The use of platelet-rich plasma (PRP) in the treatment of gastrocnemius strains: a retrospective observational study

Abstract

The aim of the present retrospective observational study was to evaluate the time of functional recovery following a specific combined therapeutic approach characterized by active exercise therapy carried out immediately after platelet-rich plasma (PRP) injections for the treatment of the muscular lesion of the distal musculotendinous junction of the gastrocnemius medial head. Medical records of 31 subjects treated with three PRP intra-lesional ultrasound-guided injections and 30 patients treated with the standard therapeutic approach (the control group) were analyzed. Both groups followed the same rehabilitation therapy. Patients in the control group were able to start active exercise with a significant delay when compared to the PRP-treated subjects (17 + 7.2 days) and 9 + 3.8 days (p = 0.0001), respectively. This delay was mainly due to the persistence of pain in the subjects in the control group. The time necessary to return to walking without pain was significantly shorter in the PRP-treated group: 24.27 12.36 days versus 52.4 20.03 days in the control group (p 0.001), as was the time needed to fully return to practicing the previous sport activity: 53.33 * 27.74 days versus 119.3 + 43.87 days in the control group (p 0.001). The present study showed that ultrasound-guided delivery of PRP into the site of muscle injury has to be considered a valid therapeutic approach with the potential to significantly reduce time and costs for reaching a complete functional recovery.

Introduction

Musculoskeletal injuries represent a challenging problem for traumatology and sports medicine as they are the most common cause of severe long-term pain and physical disability and account for the majority of all sport-related injuries [1]. Among them, the strain of the distal musculotendinous junction of the gastrocnemius medial head is relatively common [2, 3]. Standard therapeutic approaches usually include rest, ice, compression, elevation, and nonsteroidal anti-inflammatory medications (NSAIDs), followed by a passive stretching program for 2 weeks [4-6]. The healing of the muscle strain usually occurs slowly, and athletes are discouraged from resuming their sport activity until walking without pain is possible (approximately 4–12 weeks). During this period, athletes usually follow different reeducation programs, and sometimes they are suggested to apply heel lifts in order to reduce pain and discomfort [4]. With this regard, it has to be underlined that no consensus guidelines or agreed-upon criteria for a safe return to the previous level of physical activity are available [7, 8]. Moreover, it has been demonstrated that the long recovery period may also be due to the structural alterations of the musculotendinous junction induced by the immobilization after the injury [9]. For this reason, it is commonly accepted that a quickMobilization, followed by a rehabilitation program, may facilitate an adequate structural resolution of the lesion [10]. Abundant evidence indicates that growth factors (GFs) may play a significant role during the muscle regeneration processes [11–14]. Indeed, it has been clearly demonstrated that fibroblast growth factor (FF), insulin-like growth factor-1 and 2 (IGF-1 and 2), transforming growth factor-B (TGF-B), hepatocyte growth factor (HGF), tumor necrosis factor-a (TNF-a), and interleukin-6 (IL-6) are potent activators of myogenic precursor cells [15]. Some of them are also known to stimulate the differentiation and fusion of myotubes into multinucleated mature myofibers during the regeneration process [15–19]. Conceivably, the role of these GFs during the reparative processes is at the base of the concern expressed by several authors about the use of NSAIDs, which seem to negatively interfere with the healing process, in particular during its early phase [11, 12–15]. Several different GFs are contained in platelet alpha-granules (platelet-derived growth factor, TGF-B, FGF, IGF-1 and IGF-2, vascular endothelial growth factor, and epidermal growth factor) [11]. Although the different roles of all the GFs involved in the healing process are only partially known, the efficacy of many of them has been extensively demonstrated [15, 19–21].

These characteristics are at the base of the use of platelet-rich plasma (PRP) in several circumstances, all of them characterized by the need to activate, modulate, speed up, or ameliorate the process of tissue repair [12, 13, 22]. PRP is a biological blood product obtained from the patient that has anti-inflammatory [23] and pro-regenerative [24] functions. It is rich in GFs and physiologic proportions that act synergistically during the different phases of the healing process. It has been demonstrated that PRP is able to Correspondence: Paolo Borrione, Department of Movement, Human, and Health Sciences, University of Rome “Foro Italico, Piazza Lauro de Bosis 15, Rome, 00194, Italy. E-mail: paolo.borrione@uniroma4.it

Paolo Borrione ®123, Chiara Fossati”, Maria TeresaPereira?, Silvana Giannini?, Marco Davico, Carlo Minganti’ &Fabio Pigozzil,2

‘Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy, ‘Villa Stuart Sport Clinic-FIFA Centre of Excellence, Rome, Italy, and Department for Health andPerformance, Regional Antidoping and Toxicology Center, Orbassano, TO, Italy

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