction ( P = 0.0005 ) , were found after PRP injections . Conclusions Although PRP injections produced more pain and swelling reaction with respect to that produced by PRGF , similar results were found at the follow-up times , with a significant clinical improvement with respect to the basal level . Better results were achieved in younger patients with a low degree of cartilage degeneration . Level of evidence II 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 AIM Professional athletes require faster recovery after trauma . The aim of our study was to evaluate the efficacy of ultrasound guided platelets rich plasma ( PRP ) treatment for acute muscle injury comparing with traditional conservative therapy . MATERIAL S AND METHODS Thirty consecutive men ( mean age 24 years old ) professional athletes with acute local muscle injury were enrolled . All patients underwent US and sonoelastography examination . Patients were r and omly assigned to 2 groups : group A received targeted PRP injection under US guidance and additionally conservative treatment and group B received conventional conservative treatment only . The pain was assessed according to visual analogue scale ( 0 to 10 ) , muscle function according to pain on resisted ﬂexion or strength , and range of motion . Both groups were further evaluated in the days 1 , 7 , 14 , 21 , and 28 after treatment starting . US criteria for regeneration were considered to be the disappearance of hypoechoic areas of muscle damage , fibrous tissue more stiff on sonoelastography , and neovascularity appearances . RESULTS The pain relief was more important in group A compared to group B starting from day 1 and continuing in the next 3 evaluation sessions ( p<0.05 ) . At the end of observation ( 28 day ) , 93 % of pain regression was declared by patients in group A vs 80 % of regression of pain in group B ( p>0.05 ) . Assessing the physical evolution in the 7th and 14th days significant changes in strength ( p<0.05 ) and range of motion ( p<0.05 ) for PRP treatment group was observed . After 28 days no significant differences between groups were observed concerning the pain on resisted ﬂexion and strength ( p>0.05 ) but the range of movement improved better in group A compared with group B ( p < 0.05 ) . Subjective global function scores improved significantly in group A compared with group B on the 28th day ( p<0.05 ) . The mean time for the physical recovery movement volume and the ability to practice sport was 10+/-1.2 days in group A and 22+/-1.5 days in group B. CONCLUSIONS Injections of PRP under ultrasound guidance had asignificantly higher level of pain relief , physical recovery , and faster regeneration compared with conventional conservative treatment in acute muscle trauma in professional athletes Objective This pilot study aim ed to inform future research evaluating the effectiveness of Platelet Rich Plasma ( PRP ) injection for tendinopathy . Design R and omized control trial ( RCT ) and synchronous observational cohort studies . For the RCT , consecutive consenting patients treated at an academic sports medicine clinic were r and omly assigned to either a PRP or placebo control group . Setting The Glen Sather Sport Medicine Clinic , Edmonton , Canada . Patients The RCT included 9 participants with rotator cuff tendinopathy . The cohort study included 178 participants with a variety of tendinopathies . Interventions Patients receiving PRP were injected with 4 ml of platelets into the supraspinatus and /or infraspinatus , while patients in the placebo group were injected with 4ml of saline . All participants undertook a 3-month st and ardized , home-based , daily exercise program . Main Outcome Measures Participants in the RCT were re-evaluated 3 , and 6 months post-injection . Change scores before and after injection on pain , disability and MRI-documented pathology outcomes were compared . In the cohort study , pain and disability were measured at 1 , 2 and 3 months post-injection . Results For the RCT , 7 participants received PRP and 2 received placebo injections . Patients receiving PRP reported clinical ly important improvements in pain ( > 1.5/10 on VAS ) , disability ( > 15 point DASH change ) , and tendon pathology while those receiving placebo injections did not . In the observational cohort , statistically and clinical ly significant improvements in pain and disability were observed . Conclusion This pilot study provides information for planning future studies of PRP effectiveness . Preliminary results indicate intratendinous , ultrasound-guided PRP injection may lead to improvements in pain , function , and MRI-documented tendon pathology . Trial Registration Controlled-Trials.com IS RCT The purpose of this prospect i ve r and omised clinical study was to compare the efficacy of recombinant bone morphogenetic protein 7 ( rhBMP-7 ) and platelet-rich plasma ( PRP ) as bone-stimulating agents in the treatment of persistent fracture non-unions . One hundred and twenty patients were r and omised into two treatment groups ( group rhBMP-7 vs. group PRP ) . Sixty patients with sixty fracture non-unions were assigned to each group ( median age : 44 years , range 19 - 65 , for the rhBMP-7 group and 41 years , range 21 - 62 , for the PRP group , respectively ) . In the rhBMP-7 group , there were 15 tibial non-unions , 10 femoral , 15 humeral , 12 ulnar , and 8 radial non-unions . In the PRP group , there were 19 tibial non-unions , 8 femoral , 16 humeral , 8 ulnar , and 9 radial non-unions . The median number of operations performed prior to our intervention was 2 ( range 1 - 5 ) and 2 ( range 1 - 5 ) with autologous bone graft being used in 23 and 21 cases for the rhBMP-7 and PRP groups , respectively . Both clinical and radiological union occurred in 52 ( 86.7 % ) cases of the rhBMP-7 group compared to 41 ( 68.3 % ) cases of the PRP group , with a lower median clinical and radiographic healing time observed in the rhBMP-7 group ( 3.5 months vs. 4 months and 8 months vs. 9 months , respectively ) . This study supports the view that in the treatment of persistent long bone non-unions , the application of rhBMP-7 as a bone-stimulating agent is superior compared to that of PRP with regard to their clinical and radiological efficacy Background : Tendinopathies represent a serious challenge for orthopaedic surgeons involved in treatment of athletes . Purpose : To compare the effectiveness and safety of platelet-rich plasma ( PRP ) injections and focused extracorporeal shock wave therapy ( ESWT ) in athletes with jumper ’s knee . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Forty-six consecutive athletes with jumper ’s knee were selected for this study and r and omized into 2 treatment groups : 2 autologous PRP injections over 2 weeks under ultrasound guidance ( PRP group ; n = 23 ) , and 3 sessions of focused extracorporeal shock wave therapy ( 2.400 impulses at 0.17 - 0.25 mJ/mm2 per session ) ( ESWT group ; n = 23 ) . The outcome measures were Victorian Institute of Sports Assessment –Patella ( VISA-P ) question naire , pain visual analog scale ( VAS ) , and modified Blazina scale . A review er who was blinded as to the group allocation of participants performed outcome assessment s before treatment and at 2 , 6 , and 12 months after treatment . Nonparametric tests were used for within-group ( Friedman/Wilcoxon test ) and between-group ( Kruskal-Wallis/Fisher test ) testing , and the significance level was set at .05 . Results : The 2 groups were homogeneous in terms of age , sex , level of sports participation , and pretreatment clinical status . Patients in both groups showed statistically significant improvement of symptoms at all follow-up assessment s. The VISA-P , VAS , and modified Blazina scale scores showed no significant differences between groups at 2-month follow-up ( P = .635 , .360 , and .339 , respectively ) . The PRP group showed significantly better improvement than the ESWT group in VISA-P , VAS scores at 6- and 12-month follow-up , and modified Blazina scale score at 12-month follow-up ( P < .05 for all ) . Conclusion : Therapeutic injections of PRP lead to better midterm clinical results compared with focused ESWT in the treatment of jumper ’s knee in athletes Objective This study aim ed to find a simple , cost-effective , and time-efficient method for the preparation of platelet-rich plasma ( PRP ) , so the acquired benefits will be readily available for multiple procedures in smaller outpatient clinics and to explore the safety and efficacy of the application of PRP in the treatment of degenerative lesions of articular cartilage of the knee . Design The study was design ed as a prospect i ve , cohort study with a control group . A total of 120 patients with Grade 1 , 2 , or 3 osteoarthritis according to the Kellgren and Lawrence grading scale were enrolled in the study . One group of patients was treated using three intra-articular applications of PRP , and the second group of patients was given three injections of hyaluronic acid . Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index and the 11-point pain intensity Numeric Rating Scale . Results On average , a 4.5-fold increase in platelet concentration was obtained in the PRP group . No severe adverse events were observed . Statistically significantly better results in the Western Ontario and McMaster Universities Osteoarthritis Index and Numeric Rating Scale scores were recorded in a group of patients who received PRP injections after a 3- and 6-mo follow-up . Conclusions Our preliminary findings support the application of autologous PRP as an effective and safe method in the treatment of the initial stages of knee osteoarthritis . Further studies are needed to confirm these results and to investigate the persistence of the beneficial effects observed 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 PURPOSE The aim of this study was to determine whether addition of plasma rich in growth factors ( PRGF ) improves functional and structural outcomes after arthroscopic repair of full-thickness rotator cuff tears . METHODS The study design was independent ( investigator-sponsored ) , r and omized in parallel groups , double-blind , and controlled with a conventional surgical technique clinical trial . Sixty-nine patients with rotator cuff tears were included . Subsequently , 6 patients in whom less than 50 % footprint coverage of the repair was possible were excluded . Before arthroscopic repair , patients were r and omly assigned to receive PRGF at the end of arthroscopy ( injected first in the repaired area and then spread over the tendon suture ) or only conventional surgery .  Efficacy was evaluated 1 year after surgery using functional ( UCLA score ) and structural ( arthro-MRI ) assessment s. RESULTS The baseline UCLA scores of the PRGF ( 14.9 ; 95 % confidence interval [ CI ] : 13.7 to 16.12 ) and control ( 13.2 ; 95 % CI : 13.3 to 16.3 ) groups were similar . After surgery , both groups showed an improvement in UCLA score , without significant differences between groups ( 23.2 ; CI 95 % : 20.8 to 25.7 , and 23.8 ; 95 % CI : 21.0 to 26.7 , respectively ) . Furthermore , no significant differences were observed in satisfaction 1 year after surgery . Tendon healing evaluated with arthro-magnetic resonance imaging showed total healing in 40 % of cases , partial healing in 30 % , and lack of healing in 30 % , again with no significant differences between groups . No adverse events were recorded . CONCLUSIONS The present clinical trial does not support the use of plasma rich in growth factors in the arthroscopic repair of rotator cuff tears because no differences in rotator cuff healing or improvements in function were observed in the 1-year postsurgical clinical and radiological follow-up assessment s. LEVEL OF EVIDENCE Level I , r and omized , double-blind , controlled clinical trial Background : Studies have demonstrated the potential of platelet-rich plasma ( PRP ) to heal damaged tissue . To date , there are no published reports of clinical outcomes of partial ulnar collateral ligament ( UCL ) tears of the elbow treated with PRP . Hypothesis : Platelet-rich plasma will promote the healing of partial UCL tears and allow a return to play . Study Design : Case series ; Level of evidence , 4 . Methods : Thirty-four athletes with a partial-thickness UCL tear confirmed on magnetic resonance imaging were prospect ively followed . All patients had failed at least 2 months of nonoperative treatment and an attempt to return to play . Baseline question naires , including the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow ( KJOC ) and Disabilities of the Arm , Shoulder and H and ( DASH ) measures , were completed by each patient before injection . Baseline ultrasound measurement of the humeral-ulnar joint space was assessed with 10 lb of valgus stress on the elbow . Each patient received a single type 1A PRP injection at the UCL under ultrasound guidance . The same treating physician at a single institution performed all injections with the same PRP preparation used . Patients completed a course of guided physical therapy and were allowed to return to play based on their symptoms and physical examination findings . Outcome scores , including KJOC and DASH scores , were collected after return to play and were compared with baseline scores . Ultrasound measurements were collected at final follow-up and compared with preinjection values . Results : At an average follow-up of 70 weeks ( range , 11 - 117 weeks ) , 30 of 34 athletes ( 88 % ) had returned to the same level of play without any complaints . The average time to return to play was 12 weeks ( range , 10 - 15 weeks ) . The average KJOC score improved from 46 to 93 ( P < .0001 ) . The average DASH score improved from 21 to 1 ( P < .0001 ) . The sports module of the DASH question naire improved from 69 to 3 ( P < .0001 ) . Medial elbow joint space opening with valgus stress decreased from 28 to 20 mm at final follow-up ( P < .0001 ) . The difference in medial elbow joint space opening ( stressed vs nonstressed ) decreased from 7 to 2.5 mm at final follow-up ( P < .0001 ) . One player had persistent UCL insufficiency and underwent ligament reconstruction at 31 weeks after injection . Conclusion : The results of this study indicate that PRP is an effective option to successfully treat partial UCL tears of the elbow in athletes BACKGROUND Over 23,000 people per day require treatment for ankle sprains .  Platelet-rich plasma ( PRP ) is an autologous concentration of platelets that is thought to improve healing by promoting inflammation through growth factor and cytokine release . Studies to date have shown mixed results , with few r and omized trials . OBJECTIVES To determine patient function among patients r and omized to receive st and ard therapy plus PRP  , compared to patients who receive st and ard therapy plus sham injection ( placebo ) . METHODS Prospect i ve , r and omized , double-blinded , placebo-controlled trial . Patients with severe ankle sprains were r and omized . Severity was grade d on degree of swelling , ecchymosis , and ability to bear weight . PRP with lidocaine and bupivacaine was injected at the point of maximum tenderness by a blinded physician under ultrasound guidance . The control group was injected in a similar fashion with sterile 0.9 % saline . Both groups had visual analog scale ( VAS ) pain scores and Lower Extremity Functional Scale ( LEFS ) on days 0 , 3 , and 8 . LEFS and a numeric pain score were obtained via phone call on day 30 . All participants were splinted , given crutches , and instructed to not bear weight for 3 days ; at this time patients were reevaluated . RESULTS There were 1156 patients screened and 37 were enrolled . Four withdrew before PRP injection was complete ; 18 were r and omized to  PRP and 15 to placebo . There was no statistically significant difference in VAS and LEFS scores between groups . CONCLUSION In this small study , PRP did not provide benefit in either pain control or function over placebo 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 During platelet activation over 30 growth factors are released from their alpha granules . By concentrating platelets , higher levels of growth factors are obtained and can be used to stimulate the healing processes . Moreover , during blood centrifugation , huge numbers of leukocytes and thrombocytes can be obtained to form leukocyte and platelet-rich plasma ( L-PRP ) . After platelet degranulation the active gelatinous matrix called leukocyte and platelet-rich gel ( L-PRG ) is formed . In the present clinical study , we report the influence of PLRG and freeze-dried allografts on healing of large femoral bone cysts . Each of 6 participants was followed on a regular basis with clinical examinations , roentgenograms and dual-energy X-ray absorptiometry ( DXA ) examinations . Our four-year follow up clinical study using allografts and PLRG in the treatment of large cystic lesions of the proximal femur showed that mixing these substances is not efficient and it might induce unknown local reactions between them causing complete bone graft destruction . Further studies are necessary to fully underst and the mechanisms of the local activity of L-PRP gel 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 The aims of this study were to analyze the range of cartilage damage and patellofemoral joint ( PFJ ) degeneration in degenerative osteoarthritis ( OA ) and determine the duration for the positive effects of platelet-rich plasma ( PRP ) injection . This study included 65 patients suffering from OA that were treated with intra-articular PRP injection .  The patients were prospect ively evaluated at 1 , 3 , 6 , 9 , and 12 months after the procedure using a visual analogue scale ( VAS ) score and an International Knee Documentation Committee ( IKDC ) score . Clinical improvement in the average VAS score from 7.4 before the procedure to 4.2 at 6 months post-procedure had been reported , but the symptoms tended to deteriorate to 5.0 1 year after injection . The IKDC score also showed statistical significance ( P < 0.05 ) . Patients reported relapsed pain 8.8 months after the procedure . Developing degeneration according to the Kellgren – Lawrence grade reduced the clinical effects of PRP ( P < 0.05 ) and also accelerated the time for feeling relapsed pain ( P < 0.05 ) . There was a statistically significant negative correlation between patient age and the PRP potential in the VAS score ( slope = 0.1667 ) and IKDC score ( slope = 1.3333 ) . The presence of PFJ degeneration is expected to produce a worse outcome ( P < 0.05 ) . While intra-articular PRP injection can be used for the treatment of early OA , increasing age , and developing degeneration result in a decreased potential for PRP injection therapy OBJECTIVES To evaluate the efficacy of autologous conditioned plasma ( ACP ) compared with extracorporeal shockwave ( ESWT ) and conventional treatments for plantar fasciitis . DESIGN R and omized trial . SETTING Sports medicine center in a tertiary care hospital . PATIENTS Fifty-four subjects ( age range , 29 - 71 years ) with unilateral chronic plantar fasciitis with more than 4 months of symptoms . METHODS Subjects r and omized to 3 groups : 19 to  ACP and conventional treatment ( ACP group ) , 19 to ESWT and conventional treatment ( ESWT group ) , and 16 to conventional treatment alone . Conventional treatment included stretching exercises and orthotics if indicated . MAIN OUTCOME MEASUREMENTS Outcomes were pain-Visual Analog Scale ( VAS ) , American Orthopaedic Foot and Ankle Society ( AOFAS ) ankle-hindfoot scale , and ultrasound plantar fascia thickness assessed at baseline before treatment and at 1 month , 3 months , and 6 months after treatment . RESULTS VAS , AOFAS ankle-hindfoot scale , and plantar fascia thickness improved in all groups . Significant VAS pain score improvements in the ACP group compared with conventional treatment at month 1 ( P = .037 ) and for the ESWT group compared with conventional treatment at months 1 , 3 , and 6 ( P = .017 , P = .022 , and P = .042 ) . The AOFAS ankle-hindfoot scale score improved in the ACP group at months 3 and 6 ( P = .004 and P = .013 ) and , for the ESWT group , at months 1 and 3 ( P = .011 and P = .003 ) compared with conventional treatment . Significant improvements in plantar fascia thickness were seen in the ACP group at months 1 and 3 compared with conventional treatments ( P = .015 and P = .014 ) and at months 3 and 6 compared with the ESWT group ( P = .019 and P = .027 ) . No adverse events reported . CONCLUSIONS Treatment of plantar fasciitis with ACP or ESWT plus conventional treatments result ed in improved pain and functional outcomes compared with conventional treatment alone . There was no significant difference between ACP and ESWT in terms of VAS and AOFAS ankle-hindfoot scale improvements , although the ACP group demonstrated greater reductions in plantar fascia thickness BACKGROUND in the treatment of early osteoartrosis , analgesics and non-steroidal anti-inflammatory drugs are frequently used to relieve pain . Currently , platelet rich plasma is used as an alternative in the treatment of osteoartrosis . The aim of this study was to evaluate the effect of platelet rich plasma compared to paracetamol as a treatment for patients with knee osteoartrosis grade I. METHODS we evaluated 42 patients who were r and omized into two groups . Group one was treated with 5 mL of platelet rich plasma in two applications , while group two was treated with 1 gr of oral paracetamol every 8 hours for 30 days . Both patient groups received supervised physical rehabilitation during the 6 month observation period . Peripheral blood sample s were taken to measure plasma IL-1β , TNF-a and TGF-β1 levels at day 0 and at 6 months post-treatment . Clinical evaluation was conducted using the KOOS at the start of the study and for every subsequent month during the study period . RESULTS the Knee injury and Osteoarthritis Outcome Score ( KOOS ) for group one at the start of the treatment was measured at 30.1 points , whereas at the end , it was measured at 48.2 points , showing a clinical improvement of 60 % . There were no statistically significant differences in IL-1β and TNF-a levels between groups treated either with platelet rich plasma or paracetamol . CONCLUSIONS Our patients treated with platelet rich plasma showed a statistically significant increase in the serum levels of TGF-β1 , which was associated with an improvement in the clinical evaluation used ( KOOS ) Purpose . To compare a single leukocyte-poor ( type-4B ) platelet-rich plasma ( PRP ) injection versus bupivacaine injection for recalcitrant lateral epicondylar tendinopathy ( LET ) . Methods . 25 patients aged 27 to 50 years with painful and recalcitrant LET of the humerus were r and omised to receive leukocyte-poor ( type-4B ) PRP ( n=15 ) or bupivacaine ( n=10 ) injection . Outcome measures included visual analogue scale ( VAS ) for pain , modified Mayo clinic performance index for elbow ( MMCPIE ) for elbow function , and Nirschl score for activity-related pain at 1 , 3 , 6 , and 12 months by a single assessor . Results . At baseline , the PRP and bupivacaine groups were comparable in terms of age , sex , duration of symptoms , VAS for pain , MMCPIE score , and Nirschl score . After one month , the percentage of improvement was less in the PRP than bupivacaine group in terms of the VAS for pain ( 17.7 % vs. 26.5 % ) , MMCPIE score ( 24.0 % vs. 27.6 % ) , and Nirschl score ( 20.7 % vs. 31.1 % ) . Nonetheless , improvement in the respective scores was greater in the PRP than bupivacaine group after 3 months ( 42.5 % vs. 30.9 % , 34.1 % vs. 27.2 % , and 50.7 % vs. 39.6 % ) , 6 months ( 67.3 % vs. 20.1 % , 40.6 % vs. 16.3 % , and 71.4 % vs. 31.1 % ) , and one year ( 83.2 % vs. 45.6 % , 47.0 % vs. 21.7 % , and 76.6 % vs. 56.3 % ) . The differences in scores between groups were significant at 6 months and one year only ( p<0.001 ) . Conclusion . Leukocyte-poor ( type-4 ) PRP injection for recalcitrant LET enabled good improvement in pain and function Most studies suggested that arthroscopic microfracture is effective method at only less than 40 years of age . Thus , the authors thought that “ how can this indication regarding age be extended ? , ” and tried to find a way to use this technique effectively over 40 years of age . The aim of this study was the first to report the results regarding the PRP as an adjunct for arthroscopic microfracture in the early osteoarthritic ( OA ) knee with cartilage lesion over 40 years of age . 