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Published in: Skeletal Radiology 4/2019

01-04-2019 | Scientific Article

Platelet-rich plasma vs. steroid injections for hamstring injury—is there really a choice?

Authors: Peter Yong Soo Park, Chunyan Cai, Pritish Bawa, Manickam Kumaravel

Published in: Skeletal Radiology | Issue 4/2019

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Abstract

Objective

To assess the effectiveness of pain relief in patients with grade 2 proximal hamstring injury, treated with platelet-rich plasma (PRP) or corticosteroid injection, by using the primary outcome of visual analog scale (VAS) at 1 week and 4 weeks of follow-up.

Materials and methods

A single institution retrospective study was performed for image-guided PRP or steroid injections between 12/1/2015 and 10/30/2017 for proximal hamstring injuries. VAS was measured at 1 week and 4 weeks post-injection via telephone interviews and the pain response was recorded into two groups (negative/no change vs. positive). A comparison of pain responses between PRP and steroid was conducted by generalized estimating equation.

Results

Among 56 patients, 32 received PRP and 24 received steroid injections with ages from 13 to 75 years old. At 1 week post-injection follow-up, 23 patients (71.9%) from the PRP group and 11 patients (45.8%) from the steroid group showed positive response. After controlling for age, pre-procedure pain level, and gender, the positive response rate in the PRP group was higher than the steroid group (aOR: 4.04, 95% CI: 1.04–15.63, p value = 0.04). At 4 weeks post-injection, 23 patients (71.9%) from the PRP group and 13 patients (54.2%) from the steroid group showed positive response with no statistical significance (aOR: 2.48, 95% CI: 0.63–9.79, p value = 0.19).

