Ultrasound-guided Platelet-rich Plasma Research Articles

The Biological Effect of Platelet-Rich Plasma on Rotator Cuff Tears: A Prospective Randomized In Vivo Study.

The positive effect of platelet-rich plasma (PRP) on tendon metabolism has been extensively investigated and proven in vitro. Additionally, in vivo animal studies have correlated the application of PRP with the enhancement of tenocyte anabolic activity in the setting of tendon degeneration. However, less is known about its in vivo effect on human tendon biology. The purpose of the current prospective randomized comparative study was to evaluate the effect of PRP on torn human supraspinatus tendon. Twenty consecutive eligible patients with painful and magnetic resonance imaging (MRI)-confirmed degenerative supraspinatus tendon tears were randomized in a one-to-one ratio into two groups. The patients in the experimental group (n = 10) underwent an ultrasound-guided autologous PRP injection in the subacromial space 6 weeks before the scheduled operation. In the control group (n = 10), no injection was made prior to surgery. Supraspinatus tendon specimens were harvested from the lateral end of the torn tendon during shoulder arthroscopy and were evaluated under optical and electron microscopy. In the control group, a mixed cell population of oval and rounded tenocytes within disorganized collagen and sites of accumulated inflammatory cells was detected. In contrast, the experimental group yielded abundant oval-shaped cells with multiple cytoplasmic processes within mainly parallel collagen fibers and less marked inflammation, simulating the intact tendon structure. These findings indicate that PRP can induce microscopic changes in the ruptured tendon by stimulating the healing process and can facilitate a more effective recovery.

Effectiveness of ultrasound guided platelet rich plasma injection in comparison with extracorporeal shock wave therapy on improving pain and function in medial epicondylitis of elbow: a randomized controlled trial

Background: Effectiveness of ultrasound guided Platelet Rich Plasma injection in comparison with extracorporeal shock wave therapy on improving pain and function in medial epicondylitis of elbow: A randomized controlled trial Objective was to determine the effectiveness of ultrasound guided Platelet Rich Plasma injection in comparison with extracorporeal shock wave therapy on improving pain and function in medial epicondylitis of elbow. Methods: Randomized controlled trial was conducted on fifty-four patients with medial epicondylitis of elbow attending Sports Medicine OPD at RIMS, hospital, Imphal, were selected for this study and randomized into 2 treatment groups: platelet rich plasma injection and extracorporeal shock wave therapy. The outcome measures were visual analog scale and Mayo elbow performance score. For descriptive statistics mean, standard deviation and frequency were used. Students t-test and Chi square tests were used for analysis of different variables. A p-value <0.05 was taken as significant. Results: The baseline characteristics of the patients in the control and intervention group were not statistically significant. At the end of 12 weeks and 24 weeks, there was statistically significant improvement in both mean difference of VAS (p=0.04) (p=0.03) and MEPS (p=0.00) (p=0.03) from baseline in both the groups but this improvement was significantly more in the PRP group. Conclusions: Platelet rich plasma injection is superior to extracorporeal shock wave therapy on improving pain and function in medial epicondylitis at the end of 6 months.

Ultrasound-Guided PRP and SVF Therapy Shows Sustained Improvement in Severe Knee Osteoarthritis: A 12-Month Retrospective Study.

BACKGROUND Knee osteoarthritis (OA) is a chronic disease caused by cartilage degeneration in the joint accompanied by joint deformities, pain, and stiffness. This study assessed the changes over time in the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) and Visual Analog Scale (VAS) values of patients after the combined application of stromal vascular fraction (SVF) and platelet-rich plasma (PRP). MATERIAL AND METHODS A retrospective clinical study was designed. Thirty-four patients (8 males, 26 females, mean age 65.21±10.71, range 30-83 years) with pain due to knee osteoarthritis received SVF and PRP between 2019 and 2020. During and after the procedure, ultrasound-guided intra-articular spread was checked. RESULTS PRP+SVF injection provided significant improvement in the clinical symptoms of the patients measured according to their VAS and WOMAC scores, and this improvement continued until the twelfth month. The change in VAS scores of the patients was 1.76±1.18 (P=0.000) in the first month, 1.50±1.46 (P=0.000) in the sixth month, and 1.53±1.41 (P=0.000) in the twelfth month. VAS scores decreased 6.6 to 1.6 point at the end of the twelfth month. The WOMAC scores of the patients were 23.20±12.12 (P=0.000) in the first month, 19.48±12.0 (P=0.000) in the sixth month, and 20.01±10.48 (P=0.000) in the twelfth month. WOMAC scores decreased 51.99 to 20.48 point at the end of the twelfth month. CONCLUSIONS Applying ultrasound-guided PRP+SVF injection into the knee joint once in OA patients improved VAS and WOMAC scores.