49 patients who underwent arthroscopic microfracture for cartilage lesion sized less than 4 cm2 with early OA , aged 40–50 years , were enrolled and r and omly divided into 2 groups : a control group with only arthroscopic microfracture ( 25 patients ) and a study group with arthroscopic microfracture and PRP ( 24 patients ) . The patients were prospect ively evaluated with VAS , IKDC score at preoperative and postoperative 1 , 6 , 12 , and 24 months . And we perform second arthroscopies in 10 patients of each group to identify the extent of cartilage restoration at 4–6 months postoperatively . There were significant improvements in clinical results between preoperative evaluation and postoperative 2 years in both groups ( p = 0.017 ) . In the postoperative 2 years , clinical results showed significantly better in the study group than in the control group ( p = 0.012 ) . In post-arthroscopic finding , hardness and elasticity degree was better in the study group . The PRP injection with arthroscopic microfracture would be improved the results in early osteoarthritic knee with cartilage lesion in 40–50 years old , and the indication of this technique could be extended to 50 years The purpose of this study was to investigate whether platelet-rich plasma therapy for early knee osteoarthritis is associated with good clinical outcomes and a change in magnetic resonance imaging ( MRI ) structural appearances . The design was a prospect i ve cohort study following patients 1 year after platelet-rich plasma therapy for knee osteoarthritis . Twenty-two patients were treated with platelet-rich plasma for early osteoarthritis , confirmed with a baseline MRI . Inclusion criteria were Kellgren grade 0-II with knee pain in patients aged 30 to 70 years . All the patients received a 6-mL platelet-rich plasma injection using the Cascade system .  Fifteen subjects underwent clinical assessment s at baseline , 1 week , and 1 , 3 , 6 , and 12 months , and MRIs at 1 year . Pain scores significantly decreased , whereas functional and clinical scores increased at 6 months and 1 year from baseline . Qualitative MRIs demonstrated no change per compartment in at least 73 % of cases at 1 year 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 INTRODUCTION To compare the clinical , analytical and graft maturation effects of two different platelet-rich plasma ( PRP ) preparations applied during anterior cruciate ligament ( ACL ) reconstruction . MATERIAL S AND METHODS A total of 150 patients with ACL disruption were included in the study . Arthroscopic ACL reconstruction with patellar tendon allograft was conducted on all knees using the same protocol . One hundred patients were prospect ively r and omised to either a group to receive double-spinning platelet-enriched gel ( PRP ) with leukocytes ( n=50 ) or to a non-gel group ( n=50 ) . Finally , we included 50 patients treated with a platelet-rich preparation from a single-spinning procedure ( PRGF Endoret ( ® ) Technology ) without leukocytes . Inflammatory parameters , including C-reactive protein ( CRP ) and knee perimeters ( PER ) , were measured 24 hours and 10 days after surgery . Postoperative pain score ( visual analogue score [ VAS ] ) was recorded the day after surgery . Follow-up visits occurred postoperatively at 3 , 6 , and 12 months . The International Knee Documentation Committee scale ( IKDC ) was included to compare functional state , and MRI was conducted 6 months after surgery . RESULTS The PRGF group showed a statistically significant improvement in swelling and inflammatory parameters compared with the other two groups at 24 hours after surgery ( p<0.05 ) . The results did not show any significant differences between groups for MRI and clinical scores . CONCLUSIONS PRGF used in ACL allograft reconstruction was associated with reduced swelling ; however , the intensity and uniformity of the graft on MRI were similar in the three groups , and there was no clinical or pain improvement compared with the control group . LEVEL OF EVIDENCE II Background : Elbow tenderness and pain with resisted wrist extension are common manifestations of lateral epicondylar tendinopathy , also known as tennis elbow . Previous studies have suggested platelet-rich plasma ( PRP ) to be a safe and effective therapy for tennis elbow . Purpose : To evaluate the clinical value of tendon needling with PRP in patients with chronic tennis elbow compared with an active control group . Study Design : R and omized controlled trial ; Level of evidence , 2 . Methods : A total of 230 patients with chronic lateral epicondylar tendinopathy were treated at 12 centers over 5 years . All patients had at least 3 months of symptoms and had failed conventional therapy . There were no differences in patients r and omized to receive PRP ( n = 116 ) or active controls ( n = 114 ) . The PRP was prepared from venous whole blood at the point of care and contained both concentrated platelets and leukocytes . After receiving a local anesthetic , all patients had their extensor tendons needled with or without PRP . Patients and investigators remained blinded to the treatment group throughout the study . A successful outcome was defined as 25 % or greater improvement on the visual analog scale for pain . Results : Patient outcomes were followed for up to 24 weeks . At 12 weeks ( n = 192 ) , the PRP-treated patients reported an improvement of 55.1 % in their pain scores compared with 47.4 % in the active control group ( P = .163 ) . At 24 weeks ( n = 119 ) , the PRP-treated patients reported an improvement of 71.5 % in their pain scores compared with 56.1 % in the control group ( P = .019 ) . The percentage of patients reporting significant elbow tenderness at 12 weeks was 37.4 % in the PRP group versus 48.4 % in the control group ( P = .143 ) . Success rates for patients at 12 weeks were 75.2 % in the PRP group versus 65.9 % in the control group ( P = .104 ) . At 24 weeks , 29.1 % of the PRP-treated patients reported significant elbow tenderness versus 54.0 % in the control group ( P = .009 ) . Success rates for patients with 24 weeks of follow-up were 83.9 % in the PRP group compared with 68.3 % in the control group ( P = .037 ) . No significant complications occurred in either group . Conclusion : No significant differences were found at 12 weeks in this study . At 24 weeks , however , clinical ly meaningful improvements were found in patients treated with leukocyte-enriched PRP  compared with an active control group 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 Purpose The purpose of this study was to determine whether platelet-rich plasma ( PRP ) might prevent blood loss and postoperative pain and expedite wound healing following total knee arthroplasty ( TKA ) . Methods Forty consecutive patients with knee arthritis who were matched for age , sex and body mass index ( BMI ) were r and omly allocated to either receive or not receive PRP application over the wound , including capsule , medial and lateral recesses , during TKA . Postoperative haemoglobin , blood loss , blood transfusion , visual analogue scale ( VAS ) score , wound score , Knee Society Score ( KSS ) and Western Ontario and McMaster Osteoarthritis Index ( WOMAC ) score were recorded and evaluated . Results The platelet-rich plasma and control groups comprised 17 and 23 patients , respectively . The PRP group recorded significantly less reduction in haemoglobin and need for blood transfusion ( p = 0.00 and p = 0.001 , respectively ) , experienced less pain ( p = 0.00 ) and required fewer narcotics than the control ( p = 0.00 ) . There was significant difference in range of motion ( ROM ) at three months ( p = 0.01 ) , no significant difference in wound scores ( p = 0.311 ) and significant difference in KSS and WOMAC scores at 12 weeks ( p = 0.00 , 0.00 ) . However no significant difference was found at six months . Conclusions PRP has significant effect in preventing blood loss , postoperative pain and need for narcotics after TKA and has a positive effect on short-term clinical outcome OBJECTIVES The aim was to assess the efficacy of two intra-tendinous injections of platelet-rich plasma ( PRP ) on epicondylitis of recent evolution ( ≤3 months ) . METHODS Our study was a double-blind placebo-controlled r and omized trial . Two US-guided injections of either PRP ( autologous conditioned plasma ) or saline solution were performed with an interval of 4 weeks . The exclusion criterion was previous CS infiltration . Patients were monitored by an independent evaluator blinded to treatment at baseline and 1 , 3 , 6 and 12 months of follow-up . The primary evaluation criterion was the relative improvement from baseline to 6 months in pain score on visual analog scale ( 0 - 10 ) . Secondary