Conclusions

The PRP group had shown more favorable response compared to steroid group at 1 week post-injection, which suggests that PRP therapy can be considered as a conservative treatment choice for grade 2 proximal hamstring injuries with better short-term pain relief based on limited pilot data.
Literature
1.
go back to reference Lempainen L, Sarimo J, Mattila K, et al. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med. 2009;37:727–34.CrossRefPubMed Lempainen L, Sarimo J, Mattila K, et al. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med. 2009;37:727–34.CrossRefPubMed
2.
go back to reference Chaudhury S, De La Lama M, Adler RS, et al. Platelet-rich plasma for the treatment of lateral epicondylitis: sonographic assessment of tendon morphology and vascularity (pilot study). Skelet Radiol. 2013;42:91–7.CrossRef Chaudhury S, De La Lama M, Adler RS, et al. Platelet-rich plasma for the treatment of lateral epicondylitis: sonographic assessment of tendon morphology and vascularity (pilot study). Skelet Radiol. 2013;42:91–7.CrossRef
3.
go back to reference Van Den Dolder J, Mooren R, Vloon A, et al. Platelet-rich plasma: quantification of growth factor levels and the effect on growth and differentiation of rat bone marrow cells. Tissue Eng Part A. 2010;16:1021–9.CrossRef Van Den Dolder J, Mooren R, Vloon A, et al. Platelet-rich plasma: quantification of growth factor levels and the effect on growth and differentiation of rat bone marrow cells. Tissue Eng Part A. 2010;16:1021–9.CrossRef
4.
go back to reference Sampson S, Gerhardt M, Mandelbaum B. Platelet-rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskeletal Med. 2008;1:165–74.CrossRef Sampson S, Gerhardt M, Mandelbaum B. Platelet-rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskeletal Med. 2008;1:165–74.CrossRef
5.
go back to reference Menetrey J, Kasemkijwattana C, Day C, et al. Growth factors improve muscle healing in vivo. J Bone Joint Surg (Br). 2000;82:131–7.CrossRef Menetrey J, Kasemkijwattana C, Day C, et al. Growth factors improve muscle healing in vivo. J Bone Joint Surg (Br). 2000;82:131–7.CrossRef
6.
go back to reference Crane D, Everts P. Platelet-rich plasma (PRP) matrix graphs. Pract Pain Manag. 2008;8(1):12–26. Crane D, Everts P. Platelet-rich plasma (PRP) matrix graphs. Pract Pain Manag. 2008;8(1):12–26.
7.
go back to reference Foster T, Puskas B, Mandelbaum B, et al. Platelet-rich plasma from basic science to clinical applications. AM J Sports Med. 2009;37:2259–72.CrossRefPubMed Foster T, Puskas B, Mandelbaum B, et al. Platelet-rich plasma from basic science to clinical applications. AM J Sports Med. 2009;37:2259–72.CrossRefPubMed
8.
go back to reference Karli D, Robinson B. Platelet-rich plasma for hamstring tears. Pract Pain Manag. 2010;10(5):17–18. Karli D, Robinson B. Platelet-rich plasma for hamstring tears. Pract Pain Manag. 2010;10(5):17–18.
9.
go back to reference Habib GS, Saliba W, Nashashibi M. Local effects of intra-articular corticosteroids. Clin Rheumatol. 2010;29:347–56.CrossRefPubMed Habib GS, Saliba W, Nashashibi M. Local effects of intra-articular corticosteroids. Clin Rheumatol. 2010;29:347–56.CrossRefPubMed
10.
go back to reference Diiorio TM, Burkholder JD, Good RP, Parvizi J, Sharkey PF. Platelet-rich plasma does not reduce blood loss or pain or improve range of motion after TKA. Clin Orthop Relat Res. 2012;470:138–43.CrossRefPubMed Diiorio TM, Burkholder JD, Good RP, Parvizi J, Sharkey PF. Platelet-rich plasma does not reduce blood loss or pain or improve range of motion after TKA. Clin Orthop Relat Res. 2012;470:138–43.CrossRefPubMed
11.
go back to reference Lai LP, Stitik TP, Foye PM, Georgy JS, Patibanda V, Chen B. Use of platelet-rich plasma in intra-articular knee injections for osteoarthritis: a systematic review. PM R. 2015;7:637–48.CrossRefPubMed Lai LP, Stitik TP, Foye PM, Georgy JS, Patibanda V, Chen B. Use of platelet-rich plasma in intra-articular knee injections for osteoarthritis: a systematic review. PM R. 2015;7:637–48.CrossRefPubMed
12.
13.
go back to reference Hamid MS, Mohamed Ali MR, Yusof A, et al. Platelet-rich plasma injections for the treatment of hamstring injuries: a randomized controlled trial. Am J Sports Med. 2014;42(10):2410–8.CrossRef Hamid MS, Mohamed Ali MR, Yusof A, et al. Platelet-rich plasma injections for the treatment of hamstring injuries: a randomized controlled trial. Am J Sports Med. 2014;42(10):2410–8.CrossRef
14.
go back to reference Mlynarek RA, Kuhn AW, Bedi A. Platelet-rich plasma in orthopedic sports medicine. Am J Orthop. 2016;45(5):290–326.PubMed Mlynarek RA, Kuhn AW, Bedi A. Platelet-rich plasma in orthopedic sports medicine. Am J Orthop. 2016;45(5):290–326.PubMed
15.
go back to reference Wetzel RJ, Patel RM, Terry MA. Platelet-rich plasma as an effective treatment for proximal hamstring injuries. Orthopedics. 2013;36(1):e64–70.CrossRefPubMed Wetzel RJ, Patel RM, Terry MA. Platelet-rich plasma as an effective treatment for proximal hamstring injuries. Orthopedics. 2013;36(1):e64–70.CrossRefPubMed
16.
go back to reference De Vos RJ, Weir A, van Schie HT, et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010;13(303):144–9.CrossRef De Vos RJ, Weir A, van Schie HT, et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010;13(303):144–9.CrossRef
17.
go back to reference De Vos RJ, Windt J, Weir A. Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review. Br J Sports Med. 2014;48:952–6.CrossRefPubMed De Vos RJ, Windt J, Weir A. Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review. Br J Sports Med. 2014;48:952–6.CrossRefPubMed
18.
go back to reference Bird SB, Dickson EW. Clinically significant changes in pain along the visual analog scale. Ann Emerg Med. 2001;38:639–43.CrossRefPubMed Bird SB, Dickson EW. Clinically significant changes in pain along the visual analog scale. Ann Emerg Med. 2001;38:639–43.CrossRefPubMed
19.
go back to reference Nourissat G, Ornetti P, Berenbaum F, et al. Does platelet-rich plasma deserve a role in the treatment of tendinopathy? Joint Bone Spine. 2015;82(4):230–4.CrossRefPubMed Nourissat G, Ornetti P, Berenbaum F, et al. Does platelet-rich plasma deserve a role in the treatment of tendinopathy? Joint Bone Spine. 2015;82(4):230–4.CrossRefPubMed
20.
go back to reference Dean BJ, Lostis E, Oakley T, et al. The risks and benefits of glucocorticoid treatment for tendinopathy: a systemic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum. 2014;43(4):570–6.CrossRefPubMed Dean BJ, Lostis E, Oakley T, et al. The risks and benefits of glucocorticoid treatment for tendinopathy: a systemic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum. 2014;43(4):570–6.CrossRefPubMed
21.
22.
go back to reference Bava ED, Barber FA. Platelet-rich plasma products in sports medicine. Phys Sportsmed. 2011;39(3):94–9.CrossRefPubMed Bava ED, Barber FA. Platelet-rich plasma products in sports medicine. Phys Sportsmed. 2011;39(3):94–9.CrossRefPubMed
23.
go back to reference Davenport KL, Campos JS, Nguyen J, et al. Ultrasound-guided intratendinous injections with platelet-rich plasma or autologous whole blood for treatment of proximal hamstring tendinopathy. J Ultrasound Med. 2015;34:1455–63.CrossRefPubMed Davenport KL, Campos JS, Nguyen J, et al. Ultrasound-guided intratendinous injections with platelet-rich plasma or autologous whole blood for treatment of proximal hamstring tendinopathy. J Ultrasound Med. 2015;34:1455–63.CrossRefPubMed
24.
go back to reference Hamid MS, Ali MR, Yusof A, et al. Platelet-rich plasma: an adjuvant to hasten hamstring muscle recovery. A randomized controlled trial protocol. BMC Musculoskelet Disord. 2012;13:138.CrossRef Hamid MS, Ali MR, Yusof A, et al. Platelet-rich plasma: an adjuvant to hasten hamstring muscle recovery. A randomized controlled trial protocol. BMC Musculoskelet Disord. 2012;13:138.CrossRef
25.
go back to reference Gautam VK, Verma S, Batra S, et al. Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. J Orthop Surg. 2015;23(1):1–5.CrossRef Gautam VK, Verma S, Batra S, et al. Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. J Orthop Surg. 2015;23(1):1–5.CrossRef
26.
go back to reference Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73(1):13–22.CrossRef Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73(1):13–22.CrossRef
Metadata
Title
Platelet-rich plasma vs. steroid injections for hamstring injury—is there really a choice?
Authors
Peter Yong Soo Park
Chunyan Cai
Pritish Bawa
Manickam Kumaravel
Publication date
01-04-2019
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 4/2019
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-018-3063-9

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