Platelet-Rich Plasma Treatments of Horizontal Meniscal Tears: A Comparative Analysis

Background: Meniscus injuries remain the most common indication for orthopedic surgery. Due to advances in magnetic resonance imaging (MRI), the number of patients diagnosed with meniscus injuries that do not extend into the articular surface has increased. Although treatments of complete meniscal tears are defined, treatment of meniscus injuries that do not extend into the articular surface is not clear yet.Objective: To determine the most optimal way of delivering platelet-rich plasma (PRP) into the knee joint for treatment of meniscus injuries (not extending into the articular surface) so that patients would improve clinically, and it would have also an effect on the meniscus shown on MRI.Materials and methods: We studied treatment results in 87 patients (50 men and 37 women). The patients were divided into 2 groups: group 1 received an ultrasound-guided PRP injection into the posterior horn, and group 2 received a standard intra-articular PRP injection via the superolateral approach. The treatment efficacy was assessed using visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, Lysholm score, and Knee Society Score (KSS). We also assessed changes on MRI 6 and 12 months after treatment.Results: The comparative analysis demonstrated that based on the findings of scores and MRI the ultrasound-guided intrameniscal PRP injection is more effective.Conclusions: Our results show that the intrameniscal PRP injection is a more effective and safe way to treat such meniscus injuries.

Nanosurgical and Bioengineering Treatment of Human Anterior Cruciate Ligament Tears with Ultrasound-Guided Injection of Modified Platelet-Rich Plasma Using Human Cell Memory Based on Clinical, Ultrasound, MRI, and Nanoscope Analyses: A Double-Blind Randomized Trial.

Background: Anterior cruciate ligament (ACL) tears account for 40% to 50% of all ligamentous knee injuries. Most patients with ACL ruptures undergo surgical treatment. There is currently no objective, well-documented, repeatable, and standardized nonsurgical method for ACL tear treatment. This study aimed to investigate ACL outcomes in patients who underwent a novel nanosurgery and bioengineering treatment (NSBT) for an ACL tear. Methods: This was a double-blind randomized trial including 44 patients with a history of traumatic knee injury and a confirmed ACL tear. The final sample comprised 40 patients who met all the eligibility criteria. The patients were divided into two groups: the treatment group (n = 30) and the control group (n = 10). The treatment group underwent nanosurgery with an ultrasound-guided injection of modified platelet-rich plasma (PRP) using human cell memory (RP-hCM). The control group was treated with an ultrasound-guided PRP injection into the joint capsule. At baseline and post-treatment, all patients underwent both ultrasonography and magnetic resonance imaging (MRI), and the following clinical variables were assessed: the WOMAC score, the Lysholm knee score, the visual analog scale score, and knee instability. In most patients, the clinical outcome was verified using nanoscopy. Results: The median WOMAC, VAS, and LKS scores, as well as knee instability, improved significantly 12 weeks after the procedure in the treatment group (p < 0.001). We found a significantly larger improvement in the assessed parameters in the treatment group compared to the control group (p < 0.001). In the treatment group, all the patients had good and very good clinical outcomes, while 90% of the patients had a normal ACL signal in a follow-up MRI scan. In the control group, a physical examination revealed no changes in knee stability after treatment. Conclusions: This study showed that there is a significant difference in patient experience and the duration of recovery for patients with ACL tears treated with NSBT. The novel nonsurgical method was shown to be repeatable, objective, well documented, standardized, and highly effective.

