What do Stephen Curry, Tiger Woods, and Hines Ward have in common? They’ve all received platelet-rich plasma (PRP) injections to treat patellar tendinopathy, a chronic overuse injury often referred to as Jumper’s Knee. These PRP injections are the focus of a 3-year $300,000 grant awarded to UW by the National Basketball Association (NBA) and GE Healthcare, as part of a collaboration focused on the diagnosis and treatment of tendinopathy. The research team will test both PRP injections and dry needling, a technique where a small needle is used to stimulate tissue healing without an injection of PRP.
Patellar tendinopathy affects athletes of all levels, but limited treatment options mean that elite athletes often enter a vicious cycle of overuse and lack of rest. Non-surgical options only treat the pain, rather than the tendon itself, and surgery comes with a long recovery period. This gap in treatment options has so far been filled by the relatively-unstudied PRP injections, but a team of UW investigators hopes to shed more light on their effectiveness.
“All these elite athletes are getting injected every year, and we need to do the science to make sure there’s good evidence behind this,” said Associate Professor Ken Lee, MD. Dr. Lee is joined by four other investigators; UW Radiology colleague Professor Richard Kijowski, MD, as well as Associate Professor of Orthopedics and Rehabilitation John Wilson, PhD, Professor of Mechanical Engineering Darryl Thelen, PhD, and Professor of Orthopedics and Rehabilitation Bryan Heiderscheit, PhD.
The multi-disciplinary team has extensive experience investigating tendon overuse injuries and biomechanics, with trials examining common problems from tennis elbow to plantar fasciitis. This team science approach to studying patellar tendinopathy will follow 66 patients over a one-year period as they are randomized to receive one of three treatments: PRP injection, dry needling, or a placebo. Dr. Lee expects to see positive results with PRP, predicting that PRP will be 75% effective in reducing pain.
“However, the flipside is that we also think patients will get pain relief with dry needling. It’s a matter of: is there a difference between the two? Once we understand that better, we can better stratify patients. That’s where imaging will help,” said Dr. Lee.
The primary use of both magnetic resonance imaging (MRI) and ultrasound (US) in the study is to obtain quantitative measures of healing response in tendons, to determine the effectiveness of the treatments. Additionally, MRI and US will be used to grade severity of the tendon disease, which may govern which treatment patients receive in a clinical setting. This is key because while dry needling is covered by health insurance, PRP injections are not. Physicians want to know how effective dry needling is compared to PRP, potentially avoiding high out-of-pocket costs to their patients.
The study will begin fall of 2016 and run for three years, with patients being recruited over the next 18 months. Other grant awardees include a University of Calgary study that will assess the influence of playing surfaces and footwear on patellar tendinopathy, and a La Trobe University (Australia) study investigating the relationship between pain and change in tendon structure.