title: Treatment of chronic tendinopathy with ultrasound-guided needle tenotomy and platelet-rich plasma injection.
abstract: OBJECTIVE
  To determine whether ultrasound (US)-guided percutaneous needle tenotomy followed by a platelet-rich plasma (PRP) injection would result in pain reduction, functional improvement, or structural alterations in patients with chronic, recalcitrant tendinopathy.
  
  
  METHODS
  Part A was a retrospective observational study. Part B was a prospective observational study.
  
  
  METHODS
  Outpatient academic sports medicine center.
  
  
  METHODS
  Patients were required to have chronic (>3 months), recalcitrant tendinopathy treated with US-guided percutaneous tenotomy and PRP injection between January 2007 and October 2009. Fifty-one subjects met the inclusion criteria. Forty-one (80%) participated in part A of the study, whereas 34 subjects (67%) participated in part B.
  
  
  METHODS
  In part A, subjects completed a survey obtaining anthropomorphic, demographic, pain, and functional data. Subjects' platelet, hemoglobin, and white blood cell concentrations from their whole-blood and PRP samples were also obtained. In part B, subjects returned to the clinic after US-guided percutaneous needle tenotomy and PRP injection for a diagnostic US, which was compared with their preprocedure diagnostic US.
  
  
  METHODS
  The main outcome measures included changes in pain, function, and tendon characteristics.
  
  
  RESULTS
  The tendinopathy location was in the upper extremity in 10 subjects (24.4%), was in the lower extremity in 31 subjects (75.6%), and had been present for a mean of 40 months. The mean postprocedure follow-up was 14 months, and the maximum benefits occurred 4 months postprocedure. There were mean functional and worst-pain improvements of 68% and 58%, respectively. Eighty-three percent of subjects were satisfied with their outcomes and would recommend the procedure to a friend. Although no tendons demonstrated a normal sonographic appearance after the procedure, 84% of subjects had an improvement in echotexture, 64% had a resolution of intratendinous calcifications, and 82% had a decrease in intratendinous neovascularity. None of the variables analyzed in this study demonstrated a significant correlation with pain or functional outcome measures.
  
  
  CONCLUSIONS
  In this case series, we found US-guided percutaneous needle tenotomy followed by PRP injection to be a safe and effective treatment for chronic, recalcitrant tendinopathy, and this treatment was associated with sonographically apparent improvements in tendon morphology. However, because of the intrinsic limitations of the study design and the heterogeneity of treated tendons, further research is required to corroborate our findings.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, MN, USA. finnoff.jonathan@mayo.edu
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Finnoff
authors.forename: Steven P
authors.initials: SP
authors.lastname: Fowler
authors.forename: Jim K
authors.initials: JK
authors.lastname: Lai
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Santrach
authors.forename: Elaine A
authors.initials: EA
authors.lastname: Willis
authors.forename: Yusef A
authors.initials: YA
authors.lastname: Sayeed
authors.forename: Jay
authors.initials: J
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009339:Needles; D010045:Outpatients; D010147:Pain Measurement; D053657:Platelet-Rich Plasma; D011446:Prospective Studies; D012189:Retrospective Studies; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000628:therapy*; D013710:Tendons / Q000000981:diagnostic imaging / Q000601:surgery*; D058971:Tenotomy / Q000295:instrumentation*; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult