Dr. Michael Khadavi submitted this very interesting case:
A 34-year-old with symptomatic infrapatellar pain. The initial US and MR were consistent with patellar tendinosis.
Underwent an US-guided needle fenestration followed by a leukocyte-rich PRP injection. Subsequently developed a marked increase in pain that persisted beyond the expected increase in pain after a PRP injection. US was performed 2 weeks after the PRP injection.
6 months after the PRP injection the patient was still experiencing diffuse patellar tendon pain and was unable to run or jump. A repeat MR was obtained.
Have others experienced similar reactions to either PRP or tendon tenotomies? Other thoughts?
It appears the before US image is the quad tendon insertion.
I wonder if the author is willing to share platelet counts and WBC counts if those were done and how much volume was used. The patellar tendon didn’t look too bad on MR pre-procedure. Lr-PRP preparations have been shown to increase edema and pro-inflammatory proteins in the tendon. https://pubmed.ncbi.nlm.nih.gov/28301205/
Anton-
Great catch, this is the long-axis shot of his quad tendon from my diagnostic US scan. I just looked back and somehow the pre-procedural image of the patellar tendon did not get saved! So we just have the MRI to go off on for pre-procedural images.
Unfortunately I did not have a hem analyzer at this time, but we aspirated 52ml blood and used an arthrex angel to centrifuge at a leuk rich setting (7%), and then I injected 4ml.
Yes–MRI wasn’t bad pre-procedural, just mild origin tendonitis that was consistent with his hx and exam.
Great article you shared.
-Mike
Interesting case, Mike. It’s so diffusely edematous. Not sure what to make of it. No signs of infection? Maybe a tendon scraping would decrease the vascular inflow? If really struggling, wonder if a biopsy would be helpful?
Jake-
Yah, no signs of injection. I’ve never done tendon scraping before. Should I!?
I’ve considered a tendon biopsy but it requires a decent chunk of tendon…any super minimally invasive way to get it?
Thanks for the comments!
-Mike