Ultrasound-guided platelet-rich plasma vs. radiofrequency nerve ablation for refractory plantar fasciitis

Objectives: Plantar fasciitis (PF), which accounts for approximately 80% of heel pain, is a common condition affecting adults' quality of life. There are many different treatment modalities used in the treatment of PF. In this study, we compared the clinical and functional outcomes of patients diagnosed with chronic PF in our clinic who underwent USG-guided PRP (platelet-rich plasma) injection and patients who underwent RFNA (radiofrequency nerve ablation) treatment. Methods: Ultrasound-guided PRP injection or RFNA was performed on 95 patients who were diagnosed with chronic PF and met the inclusion criteria. This group of patients was followed for at least one year (October 2021-October 2023), and the clinical and functional results of the patients were compared. Results: The mean pre-treatment Visual Analog Scale (VAS), Foot Function Index (FFI), and American Orthopaedic Foot and Ankle Society (AOFAS) posterior-ankle scores were similar, and no significant difference was found (P&amp;gt;0.05). A significant improvement was observed in the groups' FFI, VAS, and AFOAS scores after treatment (P&amp;lt;0.05). However, no significant difference was found in treatment modalities (P&amp;gt;0.05). Conclusions: As a result of the study, it was concluded that PRP injection and RFNA are effective treatment methods in patients diagnosed with chronic plantar fasciitis without response to other conservative treatment methods, but these two methods are not superior to each other.

Comparison of efficacy of ultrasound-guided platelet rich plasma injection versus dry needling in lateral epicondylitis-a randomised controlled trial.

To assess whether Ultrasound guideddry needling is adequate for both common extensor tendon tears and tendinosis or whether ultrasound guidedplatelet rich plasma (PRP) has a superior outcome when compared to dry needling when there are tears of the common extensor tendon. This is a single-centre, single-blinded, randomised controlled trial conducted between November 2018 and April 2020. 40 patients diagnosed with lateral epicondylitis based on clinical and sonographic features and having comparable baseline characteristics were randomly assigned to the two study groups (dry needling and PRP). Inclusion criteria were patients aged 20years or more who were symptomatic for at least 3 months with sonographic evidence of lateral epicondylitis. Exclusion criteria were complete tear of common extensor tendon confirmed on ultrasound and presence of other associated diseases like osteoarthritis of shoulder and elbow. There was significant improvement in the visual analogue scale pain score in PRP group compared to the dry needling group at 9 months. However, this difference was not evident at 3 and 6 months follow-up. Mean improvement in common extensor tendon thickness in PRP group (5.1 mm at 3 months and 4.3 mm at 6 months) was slightly better than dry needling (4.4 mm at 3 months and 4.0 mm at 6 months). There was no difference in tear (if present) healing between both groups at 3months. However at 6months follow up, PRP demonstrated significant (mean-2.5) healing in tear compared to dry needling (mean-3.1). Two injections of Ultrasound guidedPRP are more beneficial non operative treatment compared to ultrasound guideddry needling, in lateral epicondylitis.

EFFECTIVENESS OF ULTRASOUND GUIDED PLATELET RICH PLASMA INJECTION IN COMPARISON WITH EXTRACORPOREAL SHOCK WAVE THERAPY ON IMPROVING PAIN AND FUNCTION IN PATELLAR TENDINOPATHY: A RANDOMIZED CONTROLLED TRIAL

