EFFICACY OF PLATELET-RICH PLASMA IN THE REHABILITATION OF ATHLETES WITH PERONEAL TENDINOPATHY: A PROSPECTIVE NON-RANDOMIZED STUDY OF 60 PATIENTS
Abstract and keywords
Abstract (English):
INTRODUCTION. Peroneal tendons pathology is an underestimated cause of pain in the lateral part of the foot in athletes, which is difficult to distinguish from lateral ankle ligament injuries. As a result, the athlete's training and participation in competitions may be restricted for a long time. Platelet-rich plasma (PRP) injections have been suggested as a promising method for the treatment of peroneal tendinopathy. AIM. To evaluate the effectiveness of the use of PRP in the complex rehabilitation of athletes with peroneal tendinopathy by comparing the time to return to play (RTP) and the evaluation of pain symptoms. To develop a model for pain evaluation and physical activity dosingin athletes with this pathology, in order to objectify the transition from one rehabilitation stage to another. MATERIAL AND METHODS. This prospective, non-randomised study analyzed the treatment outcomes of 60 male patients, aged 21.0±1.4 years with peroneal tendinopathy. Depending on the treatment, two groups of patients were identified. Group I (30 athletes),in addition to complex rehabilitation (physiotherapy and physical therapy), had percutaneous PRP injections under the ultrasound guidance. Group II (30 athletes) received only physiotherapy and exercise therapy. RESULTS AND DISCUSSION. A statistically significant difference in pain symptoms between the groups was observed starting from the 28th day of treatment. The average time for the athletes in group I to return to regular training activities was on average 10 days shorter than for those in group II (p<0.001). CONCLUSION. The use of PRP, in the rehabilitation of athletes with peroneal tendinopathy is more effective than a comprehensive programme. The developed model of pain evaluation makes it possible to determine the degree of physical activity at various stages of he rehabilitation process, as well as to adequately estimate readiness to RTP.

Keywords:
sports injury, ankle joint, tendonitis, tendinopathy, peroneal tendons, platelet-rich plasma, rehabilitation
Text
Text (PDF): Read Download
References

1. Florit D., Pedret C., Casals M., Malliaras P., Sugimoto D., Rodas G. Incidence of tendinopathy in team sports in a multidisciplinary sports club over 8 seasons. Journal of Sports Science and Medicine. 2019; 18(4): 780-788.

2. van Dijk A.D., Kerkhoffs G.M.M.J., Chiodo C., DiGiovanni C.W. Chronic disorders of the peroneal tendons: Current Concepts Review of the Literature. The Journal of the American Academy of Orthopaedic Surgeons. 2019; 27(16): 590-598. http://doi.org/10.5435/JAAOS-D-18-00623

3. Dombek M.F., Lamm B.M., Saltrick K., Mendicino R.W., Catanzariti A.R. Peroneal tendon tears: a retrospective review. The Journal of Foot and Ankle Surgery. 2003; 42(5): 250-258. http://doi.org/10.1016/s1067-2516(03)00314-4

4. Achkasov E.E., Sereda A.P., Repetyuk A.D. Peroneal tendon lesions in athletes (review). Traumatology and Orthopedics of Russia. 2016; 22(4): 146-154. http://doi.org/10.21823/2311-2905-2016-22-4-146-154

5. van Dijk P.A, Miller D., Calder J., DiGiovanni C.W., Kennedy J.G., Kerkhoffs G.M., Kynsburtg A., Havercamp D., Guillo S., Oliva X.M., Pearce C.J., Pereira H., Spennacchio P., Stephen J.M., van Dijk C.N. The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. Knee Surgery, Sports Traumatology, Arthroscopy. 2018; 26(10): 3096-3107. http://doi.org/10.1007/s00167-018-4971-x

6. Franco M.F., Madaleno F.O., de Paula T.M.N., Ferreira T.V., Pinto R.Z., Resende R.A. Prevalence of overuse injuries in athletes from individual and team sports: A systematic review with meta-analysis and GRADE recommendations. Brazilian Journal of Physical Therapy. 2021; 25(5): 500-513. http://doi.org/10.1016/j.bjpt.2021.04.013

