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 <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 < 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.