Background: Patellar Tendinopathy is an insertional tendinopathy of the extensor apparatus of the knee that affect athletes practicing several sports at every level of participation but is found mainly in elite athletes involved in jumping activities. The characteristic complaint is an anterior knee pain with insidious onset, localized in the involved area. Diagnosis is clinical and is typically based on medical history and clinical findings. Many methods to treat Patellar Tendinopathy have been evaluated, and there is no true consensus on the most efficacious treatment strategy. Objectives: To determine the effectiveness of ultrasound guided platelet rich plasma injection in comparison with extracorporeal shock wave therapy on improving pain and function among athletes with Patellar Tendinopathy. Study Design: Randomized controlled trial Methods: Forty-four athletes with patellar tendinopathy meeting the inclusion and exclusion criteria were selected for this study and randomized into 2 treatment groups: autologous PRP injections under ultrasound guidance (PRP group n = 22), and 3 sessions of focused extracorporeal shock wave therapy (ESWT group n = 22). The outcome measures were Victorian Institute of Sports Assessment–Patella (VISA-P) questionnaire and pain visual analog scale (VAS). For descriptive statistics mean, standard deviation and frequency were used. Continuous variables were analysed by students t-test. Categorical variables were analysed using Chi-square test. Within the group comparison (baseline and follow-up data of each group) was done by Repeated measures ANOVA. Between the groups comparison was analysed using students t-test. A p-value &lt;0.05 was taken as significant. Results: The 2 groups were homogeneous in terms of their baseline characteristics like age, gender, duration of symptoms and side of affection. Within group comparison showed statistically significant improvement in VISA-P score and reduction in VAS from baseline at all follow ups (p=0.00) in the PRP group. While in the ESWT group, maximum improvement was seen from baseline to 1st follow up at 4 weeks (p = 0.01). However subsequent follow up showed reduction in VISA-P Scores and increased VAS but remained above the baseline values and it was statistically significant (p &lt; 0.05) (Table III). Conclusion: Ultrasound guided injection of platelet rich plasma lead to significant improvement in pain and function over the long term in comparison with focused ESWT in the treatment of patellar tendinopathy in athletes and thereby enabling faster return to sports.

Effectiveness of Ultrasound-guided Platelet-rich Plasma Injection Vs Pulsed Ultrasound Therapy on Improving Pain and Function in Athletes with Medial Collateral Ligament Injury of Knee: A Randomised Controlled Trial

Effectiveness of Ultrasound-guided Platelet-rich Plasma Injection Vs Pulsed Ultrasound Therapy on Improving Pain and Function in Athletes with Medial Collateral Ligament Injury of Knee: A Randomised Controlled Trial

Ultrasound guided platelet rich plasma or corticosteroid for supraspinatus tendonosis or partial tear: an observational study of clinical outcome

Background: The clinical application of platelet rich plasma (PRP) in rotator cuff tears has increased recently. Many studies have found no difference between placebo controls and PRP and corticosteroids (CS) and some have found more rapid benefits with PRP injections. The present study was undertaken with the objectives to observe and assess efficacies of the two different treatment modalities in terms of symptomatic relief and recovery of ROM and to ascertain the duration of symptom free period and functional improvement on follow up. Methods: Observational clinical outcome study, conducted at a tertiary care hospital between September 2020 and March 2022 after institute ethical committee clearance. A total of 100 patients, with a positive clinical test for supraspinatus and magnetic resonance imaging (MRI) suggestive of supraspinatus tendinitis were divided to 2 groups and based on whether they received either intra-articular CS or PRP injection under ultrasonography (USG) guidance All patients were followed up at for assessing the outcomes at 6 weeks, 3 months and 6 months from intervention Results: The clinical outcome of the group receiving the PRP was better than group receiving CS intervention. Conclusions: PRP should therefore be considered as a viable option to treat supraspinatus tendinopathy/partial tear as it is cheap, readily available modality using patients own blood which is more acceptable to patient and also safe to individual where complications related to corticosteroids anticipated. Ultrasound guided procedure were found to enhance the accuracy of injection.

Effectiveness and safety of an ultrasound-guided injection of platelet-rich plasma versus sodium hyaluronate in patients with knee osteoarthritis

Purpose: To examine the effectiveness and safety of ultrasound-guided platelet-rich plasma (PRP) injection versus sodium hyaluronate injection in patients with knee osteoarthritis (KOA).Methods: The clinical data of 92 patients treated at the West China Hospital Sichuan University-Ziyang Hospital between May 2020 and December 2021 were retrospectively analyzed. Patients were allocated to PRP group (ultrasound-guided PRP injection) and a hyaluronic acid (HA) group (sodium hyaluronate injection) with each group containing 46 patients. Before and after treatment, the two groups were compared in terms of visual analog scale (VAS) score, Lysholm score, levels of serum inflammatory factors, insulin-like growth factor (IGF)-1, fibroblast growth factor (FGF)-2 and WOMAC score.Results: After treatment, PRP group exhibited significantly lower pain scores and higher function scores than HA group. Furthermore, PRP group exhibited lower levels of inflammation markers, higher levels of growth factors as well as better treatment efficiency and incidence of adverse reactions when compared with HA group (p &lt; 0.05).Conclusion: Ultrasound-guided PRP therapy ameliorates pains and joint functions in KOA patients. The therapeutic effect may be associated with the regulation of cartilage performance and alleviation of inflammatory state. Therefore, PRP injection therapy combined with ultrasound guidance might also have clinical potential for other applications.

Comparison of Clinical Outcomes after Platelet-Rich Plasma and Rotator Cuff Repair in High-Grade Intrasubstance Partial Rotator Cuff Tears.

Platelet-rich plasma injections have been shown to have many useful applications in various musculoskeletal pathologies. Research on the use of PRP for intrasubstance partial-thickness rotator cuff tears is lacking, although these tears have unique properties that may increase the efficacy of platelet-rich plasma injections. Patients with MRI-confirmed high-grade intrasubstance partial-thickness rotator cuff tears, that had failed traditional non-operative treatment, were offered either surgical repair (Group 1) or a single ultrasound-guided platelet-rich plasma injection into the tear site (Group 2). Patients were followed at 2 weeks, 6 weeks, 3 months, and a minimum of 2 years post-injection with ASES scores. A total of 25 patients received platelet-rich plasma injections, compared to 20 patients who had rotator cuff repair for intrasubstance tears in the last 3 years. The mean pre-injection ASES score for the platelet-rich plasma group was 53.2 and this improved to 92.9 at a minimum 2-year follow-up. The average convalescence period following platelet-rich plasma injection was 3.3 months. The average post-operative convalescence period for arthroscopic rotator cuff repair was 4.6 months. Both surgical repair and platelet-rich plasma injection into the tear site are equally effective in the treatment of high-grade intrasubstance partial-thickness rotator cuff tears, while platelet-rich plasma provides significantly shorter recovery time.

The effectivity of ultrasound-guided platelet-rich plasma perineural injection in improving leprosy sensory peripheral neuropathy

The effectivity of ultrasound-guided platelet-rich plasma perineural injection in improving leprosy sensory peripheral neuropathy

The conservative management for improving Visual Analog Scale (VAS) pain scoring in greater trochanteric pain syndrome: a Bayesian analysis

BackgroundGreater trochanteric pain syndrome (GTPS) possesses a harmful influence on quality of life. Numerous conservative management modalities with varying success have been proposed for patients with GTPS. However, it is not clear which treatment is more effective for reducing pain. The purpose of this Bayesian analysis was to assess the current evidence for the effectiveness of conservative treatments on improving Visual Analog Scale (VAS) pain scoring of GTPS and to determine the most effective treatment protocol.MethodsA comprehensive study search was performed from inception until July 18, 2022, via the electronic databases PubMed, the Cochrane Library, and Web of Science for potential research. The risk of bias assessment for the included studies was independently performed based on the Cochrane Collaboration Risk of Bias Tool. Bayesian analysis was conducted by using ADDIS software (v1.16.5). The DerSimonian-Laird random effects model was used to perform the traditional pairwise meta-analysis.ResultsEight full-text articles with a total of 596 patients with GTPS were included in the analysis. In comparing ultrasound-guided platelet-rich plasma application (PRP-U) to ultrasound-guided corticosteroid injection (CSI-U), patients who received PRP therapy experienced reduced pain as the VAS decreased significantly (MD, -5.21; 95% CI, -6.24 to -3.64). VAS score in group of extracorporeal shockwave treatment (ESWT) was significant improved than that in exercise (EX) group (MD, -3.17; 95% CI, -4.13 to -2.15). There were no statistically significantly different VAS scores between the CSI-U group and the CSI under landmark (CSI-B) group. The treatment efficacy rankings of the different treatments on improving VAS scores showed that the most likely efficacious treatment was PRP-U (99%) followed by ESWT (81%), CIS-U (58%), usual care (48%), CIS-B (54%), and EX (84%).ConclusionBayesian analysis revealed that PRP injection and ESWT are relatively safe and effective in the treatment of GTPS. More multicenter high-quality randomized clinical trials with large sample sizes are still needed in the future to provide further evidence.

