Service de Radiologie, Hôpital universitaire Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris-Diderot, 5, rue Thomas-Mann, 75205 Paris cedex 13, France; Inserm U698, Hôpital universitaire Bichat, Secteur C.-Bernard, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
Diagn Interv Imaging. 2013 Sep;94(9):871-7. doi: 10.1016/j.diii.2013.05.010. Epub 2013 Aug 6.
Tendinopathy is a frequent and ubiquitous disease developing early disorganized collagen fibers with neo-angiogenesis on histology. Peritendinous injection of corticosteroid is the commonly accepted strategy despite the absence of inflammation in tendinopathy. Platelet-rich plasma (PRP) might be a useful strategy to rapidly accelerate healing of the tendinopathy but there is a lack ok knowledge about the amount of PRP to be injected and the opportunity of a second injection in case of partial pain relief. The aim of our study was to assess the potential therapeutic effect of early second PRP intra-tendinous to treat persistent painful tendon tear and tendinosis in a long-term follow-up by ultrasonography (US) and clinical data in case of incomplete efficiency of first PRP treatment injection.
Twenty-four consecutive patients referred for US treatment of tendon tear or tendinosis (T+) were included retrospectively. All had previously received a single intra-tendinous injection of PRP under US guidance (PRPT+) and benefited of a second PRP injection (PRPT2+) under US guidance in order to treat persistent painful. US and clinical data were collected for each anatomic compartment for upper and lower limbs before treatment (D0), 6 weeks (W6) after first treatment, 6 weeks (W12) after second treatment and until 32-month follow-up. We used Mac Nemar test and regression model to compare US and clinical data.
The residual US size of lesions was not significantly lower at W12 after PRPT2+ as compared to W6 (P=0.86 in upper and P=NS in lower member) independently of age (P=0.22), gender (P=0.97) and kind of tendinopathy (P=NS). Quick dash test values and WOMAC values were not significantly lower in PRPT+ at W12 (average: 21.5 months) as compared to W6 (P>0.66) and long-term follow-up (P>0.75) independently of age (P=0.39), gender (P=0.63) and kind of tendinopathy (P=NS). Nevertheless, comparison between D0 and long-term follow-up (LTF) functionnal score was statistically significant (p<0.001 in upper and lower member).
Our study suggests that second early intra-tendinous PRP injection under US guidance does not permit rapid decrease of tendinopathy area in US, nor does it quickly improve clinical pain and functional data in case of incomplete efficiency of first PRP injection. However, in long-term follow-up, patients improved their ability to mobilize pathologic tendons.
组织病是一种常见且普遍的疾病，其组织学表现为早期排列紊乱的胶原纤维和新生血管形成。尽管肌腱病中不存在炎症，但皮质类固醇的腱周注射仍是一种常用的治疗策略。富含血小板的血浆（PRP）可能是一种加速肌腱病愈合的有用策略，但对于要注射的 PRP 量以及在部分疼痛缓解的情况下进行第二次注射的机会，缺乏相关知识。我们的研究旨在通过超声（US）和临床数据评估早期第二次 PRP 腱内注射治疗持续性疼痛性肌腱撕裂和肌腱病的潜在治疗效果，如果第一次 PRP 治疗注射不完全有效，可进行第二次注射。
回顾性纳入 24 例因超声治疗肌腱撕裂或肌腱病（T+）而转诊的连续患者。所有患者均曾接受过单次超声引导下 PRP 腱内注射（PRPT+）治疗，并接受了第二次超声引导下 PRP 注射（PRPT2+）治疗，以治疗持续性疼痛。在治疗前（D0）、第一次治疗后 6 周（W6）、第二次治疗后 6 周（W12）和 32 个月随访时，收集每个解剖部位的 US 和临床数据。我们使用 Mac Nemar 检验和回归模型比较 US 和临床数据。
与 W6 相比，第二次 PRPT2+治疗后 W12 时病变的 US 大小残留无显著降低（上肢体：P=0.86；下肢体：P=NS），与年龄（P=0.22）、性别（P=0.97）和肌腱病类型（P=NS）无关。与 W6（P>0.66）和长期随访（P>0.75）相比，PRPT+治疗后 W12 时快速短跑测试值和 WOMAC 值无显著降低，与年龄（P=0.39）、性别（P=0.63）和肌腱病类型（P=NS）无关。然而，上、下肢体的功能评分在 D0 与长期随访之间的比较具有统计学意义（p<0.001）。
我们的研究表明，在超声引导下进行第二次早期 PRP 腱内注射并不能迅速减少肌腱病的超声面积，也不能迅速改善第一次 PRP 注射不完全有效的情况下的临床疼痛和功能数据。然而，在长期随访中，患者改善了移动病理性肌腱的能力。
