J Ultrasound. 2012 December; 15(4): 260–266.

Published online 2012 October 8. doi:  10.1016/j.jus.2012.09.006

PMCID: PMC3558233

Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy

G. Ferrero,a E. Fabbro,a D. Orlandi,a C. Martini,a F. Lacelli,b G. Serafini,b E. Silvestri,c and L.M. Sconfienzad,e,

aScuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Italy

bDipartimento di Radiologia, Ospedale Santa Corona, ASL 2 Savonese, Pietra Ligure (SV), Italy

cServizio di Radiologia, Ospedale Evangelico Internazionale, Genova, Italy

dServizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

eDipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy

L.M. Sconfienza

Corresponding author. Servizio di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, I-20097 San Donato Milanese, Milano, Italy. Email: io@lucasconfienza.it

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Copyright © 2012 Elsevier Masson Italy.

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The efficacy of platelet-rich plasma (PRP) in the treatment and healing of chronic tendinopathy through stimulation of cell proliferation and total collagen production has been demonstrated by both in vitro and in vivo studies. The aim of this study is to evaluate the effectiveness of ultrasound (US)-guided autologous PRP injections in patellar and Achilles tendinopathy.

Materials and methods

Autologous PRP was injected under US-guidance into the Achilles and patellar tendons (30 Achilles tendons, 28 patellar tendons) in 48 prospectively selected patients (30 males, 18 females, mean age 38 ± 16 years, range 20–61 years). All patients were previously evaluated according to the Victoria Institute of Sport Assessment (VISA) scale, which assessed pain and activity level, and they all underwent US of the tendon before treatment and at follow-up after 20 days and 6 months. Statistical analysis was performed with Chi-square and Wilcoxon tests.


20 days after PRP injection the patients presented a non-significant improvement of clinical symptoms. At the 6-month follow-up VISA score increased from a mean value of 57–75.5 (p < .01). US evaluation revealed a reduction of hypoechoic areas in 26 tendons (p < .01) associated with a widespread improvement of fibrillar echotexture of the tendon and reduced hypervascularity at power Doppler.


PRP injection in patellar and Achilles tendinopathy results in a significant and lasting improvement of clinical symptoms and leads to recovery of the tendon matrix potentially helping to prevent degenerative lesions. US-guidance allows PRP injection into the tendon with great accuracy.


PM R. 2013 Mar;5(3):169-75. doi: 10.1016/j.pmrj.2012.12.010. Epub 2013 Feb 9.

Outcomes after ultrasound-guided platelet-rich plasma injections for chronic tendinopathy: a multicenter, retrospective review.

Mautner KColberg REMalanga GBorg-Stein JPHarmon KGDharamsi ASChu SHomer P.


Emory Orthopedic & Spine Center, Atlanta, GA 30329, USA. 



To determine whether ultrasound-guided platelet-rich plasma (PRP) injections are an effective treatment for chronic tendinopathies.


A retrospective, cross-sectional survey.


Four academic sports medicine centers from across the United States.


A total of 180 men and women between the ages of 18 and 75 years who received ultrasound-guided PRP injections for tendinopathy refractory to conventional treatments.


Survey on satisfaction and functional outcome.


Perceived improvement in symptoms at least 6 months after treatment, perceived change in visual analog scale score, assessment of functional pain, and overall satisfaction.


On average, patients were 48 years old, had symptoms for a median of 18 months before treatment, and answered the survey on average 15 months after treatment. Overall, 82% of patients indicated moderate to complete improvement in symptoms. The most common injection sites were the lateral epicondyle, Achilles, and patellar tendons. Other sites treated included the rotator cuff, hamstring, gluteus medius, and medial epicondyle, among others. Furthermore, 60% of patients received only 1 injection, 30% received 2 injections, and 10% received 3 or more injections. Patients’ perceived decrease in visual analog scale score was 75%, from 7.0 ± 1.8 to 1.8 ± 2.0 (-5.2, SD 2.7, 95% confidence interval -5.65 to -4.86, P < .0001). In addition, at follow-up, 95% of patients reported having no pain at rest that disrupted their activities of daily living and 68% reported no pain during activities. A total of 85% of patients were satisfied with the procedure.