Process Optimization and Efficacy Assessment of Standardized PRP for Tendinopathies in Sports Medicine: Retrospective Study of Clinical Files and GMP Manufacturing Records in a Swiss University Hospital.

Platelet-rich plasma (PRP) preparations have recently become widely available in sports medicine, facilitating their use in regenerative therapy for ligament and tendon affections. Quality-oriented regulatory constraints for PRP manufacturing and available clinical experiences have underlined the critical importance of process-based standardization, a pre-requisite for sound and homogeneous clinical efficacy evaluation. This retrospective study (2013-2020) considered the standardized GMP manufacturing and sports medicine-related clinical use of autologous PRP for tendinopathies at the Lausanne University Hospital (Lausanne, Switzerland). This study included 48 patients (18-86 years of age, with a mean age of 43.4 years, and various physical activity levels), and the related PRP manufacturing records indicated a platelet concentration factor most frequently in the range of 2.0-2.5. The clinical follow-up showed that 61% of the patients reported favorable efficacy outcomes (full return to activity, with pain disappearance) following a single ultrasound-guided autologous PRP injection, whereas 36% of the patients required two PRP injections. No significant relationship was found between platelet concentration factor values in PRP preparations and clinical efficacy endpoints of the intervention. The results were in line with published reports on tendinopathy management in sports medicine, wherein the efficacy of low-concentration orthobiologic interventions appears to be unrelated to sport activity levels or to patient age and gender. Overall, this study confirmed the effectiveness of standardized autologous PRP preparations for tendinopathies in sports medicine. The results were discussed in light of the critical importance of protocol standardization for both PRP manufacturing and clinical administration to reduce biological material variability (platelet concentrations) and to enhance the robustness of clinical interventions (comparability of efficacy/patient improvement).

One-shot platelet-rich plasma (PRP) injection is non-inferior to extracorporeal shockwave therapy in the management of supraspinatus tendinosis

PurposeSupraspinatus tendinosis (ST) refers to the intratendinous degeneration of the supraspinatus tendon. Platelet-Rich Plasma (PRP) is one of the possible conservative treatments for supraspinatus tendinosis. This prospective observational study aims to evaluate the efficacy and safety of a single ultrasound-guided PRP injection in the treatment of supraspinatus tendinosis and to assess its non-inferiority to the widely used shockwave therapy.MethodsSeventy-two amateur athletes (35 male, mean age: 43.75 ± 10.82, range 21–58 years old) with ST were finally included in the study. All the patients underwent clinical evaluation at baseline, (T0) and at 1-month (T1), 3-month (T2) and 6-month (T3) follow-up using the following clinical scales: the Visual Analogue Scale for pain (VAS), Constant Score and the Disabilities of the Arm, Shoulder and Hand Score (DASH). A T0 and T3 ultrasound examination was also performed. The findings observed in the recruited patients were compared to the clinical results observed in a retrospective control group made up of 70 patients (32 male, mean age = 41.29 ± 13.85, range 20–65 years old) treated by extracorporeal shockwave therapy (ESWT).ResultsVAS, DASH and Constant scores significantly improved from T0 to T1; the improvement in clinical scores was kept until T3. No local nor systemic adverse events were observed. An improvement in the tendon structure was observed on ultrasound examination. PRP showed a non-statistical inferiority, in terms of efficacy and safety, compared to ESWT.ConclusionThe PRP one-shot injection is a valid conservative treatment to reduce pain, and improve both quality of life and functional scores in patients with supraspinatus tendinosis. Furthermore, the PRP intratendinous one-shot injection showed a non-inferiority in terms of efficacy at the 6-month follow-up, compared to ESWT.