criteria were the Roles-Maudsley score and the assessment of pain on isometric contraction of extensor carpi radialis brevis and extensor digitorum communis . RESULTS Twenty-five patients were r and omly assigned to each group . Three patients in each arm dropped out before 6 months . In both groups , the pain score [ mean ( s.d . ) ] decreased significantly between two consecutive visits from 6.8 ( 0.8 ) ( PRP ) and 7 ( 1 ) ( saline ) at baseline to 2.5 ( 1.6 ) and 1.6 ( 1.5 ) ( PRP ) and to 2.1 ( 1.6 ) and 1.8 ( 2.1 ) ( saline ) at 6 and 12 months , respectively . At 6 months , no statistically significant difference was found between groups for relative improvement in pain score  [ autologous conditioned plasma : -63.2 ( 22.4 % ) ; saline : -69.7 ( 25.1 % ) ; P = 0.24 ] . No significant difference was found for the secondary criteria . CONCLUSION Two US-guided PRP injections for epicondylitis of recent evolution were not more efficacious  than saline injections , until 6- and 12-months follow-up . TRIAL REGISTRATION Clinical Trials.gov ; https:// clinical trials.gov/ ; NCT02378285 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 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 BACKGROUND Chronic Achilles tendinopathy is responsible for a severe reduction in physical performance and persistent pain . There is currently a number of therapeutic options and the local administration of growth factors is an emerging treatment strategy . In particular , platelet-rich plasma ( PRP ) is a widely used way to provide a local regenerative stimulus for tendon healing . The aim of this study was to document the mid-term results obtained after treating recalcitrant Achilles tendinopathy with injections of high concentrate , leucocyte-rich PRP . MATERIAL S AND METHODS Twenty-seven patients ( mean age : 44.6 years ; 22 men and 5 women ) affected by chronic mid-portion Achilles tendinopathy ( 7 bilateral , for a total of 34 tendons ) , refractory to previous treatments , were enrolled . Patients were treated with three ultrasound-guided intra-tendinous injections of PRP at 2-week intervals . Patients were prospect ively evaluated at baseline , and then at 2 , 6 , and up to a mean of 54.1 months of follow-up ( minimum 30 months ) , using the following tools : Blanzina , VISA-A , EQ-VAS for general health , and Tegner scores . RESULTS The VISA-A score showed a significant improvement : the baseline score of 49.9±18.1 increased to 62.9±19.8 at 2 months ( p=0.002 ) , with a further improvement at 6 months ( 84.3±17.1 , p<0.0005 ) , and stable results at 4.5 years ( 90.0±13.9 ) . The EQ-VAS score also showed a similar positive trend . An evaluation of the activity level confirmed these findings , showing a significant improvement in the Tegner score over time ( p=0.017 for the final evaluation ) . The longer duration of symptoms before treatment was associated with a slower return to sport ( p=0.041 ) . DISCUSSION PRP injections produced good overall results for the treatment of chronic recalcitrant Achilles tendinopathy with a stable outcome up to a medium-term follow-up . Longer symptom duration was related with a more difficult return to sporting activity 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 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 Purpose . To evaluate the stages of patellar tendon graft remodelling using magnetic resonance imaging ( MRI ) after anterior cruciate ligament ( ACL ) reconstruction with or without platelet-rich plasma ( PRP ) injection . Methods . 98 patients aged 18 to 65 years with complete rupture of the ACL were r and omised to undergo reconstruction with the autologous patellar tendon grafts with or without PRP injection . For the PRP group , 8 ml of PRP was obtained in the surgery room and was percutaneously injected into the suprapatellar joint after portal suture . MRI was obtained at months 4 , 6 , and 12 . Remodelling stages of the grafts were classified as hypointense , mildly hyperintense , moderately hyperintense , severely hyperintense , and diffusely hyperintense by a radiologist blinded to treatment allocation . Results . More patients in the  PRP group than controls attained higher stages of remodelling at month 4 ( p=0.003 ) , month 6 ( p=0.0001 ) , and month 12 ( p=0.354 ) . Conclusion . PRP enabled faster remodelling of patellar tendon grafts Sampson S , Reed M , Silvers H , Meng M , M and elbaum B : Injection of platelet-rich plasma in patients with primary and secondary knee osteoarthritis : A pilot study . Objective : To evaluate the clinical effects of intraarticular platelet-rich plasma ( PRP ) injections in a small group of patients with primary and secondary osteoarthritis . Most of the current treatments for osteoarthritis are palliative and attack the symptoms rather than influencing the biochemical environment of the joint . Autologous platelet-rich plasma has emerged as a treatment option for tendinopathies and chronic wounds . In addition to release of growth factors , platelet-rich plasma also promotes concentrated anti-inflammatory signals including interleukin-1ra , which has been a focus of emerging treatments for osteoarthritis . Design : In this single-center , uncontrolled , prospect i ve preliminary study , 14 patients with primary and secondary knee osteoarthritis who met the study criteria received three platelet-rich plasma injections in the affected knee at ∼4-wk intervals . Outcome measures included the Brittberg-Peterson Visual Pain ( Visual Analog Scale [ VAS ] ) , Activities , and Expectations score and the Knee Injury and Osteoarthritis Outcome Scores at preinjection visit at 2- , 5- , 11- , 18- , and 52-wk follow-up visits . Musculoskeletal ultrasound was used to measure cartilage thickness . Results : There were no adverse events reported . The study demonstrated significant and almost linear improvements in Knee Injury and Osteoarthritis Outcome Scores , including pain and symptom relief . Brittberg-Peterson VAS showed many improvements including reduced pain after knee movement and at rest . Cartilage assessment was limited because of the small sample size . The majority of the patients expressed a favorable outcome at 12 mos after treatment . Conclusions : The positive trends and safety profile demonstrated could potentially be used to inspire a larger , blinded , and r and omized clinical trial to determine whether platelet-rich plasma is safe and effective for the treatment of knee osteoarthritis Background : Osteochondral ankle injuries commonly affect the dome of the talus , and these injuries are a common cause of athletic disability . Various treatment options are available for these injuries including intra-articular hyaluronic acid ( HA ) and platelet-rich plasma ( PRP ) injections . The purpose of this study was to compare the effects of HA and PRP as adjunct therapies after arthroscopic microfracture in osteochondral lesions ( OCLs ) of the talus . Methods : In this prospect i ve , r and omized blinded study , 40 patients with talar OCLs in their ankle joints were treated with arthroscopic debridement and a microfracture technique .  