Summary

Treatment with PRP is a valid and effective option for addressing proximal injuries of the rectus femoris in athletes that affect a tendon tissue and does not respond correctly to conservative treatment.

Abstract

Introduction

Platelet-rich plasma (PRP) treatment has been used to shorten the time to return to sports in muscle injuries. Its use has been practically abandoned due to its lack of evidence and results.
The involvement of connective tissue in muscle injury is a sign of a higher rate of recurrences and longer recovery time.
One of the anatomical regions with the most connective tissue involvement is the proximal region of the rectus femoris muscle (RFM).
The aim of this work is to report the clinical and imaging results of a group of patients with myotendinous injuries of the rectus femoris muscle of the quadriceps in its proximal region, treated with platelet-rich plasma.

Method

Patients with muscle tears of the proximal (RFM) treated with ultrasound-guided infiltrations with PRP were prospectively evaluated.
Inclusion criteria were myotendinous tears of the conjoint tendon or proximal central tendon of the rectus femoris that have presented at least one recurrence or that have failed conservative treatment for 60 days and that are competitive athletes. The diagnosis was made by ultrasound and MRI.
Exclusion criteria were patients who did not undergo proper rehabilitation or who were unable to follow it properly. The type of sport and injury mechanism were documented.
The infiltration was performed under ultrasound guidance, applying 3-5cc of Leukocyte rich - PRP intratendinously in the fibrosis, 2-3cc of Leukocytes Poor - PRP in the lesion gap, finally with Platelet Poor Plasma a hydro dissection of the adhesions of the muscle fibers and the remnant of the fibrosis is performed.
After the procedure, the specific rehabilitation protocol begins.
Clinical and ultrasound controls were performed at 7, 15, 30 and 45 days and at medical discharge.
Functional pain was documented according to VAS, time to return to running and return to sports.
An ultrasound and MRI were performed 6 months after treatment.

Results

A total of 7 patients were included. Five were soccer players and 2 rugby players, 4 patients were injured while kicking and 3 while accelerating. In 5 cases the proximal central tendon was affected and in 2 cases the conjoint tendon. Functional pain according to VAS before the procedure at 7, 15, 30, 45 days and at discharge was (6.7-4.9-3.7-2.4-1.7) respectively. The patients returned to running at 26.3 days (20-34) and to competition at 48.2 days (38-64). MRI at 6 months showed complete repair in 4 cases, partial in 2 and no signs of repair in one patient.
There was a reinjury at 86 days of treatment after 23 days of discharge.

Conclusion

We believe that considering all muscle injuries as a single pathology makes it very difficult to verify the effectiveness of PRP for their treatment. Muscle injuries with myotendinous involvement, in addition to being more complex, are those that generate a higher incidence of fibrosis and its consequences. As a weakness, we know that it is a short series without group control, but based on our experience, we believe that treatment with PRP is a valid and effective option for addressing proximal injuries of the rectus femoris in athletes that affect a tendon tissue and does not respond correctly to conservative treatment.