Compare the Efficacy of Eccentric Exercises Integrated with either Ultrasound-Guided Leukocyte- Rich PRP Injection (Including Dry Needling) or Ultrasound-Guided Dry Needling Alone: Case Series

Authors : Dr. Ruchit Shah, Dr. Vikas Trivedi, Dr. Vipin Gupta, Dr. Abhishek Pandey, Dr. Urvi Khambhati, Feral Daruwala

Volume/Issue : Volume 4 - 2019, Issue 12 - December

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 Background As already well known, patellar tendinopathy symptoms are recovered after the injections of platelet- rich plasma (PRP), still to date, rarely few studies have worked on comparison of PRP with dry needling (DN) for this condition.  Purpose To compare the efficacy of eccentric exercises integrated with either ultrasound-guided leukocyte-rich PRP injection (including dry needling) or ultrasound- guided dry needling alone in the treatment of patellar tendinopathy.  Study Design Retrospective, nonrandomized, open label, comparative case series included 50 patients of PT visited at Era’s medical college, Lucknow, Uttarpradesh between October 2018 to October 2019.  Methods As per exclusion and inclusion criteria, the patient was recruited in the study after diagnosed by clinical investigation and magnetic resonance imaging. Patients (n=50) divided into two groups and received ultrasound- guided DN alone (DN group; n = 23) or with the injection of leukocyte-rich PRP (PRP group; n = 27), along with standardized eccentric exercises. After treatment during further follow-up visits (at baseline, 12 and 26 weeks) enrolled patients were asked to complete patient-reported outcome questionnaires. Victorian Institute of Sports Assessment (VISA) scores, the visual analog scale (VAS) for pain. Tegner activity scale, Lysholm knee scale, and short form (SF-12) questionnaire were the outcome parameter that was estimated at baseline and follow up visits.  Results There was a significant difference in the mean VISA score for DM group (M=4.2, SD=1.3) and PRP group at the baseline (P=<0.001) and after 12 weeks (P=0.001) and 26 weeks (P=<0.001) of treatment. Similarly, the mean Lysholm score was significantly more evident in DM group compared to the PRP group after 26 weeks (P=<0.001) of treatment. Controversy, the mean Lysholm score was significantly less evident in the DM group compared to the PRP group at baseline (P=<0.001) and after 12 weeks (P=0.001) of treatment. SF-12 score was significantly higher in DM group compared to the PRP group at baseline (P=0.015) and, in further follow-up, it was not significantly different.  Conclusion Remedial of standardized eccentric exercise and ultrasound-guided leukocyte-rich PRP injection with DN group induces the improvement in symptoms of patellar tendinopathy compared to ultrasound-guided DN alone, but over time, the explicit advantage of PRP disappeared.

Keywords : Tendinopathy; Eccentric Exercise; Platelet- Rich Plasma; Ultrasound-Guided Dry Needling; Victorian Institute of Sports Assessment Score.


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