Thirteen r and omly selected patients received PRP , 14 patients received HA , and the remaining 13 patients received saline as a control group . The participants were assessed using the American Orthopaedic Foot & Ankle Society ( AOFAS ) and visual analog pain scale ( VAS ) scores after a 15.3-month ( range , 11 - 25 months ) follow-up . Results : Postoperatively , all the groups exhibited significantly increased AOFAS scores and decreased VAS scores compared with their preoperative results ( P < .005 ) . The AOFAS scores were significantly increased in the PRP group versus the HA and control groups ( P < .005 ) , although the increased AOFAS scores in the HA group versus the control group were also significant ( P < .005 ) . Similar to the AOFAS scores , the decrease in the VAS scores was significantly lower in the PRP group versus the HA and control groups ( P < .005 ) . In addition , the HA group had significantly lower VAS scores than the control group ( P < .005 ) . Conclusion : Both PRP and HA injections improved the clinical outcomes of patients who underwent operation for talar OCLs in the midterm period and can be used as adjunct therapies for these patients . Because a single dose of PRP provided better results , we recommend PRP as the primary adjunct treatment option in the talar OCL postoperative period . Level of Evidence : Level I , prospect i ve r and omized study INTRODUCTION Lateral epicondylitis , commonly known as tennis elbow , is the most common cause of lateral elbow pain and the second most frequently diagnosed musculoskeletal disorder in the neck and upper limb in a primary care setting . Many therapeutic options , including conservative , surgical , and minimally invasive procedures , have been advocated for the treatment of lateral epicondylitis . Although numerous small studies have been performed to assess the efficacy of various treatments , there are conflicting results with no clear consensus on the optimal treatment . In an economic environment with limited health care re sources , it is paramount that optimal cost-effective therapies with favorable patient-important outcomes be identified . METHODS AND ANALYSIS This is a protocol paper which outlines a multicenter , multidisciplinary , single-blinded , four-arm r and omized controlled trial , comparing platelet-rich plasma ( PRP ) , whole blood injection , dry needle tendon fenestration , and sham injection with physical therapy alone for the treatment of lateral epicondylitis . Patients are screened based on pre-established eligibility criteria and r and omized to one of the four study groups using an Internet-based system . The patients are followed at 6-week , 12-week , 24-week , and 52-week time points to assess the primary and secondary outcomes of the study . The primary outcome is pain . Secondary outcomes include health-related quality of life and ultrasound appearance of the common extensor tendon .  Two university centers ( McMaster University and the University of Michigan ) are currently recruiting patients . We have planned a sample size of 100 patients ( 25 patients per arm ) to ensure over 80 % power to detect a three-point difference in pain scores at 52 weeks of follow-up . ETHICS AND DISSEMINATION This study has ethics approval from the McMaster University Research Ethics Board ( REB # 12 - 146 ) and the University of Michigan Institutional Review Board ( IRB # HUM00067750 ) . Successful completion of this proposed study will significantly impact clinical practice and enhance patients ' lives . More broadly , this trial will develop a network of collaboration from which further high- quality trials in ultrasound-guided interventions will follow Background Platelet-rich plasma ( PRP ) injections are an experimental treatment for acute muscle injuries . We examined whether PRP injections would accelerate return to play after hamstring injury . The methods and the primary outcome measure were published in the New Engl and Journal of Medicine ( NEJM ) as ‘ Platelet-rich plasma injections in acute muscle injury ’ ( 2014 ) . This article shares information not available in the NEJM letter or online supplement , especially the rationale behind the study and the secondary outcome measures including 1 year re-injury data . Methods We performed a multicentre , r and omised , double-blind , placebo-controlled trial in 80 competitive and recreational athletes with acute hamstring muscle injuries . Details can be found in the NEJM ( http://www.nejm.org/doi/full/10.1056/NEJMc1402340 ) . The primary outcome measure was the time needed to return to play during 6 months of follow-up . Not previously reported secondary outcome scores included re-injury at 1 year , alteration in clinical and MRI parameters , subjective patient satisfaction and the hamstring outcome score . Results In the earlier NEJM publication , we reported that PRP did not accelerate return to play ; nor did we find a difference in the 2-month re-injury rate . We report no significant between-group difference in the 1-year re-injury rate ( HR=0.89 ; 95 % CI , 0.38 to 2.13 ; p=0.80 ) or any other secondary outcome measure . Conclusions At 1-year postinjection , we found no benefit of intramuscular PRP compared with placebo injections in patients with acute hamstring injuries in the time to return to play , re-injury rate and alterations of subjective , clinical or MRI measures Background During lower limb lengthening , poor bone regeneration is a devastating complication . Several local or systemic applications have been used to promote osteogenesis , and biologic stimulations are gaining attention , but their utility has not been proven in this setting . Questions / purpose sIn patients undergoing bilateral tibial lengthening  , we compared those receiving an osteotomy site injection of autologous bone marrow aspirate concentrate ( BMAC ) plus platelet-rich plasma ( PRP ) with those not receiving such an injection in terms of external fixator index ( time in external fixation divided by amount of lengthening ) , full weightbearing index ( time until a patient was permitted to do full weightbearing divided by amount of lengthening ) , four cortical healing indexes ( time until each cortical union divided by amount of lengthening ) , and callus shape and type . Methods Twenty-two patients ( 44 tibias ) undergoing bilateral tibial lengthening enrolled in this r and omized trial . Two patients were excluded , one due to insufficient radiographic evaluation and one who was lost to followup , leaving 20 patients ( 40 segments ) for inclusion . Ten patients ( 20 segments ) received BMAC combined with PRP injection ( treatment group ) and 10 patients ( 20 segments ) received no injection ( control group ) . All patients underwent stature lengthening for familial short stature with the lengthening over nail technique .  Autologous BMAC combined with PRP was injected at the tibial osteotomy site at the end of the index surgery . Mean distraction rates were similar between groups ( 0.75 mm/day in the treatment group versus 0.72 mm/day in the control group ; p = 0.24 ) . Full weightbearing was permitted when we observed radiographic evidence of healing at two cortices ; this assessment was made by the surgeon who was blinded to the treatment each patient received . Minimum followup was 24 months ( mean , 28 months ; range , 24–34 months ) . Results There was no difference in mean external fixator index between groups . However , mean cortical healing indexes ( anterior/posterior/medial/lateral ) were 1.14/0.81/0.96/0.88 months/cm in the treatment group and 1.47/1.26/1.42/1.22 months/cm in the control group ( all p < 0.001 ) , showing faster healing in the treatment group at each cortex . Full weightbearing was permitted earlier in the treatment group than in the control group ( index : 0.99 months/cm and 1.38 months/cm , respectively , p < 0.001 ) . Callus shape and type were not different between groups . Conclusions Autologous BMAC combined with PRP injection at the osteotomy site helped improve bone healing in distraction osteogenesis of the tibia , although the effect size was small . Level of Evidence Level I , therapeutic study . See Instructions for Authors for a complete description of levels of evidence 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 PURPOSE To assess the effect of platelet-rich plasma fibrin matrix ( PRPFM ) construct augmentation on postoperative tendon healing as determined by magnetic resonance imaging ( MRI ) and clinical outcome of arthroscopic rotator cuff repair . METHODS A comparative series of patients undergoing arthroscopic rotator cuff repair was studied . Two matched groups of patients ( 20 each ) were included : rotator cuff repairs without PRPFM augmentation ( group 1 ) and  rotator cuff repairs augmented with 2 sutured platelet-rich plasma ( PRP ) constructs ( group 2 ) . A single-row cuff repair to the normal footprint without tension or marrow vents was performed by a single surgeon . Postoperative rehabilitation was held constant . Postoperative MRI scans were used to evaluate rotator cuff healing . Outcome measures included American Shoulder and Elbow Surgeons , Rowe , Single Assessment Numeric Evaluation , Simple Shoulder Test , and Constant scores . RESULTS We followed up 40 patients ( 2 matched groups with 20 patients each ) with a mean age of 57 years ( range , 44 to 69 years ) for a mean of 31 months ( range , 24 to 44 months ) . Postoperative MRI studies showed persistent full-thickness tendon defects in 60 % of controls ( 12 of 20 ) and 30 % of PRPFM-augmented repairs ( 6 of 20 ) ( P = .03 ) . Of the control group tears measuring less than 3 cm in anteroposterior length , 50 % ( 7 of 14 ) healed fully , whereas 86 % of the PRPFM group tears measuring less than 3 cm in anteroposterior length ( 12 of 14 ) healed fully ( P < .05 ) . There was no significant difference between groups 1 and 2 in terms of American Shoulder and Elbow Surgeons ( 94.7 and 95.7 , respectively ; P = .35 ) , Single Assessment Numeric Evaluation ( 93.7 and 94.5 , respectively ; P = .37 ) , Simple Shoulder Test ( 11.4 and 11.3 , respectively ; P = .41 ) , and Constant ( 84.7 and 88.1 , respectively ; P = .19 ) scores . The Rowe scores ( 84.8 and 94.9 , respectively ; P = .03 ) were statistically different . CONCLUSIONS The addition of 2 PRPFM constructs sutured into a primary rotator cuff tendon repair result ed in lower retear rates identified on MRI than repairs without the constructs . Other than the Rowe scores , there was no postoperative clinical difference by use of st and ard outcome measures . LEVEL OF EVIDENCE Level III , case-control study Objective : The aim of the present study was to evaluate the use of previously frozen , thawed platelet gel supplementation to accelerate the healing of long bone nonunions treated by external fixation . Design : Prospect i ve case series with historical controls . Setting : University Hospital . Patients : Twenty patients affected by tibial , humeral , or forearm atrophic nonunions were treated by percutaneous stabilization with unilateral external fixators and injection of autologous platelet gel . The healing time was compared to the result obtained in a historical control group treated without platelet gel supplementation . Main Outcome Measurements : Consolidation rate and radiographic healing time of nonunions in the 2 groups were assessed by independent blinded observers . The nonunion was judged to be healed when bridging callus formation on both radiographic views was observed on at least 3 of 4 cortices . Results : The healing rate of nonunion was 90 % ( 18/20 ) in platelet gel cases and 85 % ( 17/20 ) in controls , respectively ( P = 0.633 ) . The mean time until radiographic consolidation in nonunions supplemented with platelet gel ( 147 ± 63 days ) was not different to the result in the control group ( 153 ± 61 days ; P = 0.784 ) . Analyzing the mean healing time for separate segments , no differences were noted between study and control group-that is , tibia : 112 ± 43 and 130 ± 5 days , respectively ( P = 0.382 ) ; humerus , 225 ± 36 and 202 ± 70 days , respectively ( P = 0.530 ) . Conclusion : The present study failed to show the clinical usefulness of isolated percutaneous platelet gel supplementation in long bone nonunions treated by external fixation ; however , caution should be exercised in interpreting this result because the actual numbers are small and the statistical power is limited OBJECTIVES To compare the effects of ultrasound-guided platelet-rich plasma ( PRP ) and whole blood ( WB ) injections in patients with chronic hamstring tendinopathy . METHODS In a prospect i ve double-blind r and omized controlled trial , PRP or WB was injected under ultrasound guidance into the proximal hamstring tendon in a cohort of patients with clinical ly suspected hamstring tendinosis . Question naires were administered before injection and 2 , 6 , and 12 weeks and 6 months after injection . Pain and function outcomes were measured via the Modified Harris Hip Score ( MHHS ) , Hip Outcome Scores for activities of daily living ( ADL ) and sport-specific function , and International Hip Outcome Tool 33 ( IHOT-33 ) . Diagnostic ultrasound was used to compare preinjection and 6-month postinjection tendon appearances . RESULTS The WB group showed greater improvements in pain and function over the PRP group before 12 weeks , whereas the PRP group showed improved outcomes over WB at 6 months . None of these between-group outcome measures , except 6-week IHOT-33 , showed statistical significance . Comparing preinjection and 6-month scores , the PRP group showed significant improvements in ADL ( P = .018 ) and IHOT-33 ( P = .28 ) scores , whereas the WB group showed no significant improvements from baseline . The WB group showed significantly decreased pain with 15-minute sitting ( P= .008 ) at 6 months . Ultrasound imaging showed no significant differences between PRP and WB group tendon appearances . CONCLUSIONS Both PRP and WB groups showed improvements in all outcome measures at 6 months . The PRP group showed significant improvements in 6-month ADL and IHOT-33 scores . The WB group reached significance in 15-minute sitting pain . No significant between-group differences were observed at any time point Thirty patients ( 31 elbows ) with epicondylitis unresponsive to nonsurgical treatment ( including steroid injection ) for > 6 months received a single treatment of  platelet-rich plasma injected with a peppering technique . Patients were followed using a 5-subcategory visual analog scale ( VAS ) for pain ( 0 , no pain ; 10 , worst possible pain ) , modified American Shoulder and Elbow Surgeons assessment survey , and VAS for patient satisfaction ( 0 , not at all satisfied ; 10 , very satisfied ) . Successful treatment was defined as a 25 % decrease in worst pain at follow-up with no intervention after 1 year . Two patients ( 2 elbows ) elected for surgery 1 month postinjection . Of the remaining 29 elbows followed , 28 had a 25 % reduction in worst pain at ≥1 follow-up visits , for an overall success rate of 90 % ( 28 of 31 elbows ) . Mean scores for worst pain at baseline , 3 months , and last follow-up ( patients with at least 6 months of follow-up ; 25±14 months ) were 7.2±1.6 ( n=30 elbows ) , 4.0±2.2 ( n=23 ) , and 1.1±1.7 ( n=26 ) , respectively ( P<.01 or less comparing follow-up scores to baseline using each patient as his or her own control ) . Patient satisfaction scores improved from 5.1±2.5 at 1 month to 9.1±1.9 at last follow-up ( P<.01 ) . Only 1 patient reported no improvement after 6 months . Results suggest that a single platelet-rich plasma injection can improve pain and function scores , thus avoiding surgery Distal tibial fractures tend towards delayed- or nonunion . The purpose of this study was to evaluate the safety and efficacy of early minimally invasive intervention ( MII ) in the treatment of these fractures . A total 24 consecutive patients who underwent operative treatment for distal tibial fractures were r and omized into a control and an intervention group . MII entailed aspirating iliac crest bone marrow and peripheral blood , yielding mesenchymal stem cells ( MSCs ) and platelet-rich plasma ( PRP ) respectively , that were mixed with demineralized bone matrix ( DBM ) and injected under fluoroscopic control into the fracture site . No complications occurred in either group . The median time to union was 1.5 months in the MII group and 3 months in the control group . MII was found to be a safe and efficient procedure This r and omized controlled study was conducted to assess the effects of platelet-rich plasma ( PRP ) on outcomes of total knee arthroplasty ( TKA ) . Forty patients who underwent unilateral TKA were evaluated prospect ively ; 20 received intraoperative PRP and 20 served as control subjects . The results showed no significant differences in reduction of bleeding , range of motion , swelling around the knee joint , muscle power recovery , pain , Knee Society Scores , and Knee Injury and Osteoarthritis Outcome Score between the 2 groups . Additionally , no distinct clinical characteristics were found in patients who received intraoperative PRP . Therefore , we conclude that intraoperative PRP does not improve outcomes of TKA Objective : To compare the effects of platelet-rich plasma injection with those of dry needling on shoulder pain and function in patients with rotator cuff disease . Design : A single-centre , prospect i ve , r and omized , double-blinded , controlled study . Setting : University rehabilitation hospital . Participants : Thirty-nine patients with a supraspinatus tendon lesion ( tendinosis or a partial tear less than 1.0 cm , but not a complete tear ) who met the inclusion criteria recruited between June 2010 and February 2011 . Intervention : Two dry needling procedures in the control group and two platelet-rich plasma injections