Paper 16: Effectiveness of hematoma aspiration and platelet-rich plasma muscle injections for the treatment of hamstring strains in athletes

Abstract

Objectives:The effect of platelet-rich plasma (PRP) treatment on recovery in acute hamstring injuries is controversial. Previous study results are inconsistent, and a standardized therapeutic approach has not been established yet. The objective of the study was to assess the treatment effect using a combination of hematoma aspiration and muscle strain PRP injection in partial hamstring muscle tears (grade 2 strains) in athletes.Methods:MRIs of athletes with grade 2 hamstring strains were reviewed from 2013 to 2018. From 2013 to 2015 athletes were treated conservatively and from 2016 to 2018 with a combination of ultrasound-guided hematoma aspiration and PRP muscle strain injection. The outcome, including return-to-play (in days) and recurrence rate, was compared retrospectively between both groups (conservative vs. aspiration/PRP) using ANOVA and Fisher’s Exact test. There was no significant difference in age, type of sport, and muscle involvement (including injury grade/location, hamstring muscle type, and length/cross-sectional area of the strain).Results:Fifty-five athletes (28 treated conservatively, 27 with hematoma aspiration/PRP injection) were included. Average return-to-play time (mean) was 32.4 days in the conservative group and 23.5 days in the aspiration/PRP group (p<0.001). Recurrence rate of the hamstring strain was 28.6% (8/28) in the conservative treatment group and less than 4% (1/27) in the aspiration/PRP group (p=0.025).Conclusions:Athletes with grade 2 hamstring strains treated with a combination of hematoma aspiration and PRP injection had a significantly shorter return-to-play and a lower recurrence rate compared to athletes receiving conservative treatment.Axial T2-weighted fat saturated image in a 24-year-old athlete shows a grade 2 strain of the biceps femoris muscle with hemorrhage/hematoma (dashed arrow) surrounding the sciatic nerve (solid arrow).Corona STIR image of the thighs in a 27-year-old athlete with a grade 2 strain of the right biceps femoris muscle shows muscle edema and fluid (solid arrow). A feathery pattern of edema is also present (dashed arrow).Axial/cross-sectional ultrasound image of the right hamstring muscle in a 25-year-old athlete shows a grade 2 strain of the semitendinosus muscle (dashed arrow) and the adjacent normal portion of the muscle (solid arrow).Long axis ultrasound image in the same patient shows hemorrhage/hematoma (solid arrow) surrounding the sciatic nerve (asterisk).