In this retrospective study, in which we evaluated administration of PRP for chronic tendinopathy, we found that the majority of patients reported a moderate (>50%) improvement in pain symptoms.

Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.


Am J Sports Med. 2013 Mar;41(3):625-35. doi: 10.1177/0363546512472975. Epub 2013 Jan 17.

Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial.

Krogh TPFredberg UStengaard-Pedersen KChristensen RJensen PEllingsen T.


Diagnostic Centre, Region Hospital Silkeborg, Silkeborg, Denmark.



Lateral epicondylitis (LE) is a common musculoskeletal disorder for which an effective treatment strategy remains unknown.


To examine whether a single injection of platelet-rich plasma (PRP) is more effective than placebo (saline) or glucocorticoid in reducing pain in adults with LE after 3 months.


Randomized controlled trial; Level of evidence, 1.


A total of 60 patients with chronic LE were randomized (1:1:1) to receive either a blinded injection of PRP, saline, or glucocorticoid. The primary end point was a change in pain using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire at 3 months. Secondary outcomes were ultrasonographic changes in tendon thickness and color Doppler activity.


Pain reduction at 3 months (primary end point) was observed in all 3 groups, with no statistically significant difference between the groups; mean differences were the following: glucocorticoid versus saline: -3.8 (95% CI, -9.9 to 2.4); PRP versus saline: -2.7 (95% CI, -8.8 to 3.5); and glucocorticoid versus PRP: -1.1 (95% CI, -7.2 to 5.0). At 1 month, however, glucocorticoid reduced pain more effectively than did both saline and PRP; mean differences were the following: glucocorticoid versus saline: -8.1 (95% CI, -14.3 to -1.9); and glucocorticoid versus PRP: -9.3 (95% CI, -15.4 to -3.2). Among the secondary outcomes, at 3 months, glucocorticoid was more effective than PRP and saline in reducing color Doppler activity and tendon thickness. For color Doppler activity, mean differences were the following: glucocorticoid versus PRP: -2.6 (95% CI, -3.1 to -2.2); and glucocorticoid versus saline: -2.0 (95% CI, -2.5 to -1.6). For tendon thickness, mean differences were the following: glucocorticoid versus PRP: -0.5 (95% CI, -0.8 to -0.2); and glucocorticoid versus saline: -0.8 (95% CI, -1.2 to -0.5).


Neither injection of PRP nor glucocorticoid was superior to saline with regard to pain reduction in LE at the primary end point at 3 months. However, injection of glucocorticoid had a short-term pain-reducing effect at 1 month in contrast to the other therapies. Injection of glucocorticoid in LE reduces both color Doppler activity and tendon thickness compared with PRP and saline.

Orthopedics. 2013 Jan;36(1):e64-70. doi: 10.3928/01477447-20121217-20.

Platelet-rich plasma as an effective treatment for proximal hamstring injuries.

Wetzel RJPatel RMTerry MA.


Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Ste 1350, Chicago, IL 60611, USA.


Proximal hamstring injuries can be disabling, and several traditional conservative treatments, including physiotherapy and nonsteroidal anti-inflammatory drugs, have been inconsistent. Corticosteroid injections have demonstrated success but can adversely affect local tissues. Platelet-rich plasma (PRP) has emerged as a safe, effective treatment for several orthopedic pathologies. The authors propose a PRP injection at the muscle origin as a novel treatment for proximal hamstring injuries. A retrospective review yielded 15 patients with 17 proximal hamstring injuries. Twelve injuries failed traditional conservative treatment and were ultimately treated with a PRP injection at the hamstrings muscle origin. Five patients were treated with traditional conservative treatment alone. Analysis included pre- and posttreatment visual analog scale scores, Nirschl Phase Rating Scale scores, and return to sport. No significant difference existed between the groups’ pretreatment visual analog scale scores (P=.28) and Nirschl Phase Rating Scale scores (P=.15) and their posttreatment visual analog scale scores (P=.38) and Nirschl Phase Rating Scale scores (P=.22). The PRP group demonstrated a reduction in visual analog scale scores (P<.01) and Nirschl Phase Rating Scale scores (P<.01), but the traditional conservative treatment group did not demonstrate the same reduction (P=.06 and .06, respectively). All athletes returned to their desired activity level with no major complications.