in the experimental group were applied to the affected shoulder at four-week intervals using ultrasound guidance . Measurements : The Shoulder Pain and Disability Index , passive range of motion of the shoulder , a physician global rating scale at the six-month follow-up , adverse effects monitoring and an ultrasound measurement were used as outcome measures . Results : The clinical effect of the platelet-rich plasma injection was superior to the dry needling from six weeks to six months after initial injection ( P < 0.05 ) . At six months the mean Shoulder Pain and Disability Index was 17.7 ± 3.7 in the platelet-rich plasma group versus 29.5 ± 3.8 in the dry needling group ( P < 0.05 ) . No severe adverse effects were observed in either group . Conclusions : Autologous platelet-rich plasma injections lead to a progressive reduction in the pain and disability when compared to dry needling . This benefit is certainly still present at six months after treatment . These findings suggest that treatment with platelet-rich plasma injections is safe and useful for rotator cuff disease Background : Specific growth factors have been proposed as therapeutic proteins for cartilage repair . Hypothesis : Platelet-rich plasma ( PRP ) provides symptomatic relief in early osteoarthritis ( OA ) of the knee . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : A total of 78 patients ( 156 knees ) with bilateral OA were divided r and omly into 3 groups . Group A ( 52 knees ) received a single injection of PRP , group B ( 50 knees ) received 2 injections of PRP 3 weeks apart , and group C ( 46 knees ) received a single injection of normal saline . White blood cell (WBC)–filtered PRP with a platelet count 3 times that of baseline ( PRP type 4B ) was administered in all . All the groups were homogeneous and comparable in baseline characteristics . Clinical outcome was evaluated using the Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) question naire before treatment and at 6 weeks , 3 months , and 6 months after treatment . They were also evaluated for pain by a visual analog scale , and overall satisfaction with the procedure and complications were noted . Results : Statistically significant improvement in all WOMAC parameters was noted in groups A and B within 2 to 3 weeks and lasting until the final follow-up at 6 months , with slight worsening at the 6-month follow-up . The mean WOMAC scores ( pain , stiffness , physical function , and total score ) for group A at baseline were 10.18 , 3.12 , 36.56 , and 49.86 , respectively , and at final follow-up were 5.00 , 2.10 , 20.08 , and 27.18 , respectively , showing significant improvement . Similar improvement was noted in group B ( mean WOMAC scores at baseline : 10.62 , 3.50 , 39.10 , and 53.20 , respectively ; mean WOMAC scores at final follow-up : 6.18 , 1.88 , 22.40 , and 30.48 , respectively ) . In group C , the mean WOMAC scores deteriorated from baseline ( 9.04 , 2.70 , 33.80 , and 45.54 , respectively ) to final follow-up ( 10.87 , 2.76 , 39.46 , and 53.09 , respectively ) . The 3 groups were compared with each other , and no improvement was noted in group C as compared with groups A and B ( P < .001 ) . There was no difference between groups A and B , and there was no influence of age , sex , weight , or body mass index on the outcome . Knees with Ahlback grade 1 fared better than those with grade 2 . Mild complications such as nausea and dizziness , which were of short duration , were observed in 6 patients ( 22.2 % ) in group A and 11 patients ( 44 % ) in group B. Conclusion : A single dose of WBC-filtered PRP in concentrations of 10 times the normal amount is as effective as 2 injections to alleviate symptoms in early knee OA . The results , however , deteriorate after 6 months . Both groups treated with PRP had better results than did the group injected with saline only Background : Tendinopathy is characterized by alterations in the tendon structure , but there are conflicting results on the potential of tendon structure normalization and no large studies on the quantified , ultrasonographic tendon structure and its association with symptoms . Purpose : To determine whether the tendon structure returns to values of asymptomatic individuals after treatment with 2 substances injected within the tendon  , to assess the association between the tendon structure and symptoms , and to assess the prognostic value of the baseline tendon structure on treatment response . Study Design : Cohort study ; Level of evidence , 2 . Methods : This study was part of a r and omized trial on chronic midportion Achilles tendinopathy using eccentric exercises with either a platelet-rich plasma or saline injection . Symptoms were recorded using the Victorian Institute of Sports Assessment –Achilles ( VISA-A ) question naire . The tendon structure was quantified with ultrasound tissue characterization ( UTC ) ; echo types I + II ( as a percentage of total tendon types I-IV ) are structure related . Follow-up was at 6 , 12 , 24 , and 52 weeks . A control group of asymptomatic subjects ( similar age ) was selected to compare the tendon structure . Patient symptomswere correlated with the tendon structure using a linear model . Results : Fifty-four patients were included in the symptomatic group .  The mean ( ±SD ) echo types I + II in the symptomatic group increased significantly from 74.6 % ± 10.8 % at baseline to 85.6 % ± 6.0 % at 24-week follow-up . The result for echo types I + II at 24 weeks was not significantly different ( P = .198 ) from that of the asymptomatic control group ( 87.5 % ± 6.0 % ) . In 54 repeated measurements at 5 time points , the adjusted percentage of echo types I + II was not associated with the VISA-A score ( main effect : β = .12 ; 95 % CI , −0.12 to 0.35 ; P = .338 ) . The adjusted baseline echo types I + II were not associated with a change in the VISA-A score from baseline to 52 weeks ( β = −.15 ; 95 % CI , −0.67 to 0.36 ; P = .555 ) . Conclusion : In symptomatic , tendinopathic Achilles tendons , the ultrasonographic tendon structure improved during nonoperative treatment and normalized after 24 weeks to values of matched asymptomatic controls . There was no association between the tendon structure and symptoms . The percentage of echo types I + II before treatment was not associated with change in symptoms over time . This study demonstrates that restoration of the tendon structure is not required for an improvement of symptoms Background : Chronic plantar fasciitis is a common orthopedic condition that can prove difficult to successfully treat . In this study , autologous platelet-rich plasma ( PRP ) , a concentrated bioactive blood component rich in cytokines and growth factors , was compared to traditional cortisone injection in the treatment of chronic cases of plantar fasciitis resistant to traditional nonoperative management . Methods : Forty patients ( 23 females and 17 males ) with unilateral chronic plantar fasciitis that did not respond to a minimum of 4 months of st and ardized traditional nonoperative treatment modalities were prospect ively r and omized and treated with either a single ultrasound guided injection of 3 cc PRP or 40 mg DepoMedrol cortisone .  American Orthopedic Foot and Ankle Society ( AOFAS ) hindfoot scoring was completed for all patients immediately prior to PRP or cortisone injection ( pretreatment = time 0 ) and at 3 , 6 , 12 , and 24 months following injection treatment . Baseline pretreatment radiographs and MRI studies were obtained in all cases to confirm the diagnosis of plantar fasciitis . Results : The cortisone group had a pretreatment average AOFAS score of 52 , which initially improved to 81 at 3 months posttreatment but decreased to 74 at 6 months , then dropped to near baseline levels of 58 at 12 months , and continued to decline to a final score of 56 at 24 months . In contrast , the PRP group started with an average pretreatment AOFAS score of 37 , which increased to 95 at 3 months , remained elevated at 94 at 6 and 12 months , and had a final score of 92 at 24 months . Conclusions : PRP was more effective and durable than cortisone injection for the treatment of chronic recalcitrant cases of plantar fasciitis . Level of Evidence : Level I , prospect i ve r and omized comparative series
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