7. Steinmann S., Pfeifer C.G., Brochhausen C., Docheva D. Spectrum of tendon pathologies: triggers, trails and end-state. International Journal of Molecular Sciences. 2020; 21(3): 844 p. http://doi.org/10.3390/ijms21030844

8. Hudgens J. L., Sugg K. B., Grekin J. A., Gumusio J. P., Bedi A., Mendias K. L. Platelet-rich plasma activates Pro-inflammatory signaling pathways and causes oxidative stress in tendon fibroblasts. The American Journal of Sports Medicine. 2016; 44(8): 1931-1940. http://doi.org/10.1177/0363546516637176

9. Giusti I., D'Ascenzo S., Mancò A., Di Stefano G., Di Francesco M., Rughetti A., Dal Mas A., Properzi G., Calvisi V., Dolo V. Platelet concentrations in platelet-rich plasma affect the behavior of tenocytes in Vitro. BioMed Research International. 2014: 630870. http://doi.org/10.1155/2014/630870

10. Mariani E., Pulsatelli L. Platelet concentrates in musculoskeletal medicine. International Journal of Molecular Sciences. 2020; 21(4): 1328 p. https://doi.org/10.3390/ijms21041328

11. Achkasov E.E., Bezuglov E.N., Ul`yanov A.A., Kurshev V.V., Repetyuk A.D., Egorova O.N. Application platelet-rich plasma in clinical practice. Biomedicine. 2013; (4): 46-59.

12. Thielen N.G.M., van der Kraan P.M., van Caam A.P.M. TGFβ/BMP signaling pathway in cartilage homeostasis. Cells. 2019; 8(9): 969 p. http://doi.org/10.3390/cells8090969

13. Liddle A.D., Rodríguez-Merchán E.C. Platelet-rich plasma in the treatment of patellar tendinopathy: a systematic review. The American Journal of Sports Medicine. 2015; 43(10): 2583-2590. http://doi.org/10.1177/0363546514560726

14. Barman A., Sinha M.K., Sahoo J., Jena D., Patel V., Patel S., Bhattacharjee S., Baral D. Platelet-rich plasma injection in the treatment of patellar tendinopathy: a systematic review and meta-analysis. Knee Surgery & Related Research. 2022; 34(1): 22 p. http://doi.org/10.1186/s43019-022-00151-5

15. Maffulli N., Papalia R., D’Adamio S., Diaz Balzani L., Denaro V. Pharmacological interventions for the treatment of Achilles tendinopathy: a systematic review of randomized controlled trials. British Medical Bulletin. 2015; 113(1): 101-115. http://doi.org/10.1093/bmb/ldu040

16. Everts P., Onishi K., Jayaram P., Lana J.F., Mautner K. Platelet-rich plasma: new performance understandings and therapeutic considerations in 2020. International Journal of Molecular Sciences. 2020; 21(20): 7794 p. http://doi.org/10.3390/ijms21207794

17. Kurshev V.V., Litvinenko A.S., Bezuglov E.N., Repetyuk A.D., Patrina E.V. Rehabilitation of athletes with diseases and injuries of the musculoskeletal system. Surgical Practice. 2015; (3): 71-77.

18. Dallaudière B., Pesquer L., Meyer P., Silvestre A., Perozziello A., Peuchant A., Durieux M.H., Loriaut P., Hummel V., Boyer P., Schouman-Claeys E., Serfaty J.M. Intratendinous injection of platelet-rich plasma under US guidance to treat tendinopathy: a long-term pilot study. Journal of Vascular and Interventional Radiology. 2014; 25(5): 717-723. http://doi.org/10.1016/j.jvir.2014.01.026

19. Unlu M.C, Kivrak A., Kayaalp M.E., Birsel O., Akgun I. Peritendinous injection of platelet-rich plasma to treat tendinopathy: a retrospective review. Acta Orthopaedica et Traumatologica Turcica. 2017; 51(6): 482-487. http://doi.org/10.1016/j.aott.2017.10.003

Login or Create
* Forgot password?