Ph ADAM, MDSports Clinic

Medipole Garonne Toulouse France

11ème congrès de la Société Marocaine

d’Arthroscopie03-04 Février 2017 à

Marrakech

PRP Therapy for Tendonitis Fasciitis Acute Sprains and Muscular Lesions

By UltraSonographic Guidance

Tobermory (Scotland, Mull Island)

A/Diagnosis with UltraSonic (US) Imaging is easy, rapid and inexpensive

1/ Accurate localization and palpation of lesions with Ultrasonic Probe : pain ? +++

2/ Morphological study (static and dynamic) is better, simpler and faster with US than with MRI

Hypoechogenic tendon+++ with loss of fibrillar structure Thickening Nodule Tendinous slot

Bursitis Enthesitis Muscular cavity Gap

3/Vascularization and Tissue Elasticity can be estimated

B/Treatment by US Guiding of needle and injection is efficient

1/ mechanical way : needling, tenotomy, evacuation of collection

2/ biochemical way : direct injection of PRP (growth factors)into a cavity and around tendon or fascia

(collagen synthesis and stimulation of cells)

C/US evaluation of anatomical improvement after PRP and correlation with clinical improvement

Pain Echogenicity Size of lesions

Vascularization Elasticity

Tendonitis and Fasciitis are Mechanical and Degenerative diseases

(collagen tears+++ neovessels)

Non-Inflammatory disease

« There is increasing evidence that EUS can be used to measure the mechanical properties of musculoskeletal tissue in clinical practice, with the future potential for early diagnosis to both guide and monitor therapy »

The British Journal of Radiology, 85 (2012), 1435–1445

REVIEW ARTICLE Ultrasound elastography for musculoskeletal

applications 1E E DRAKONAKI, MD, PhD, 2G M ALLEN, FRCR, MRCP and 2D J WILSON, FRCP,

FRCR

Efficacy of intra-tendinous injection of platelet-rich plasma in treating tendinosis : Comprehensive assessment of a rat model

Benjamin Dallaudière et al, Eur Radiol (2013) 23:2830–2837, DOI 10.1007/s00330-013-2926-7

PRP treatment for tendons is not a placebo !!!

Achille tendonitis : Double Needle Approach (premedication, meopa)

Achille tendonitis : Double Needle Approach (big slit)

Achille’s tendonitis : cavity in the body of tendon and nodule

Filling of cavity by PRP

Antalgic Effect and Healing : less firm and less thick tendon at 5 weeks

Patellar Tendonitis

B G W

Patellar Tendonitis : 2 targets (upper, lower) , 2 needles

Lower part

Upper part

Vascularization is increased under patella

Patellar Tendonitis

US guided injection of PRP for elbow (lateral epicondylitis)

Lateral epicondylitis : PRP « filling » of intra-tendinous tear

Calcifying epicondylitis : PRP « crushing »

Edematous lateral epicondylitis (before and after)

After PRP tendon is thin and homogeneous

Vascularization is increased into the tendon

Posterior tibial tendonitis (ankle, table tennis)Injection of PRP around the tendon (synovial sheath)

Plantar Fasciitis : spreading of PRP under US control

Partial disruption of plantar fascia (rugby, before and after PRP, no pain 4 weeks)

Total disruption

Biceps Femoris tendonitis at the knee (fibular insertion)

US guided filling by PRP Pain and cleft decreased at one month

Rotator cuff tendonitis with tear (shoulder)

Brèche Supra-Epineux

Acute recent Lateral ankle Sprain and Chronic pain after Sprain

Needle under the anterior fascicle of collateral lateral ligament

Hypervascularization of the scar in front of synovial wall3 weeks after

Acute knee Sprain (Medial Collateral

Ligament)

Axial US plane

Coronal US plane

Separation between capsulo-meniscal plane and medial collateral ligament

PRP spreading

Bigard : J Traum Sport (2012) 29, 164-170

For muscular lesions we are also using biochemical way (growth factors : stimulation of promyoblastic cells

« stem cells like » for scaffolding)

And mechanical way (draining of haematoma and occupation of the empty space by muscular fascicles)

Rectus femoris desinsertion : 1/US draining of haematoma 2/PRP filling of the cavity under US control 3/compression device

After draining

Before drainingOne month

control

Adductor long muscle desinsersion : 1/US draining of haematoma 2/PRP filling of the cavity under US control 3/Compression device

Hamstring muscle is brocken at the ischiatic enthesis PRP therapy is a very good alternative to surgery

Groin Strain (soccer)

Myo-aponeurotic desinsertion : Medial Gastrocnemius

Slowly emptying then filling (US guiding)

Key Points (tendonitis, fasciitis, sprain, muscle)

*PRP treatment with US guidance is easy and accurate with poor risks and adverse effects very limited

*PRP treatment is usually performed with only one injection

*Healing speed is highly increased with PRP (in vitro and in vivo proved)

*PRP treatment is a team working (look after the cause of the

conflict and not only the consequence, sport overtraining)

*Early treatment = Early recovery for Sportmen

(very fast for muscle injuries)