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Samuel F. Jazzo, Daniel Scribner, Stephanie Shay and Kyung-Min Kim

Additionally, the type-I cartilage that fills in the lesion after microfracture surgery has different biological and mechanical profiles from hyaline cartilage, thus making it susceptible to degeneration over time. 7 Platelet-rich plasma (PRP) injection may be an adjunctive therapy to further improve treatment

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Bradley J. Conant, Nicole A. German and Shannon L. David

time associated with surgical intervention is not feasible based on long-term goals or competition timelines. Improving outcomes for these athletes relies on reducing recovery time and increasing the likelihood of returning to competition. Platelet-rich plasma (PRP) contains a variety of growth factors

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Tristan Rodik and Brendon McDermott

Clinical Scenario:

Lateral epicondylitis (LE) is a relatively common pathology capable of producing chronic debilitation in a variety of patients. A newer treatment for orthopedic conditions is platelet-rich plasma (PrP) local injection.

Focused Clinical Question:

Is PrP a more appropriate injection therapy for LE than other common injections such as corticosteroid or whole blood?

Summary of Key Findings:

Four studies were included: 1 randomized controlled trial (RCT), 2 double-blind RCTs, and 1 cohort study. Two studies involved comparisons of PrP injection to corticosteroid injection. One of the studies involved a 2-y follow-up while another involved a 1-y follow-up. Another study involved the comparison of PrP injection with whole-blood injection with a 6-mo follow-up. The final study included a PrP-injection group and control group. The 2 studies involving PrP vs corticosteroid injections with 2-y and 1-y follow-ups both favored PrP over corticosteroid injection in terms of pain reduction and function increases. The third study favored PrP injections over whole-blood injections at 6 mo regarding pain reduction. All studies demonstrated significant improvements with PrP over comparison injections or no injection.

Clinical Bottom Line:

PrP injections provide more favorable pain and function outcomes than whole blood and corticosteroid injections for 1–2 y after injection.

Strength of Recommendation:

Consistent findings from RCTs suggest level 1b evidence in support of PrP injection as a treatment for LE.

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Cori Sinnott, Hayley M. White, Jennifer W. Cuchna and Bonnie L. Van Lunen

Clinical Scenario:

Achilles tendinopathy is a painful condition commonly affecting the general and athletic population. It presents with localized pain, stiffness, and swelling in the midportion of the Achilles tendon. The physical stress placed on the tendon results in microtrauma, which leads to subsequent inflammation and degeneration. While it is not surprising that this condition affects the physically active, nearly one-third of Achilles tendinopathy cases occur in sedentary individuals. Etiology for this condition stems from a change in loading patterns and/or overuse of the tendon, resulting in microscopic tearing and degenerative changes. There are numerous causes contributing to the maladaptive response in these patients, such as mechanical, age-related, genetic, and vascular factors. The treatment for these patients is typically load management and eccentric strengthening of the gastrocnemius–soleus complex. Unfortunately, conservative treatment can lead to surgical intervention in up to 45% of cases. A relatively new phenomenon in the treatment of this condition is the use of autologous blood injections (ABI) and platelet-rich plasma injections (PRPI). This need for a less invasive treatment fostered more investigation into ABI and PRPI to treat these nonresponsive patients. However, the evidence concerning the effectiveness of these treatments in patients with Achilles tendinopathy has not been synthesized.

Focused Clinical Question:

In patients with Achilles tendinopathy, how do variations of ABI and PRPI compared with a placebo and/or eccentric training affect pain and function?

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Mary Lynn Manduca and Stephen J. Straub

. Prior retrospective studies support this claim and suggest that decreased flexibility in males as a potential link to higher hamstring injury rates. Recently, platelet-rich plasma (PRP) injections have gained popularity as a possible treatment option to accelerate healing of muscle injury, specifically

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Shanna L. Karls, Kelli R. Snyder and Peter J. Neibert

Clinical Scenario:

For active individuals, plantar fasciitis (PF) is one of the most clinically diagnosed causes of heel pain. When conservative treatment fails, one of the next most commonly used treatments includes corticosteroid injections. Although PF has been identified as a degenerative condition, rather than inflammatory, corticosteroid injection is still commonly prescribed. However, the literature has not been examined to determine the effect of corticosteroid injection on PF.

Focused Clinical Question:

Are corticosteroid injections more effective than other interventions (placebo, platelet-rich plasma, and tenoxicam injections) in the short- and long-term treatment of PF?

Summary of Key Findings:

Corticosteroid injections are not more effective in the long-term treatment of PF pain than other treatments (platelet-rich plasma, tenoxicam).

Clinical Bottom Line:

The level 2 and 3 evidence shows that corticosteroids are more effective than placebo injections but are no more effective than tenoxicam injections and perhaps less effective than platelet-rich plasma treatment.

Strength of Recommendation:

Level 2 and 3 evidence suggests that corticosteroid injections are not more effective in the long-term treatment of PF than platelet-rich plasma or tenoxicam.

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Nicole Cascia, Tim L. Uhl and Carolyn M. Hettrich

may lead to good outcomes; however, consistent evidence in regard to RTP rates is lacking in the literature. 8 Interventions for nonoperative treatment can include platelet-rich plasma (PRP) injection therapy, rest, and/or strengthening programs. 9 – 12 As a partial UCL tear is a potential career

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Nathan Oakes and Jennifer M. Medina McKeon

 = Minor League Baseball Double A; AAA = Minor League Baseball Triple A; MLB = Major League Baseball; PRP = platelet-rich plasma; ROM = range of motion; RTP = return to play; RTSP = return to same level of play; UCL = ulnar collateral ligament. Note . 1A injectio n  = white blood cells increased, platelets

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Lucas C. Bianco, James M. May, Smokey L. Fermin, Robert Oates and Scott W. Cheatham

J Sports Med . 1998 ; 32 ( 4 ): 346 – 355 . PubMed ID: 9865413 doi:10.1136/bjsm.32.4.346 9865413 10.1136/bjsm.32.4.346 5. Kon E , Filardo G , Delcogliano M , et al . Platelet-rich plasma: new clinical application: a pilot study for treatment of jumper’s knee . Injury . 2009 ; 40 ( 6

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Sarah Daniels, Gabriela Santiago, Jennifer Cuchna and Bonnie Van Lunen

; pacemaker; other malignancy; use of pain meds during the trial unless medically necessary to ensure safety; use of topical agents other than the US gel provided; refuse to discontinue all other interventional treatment modalities; underwent a local corticosteroid or platelet-rich plasma injection within the