Effects of ultrasound-guided platelet-rich plasma combined with sodium hyaluronate on shoulder function recovery, pain degree and mental health of patients with rotator cuff injury

ABSTRACT Rotator cuff injury is a common condition that affects the shoulder and is characterized by damage to the tendons and muscles in the shoulder area. This type of injury can lead to decreased shoulder function, pain, and decreased quality of life for those affected. As such, finding effective treatments for rotator cuff injury is important for improving patient outcomes and reducing the impact of this condition on patients and society. The purpose of this study was to evaluate the effectiveness of SH (Sodium Hyaluronate) and PRP (Platelet-Rich Plasma) in treating rotator cuff injuries in the shoulder. Patients who were diagnosed with Rotator Cuff Injury (RCI) and received treatment at the hospital were selected as the study subjects and divided into four groups. Various treatments were given to patients in each group. Two-way ANOVA and Mann–Whitney tests were used to analyze the results. The study found that patients who received ultrasound-guided platelet-rich plasma combined with sodium hyaluronate had significantly higher shoulder function recovery rates and better quality of life compared to the other groups. They also reported significantly lower pain scores compared to the other groups. The results suggest that ultrasound-guided platelet-rich plasma combined with sodium hyaluronate can effectively improve the shoulder function of patients with rotator cuff injury, reducing pain and improving their overall well-being. This has implications for improving patient outcomes and reducing the impact of rotator cuff injury on patients and society by providing a promising treatment option for this common condition.

Effectiveness of Ultrasound-Guided Platelet-Rich Plasma Injection in Comparison with Standard Conservative Treatment on Improving Pain and Function Among the Athletes with Partial Tear of Anterior Talofibular Ligament of Ankle: A Randomized Controlled Trial

Background: Ankle sprain is the most common injury in the world of sports and anterior talofibular ligament (ATFL) is most commonly affected. It is often underestimated, mismanaged and often result in delayed treatment, prolonged recovery times and long-term sequela. PRP may have enhancing effect on healing of partial tear of ATFL. Thus, the purpose of this study is to determine the role of PRP on partial tear of ATFL. Methods: A randomized controlled trail was done among athletes with partial tear of ATFL who visited Department of Sports Medicine, RIMS, Imphal during January 2021 – June 2022. Patients with MRI diagnosed partial tear of ATFL (N=48) randomized into PRP injection plus rehabilitation, (n=24) and rehabilitation alone, (n=24) groups. The outcomes were compared using Foot and Ankle Disability Index (FADI) score for function and Visual analogue scale for pain at baseline, 2nd, 6th, 12th and 24th weeks respectively. Results: Baseline characteristics were not statistically significant. There was statistically significant improvement seen in within the group comparison from baseline to 2nd, 6th, 12th and 24th weeks in both FADI and VAS in both the groups. There were statistically significant difference in mean changes of VAS and FADI score between the two groups from baseline to 2nd (p=0.007);(p=0.012), 6th (p=0.018);(p=0.009) and 12th (p=0.004); (p=0.001) follow-ups respectively with PRP group having more improvement however no significant difference at 24th weeks. Conclusion: Ultrasound guided PRP injection along with standard rehabilitation program might be a treatment of choice for partial ATFL tear. Keywords: ATFL tear, PRP, FADI, VAS, USG-guided.

Optimal Injection Volume in Treatment of Tendinopathy

Background: Tendinopathy, a pathology of tendons characterized by inflammation and or degeneration, is a prevalent cause of disease and disability in active and working patients. Within the past decade, orthobiologic injections such as Platelet Rich Plasma (PRP) have become increasingly popular within the musculoskeletal physician’s practice for treatment of chronic tendinopathies. However, there is a lack of standardization of PRP preparation and injection protocols, leading to gaps in our knowledge regarding the optimal administration dosages to maximize treatment efficacy. Purpose: This review aims to compile and evaluate the existing data for PRP injection volumes for various tendinopathies in hopes of contributing to standardization of PRP protocols, with a further goal of minimiz-ing waste of a costly therapeutic. Study Design: Systematic Review Methods: In June 2020, comprehensive electronic database searches were conducted by a medical librarian in Medline via PubMed, EMBASE (embase.com), CINAHL (EbscoHost), CENTRAL and Scopus according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data was extracted from studies meeting inclusion criteria on injection volumes and outcomes and grouped based on anatomic injection location. Results: Twenty-eight studies were identified for inclusion in which ultrasound-guided intra-tendinous PRP injections were administered to patients to treat various tendinopathies. For all tendon locations, the mini-mum volume of injectate reported achieved positive clinical outcomes in patients compared to baseline. Conclusions: Despite its many benefits—tendon healing, pain relief, increased function—PRP can pose a significant financial burden to patients, with patients often having to pay for the full cost out-of-pocket due to lack of insurance coverage. This study provides evidence that PRP can be effective at smaller volumes, minimizing waste and the out-of-pocket cost to the patient. In addition, this study further stresses the impor-tance of protocol standardization. Clinical Relevance: Though more data is needed, it is apparent that the minimum amount of injectate used clinically for various anatomic locations is enough for overall positive outcomes, and therefore can be the recommended dose given. As such, the authors have incorporated the minimum injection volume into their practice using the following volumes: Rotator Cuff-1 mL, Lateral or Medial Epicondyle-1.5 mL, Gluteal or Hamstring-3 mL, Patella-2 mL, Achilles-3 mL. Unfortunately, without more data available in the literature, the authors cannot make stronger recommendations at this time. What is known about the subject: Among intralesional injections for the treatment of tendinopathy, PRP has shown positive results in multiple trials and has made its way into many musculoskeletal physicians’ practice. However, there is a significant lack of standardization in PRP protocols. What this study adds to existing knowledge: While other reviews have highlighted the discrepancies amongst PRP protocols, our review is the first to examine injection volume and its effect on outcomes. We were able to suggest a minimum injectate amount for positive outcomes, either pain relief or improvement in the tendon appearance on imaging.

Comparison of Ultrasound-Guided Steroid and Platelet-Rich Plasma (PRP) Injection in Patients with Carpal Tunnel Syndrome

Objective: Imaging-guided injection treatments can yield effective results in patients with mild-to-moderate carpal tunnel syndrome (CTS) resistant to conservative methods. Methods: Patients who presented with typical median nerve entrapment findings for at least 3 months, were diagnosed with mild-moderate CTS electrophysiologically, and underwent ultrasound-guided steroid and PRP injection were included in the study. Visual analog scale (VAS) scores, Boston Carpal Tunnel Questionnaire (Functional status scale (FSS) and Symptom severity scale (SSS) parameters) scores were recorded in the pre-procedure, 1st month and 6th month controls of the patients. Sonographically, median nerve cross-sectional area (CSA) measurements were recorded at pre-procedure and post-procedure 1st and 6th month controls. Results: In 27 patients (21 women, 6 men), 40 median nerve injections (9 patients right, 5 patients left, 13 patients bilateral) were evaluated. In all patients, CSA, VAS, FSS, and SSS scores were significantly lower at 1 month and 6 months after the procedure than before the procedure. (p=0.000, p=0.000, p=0.000, P=0.000, respectively). While the VAS scores were found to be significantly lower in the steroid group than in the PRP group at 1 month (p=0.04), there was no significant difference between the two groups in terms of CSA, FSS, and SSS scores (p=0.1, p=0.5, p=0.8, respectively). At 6 months, CSA, VAS, FSS, and SSS scores were significantly lower in the PRP group compared to the steroid group (p=0.000, p=0.000, p=0.000, p=0.000 respectively). Conclusion: In mild-to-moderate carpal tunnel syndrome, steroid injections applied under ultrasonography guidance of the median nerve are effective for a short time, and PRP injections are a superior and safe option to steroids for long-term efficacy.