Sports Medicine | PRP for Quadricep Tendon Injury
The patella is commonly refered to as the kneecap. It is the small bone that is located in the front of your knee. When you bend and straighten your knee, the patella glides up and down the groove in the thigh bone. Tendons connect muscle to bone. The quadriceps muscle that is located on the front of the thigh attaches to the top of patella via the quadriceps tendon. The quadriceps tendon covers the patella and continues down to form the “rope-like” patellar tendon that connects the large quadriceps muscle to the knee.
Quadriceps tendinitis is also called knee tendinitis. Knee tendinitis is the inflammation and irritation of the quadriceps tendon. It is common among the athletes and individuals who are very active. This condition is present in those who are involved in activities that put excess strain on the knees and legs. Alignment and overuse of the knee structures lead to strain, irritation, and/or injury of the quadriceps muscle and tendon. This produces pain, weakness, and swelling of the knee joint
Cause
Quadriceps tendonitis occurs due to stress placed on the supporting structures of the knee. Jumping, running, and/or quick movements often contribute to quadriceps tendonitis. Overuse of the muscle especially due to extensive sports activities, can result in ‘micro tears’ in the quadriceps tendon which leads to inflammation and pain. In extreme cases, the quadriceps tendon may become damaged to the point of complete rupture. The factors that are linked to the overuse of tendon injuries are classified into extrinsic and intrinsic categories. Extrinsic factors that could potentially cause this condition include inappropriate footwear, training errors (frequency, intensity, duration), and surface (hard surface, cement) being used for a sporting event(such as running). Intrinsic factors include age, flexibility, and joint laxity. Chronic quadriceps tendonitis often referred to as tendonosis is when there is degeneration and/or scarring of the tendon. Chronic tendon injuries are much more common in older athletes (30 to 50 years old).
Symptoms
The most common symptom of quadriceps tendonitis is pain when you move your knee. The pain is usually slight, but worsens as the condition develops. You may also observe swelling around the area where the quadriceps muscle meets the knee. You may also experience a feeling of “warmth” or “burning” in the area. There is also stiffness of the knee (during and after exercise) and localized tenderness that increases as you move your knee. Stiffness of the knee is also common when you first get up in the morning (or after a long period of rest or inactivity).
Diagnosis
The physician may ask you about your complete medical history of any past knee problems, followed by careful examination of the knee. There is usually tenderness with palpation of the inflamed tissues at the insertion of the tendon into the bone. The knee will be assessed for range of motion, strength, flexibility, and joint stability. Your physician will also look into the intrinsic and extrinsic factors that affect the knee. Potential problems with lower extremity alignment are identified. Your doctor will also check to see if the quadriceps tendon is partially torn or ruptured.
X-ray may also be required to show any fractures or the presence of calcium deposits in the quadriceps muscle. X-rays will not be helpful in diagnosing a soft tissue injury. In these cases, other tests, such as ultrasonography or magnetic resonance imaging (MRI), may be suggested. Tendon tears are detected by ultrasound waves while MRIs detect the problems in the soft tissues of the body.
Treatment
Decreasing inflammation caused by this condition is very important to control. Your doctor may prescribe NSAIDs especially when the problem is coming from overuse. Acetaminophen may be used for pain control if you cannot take anti-inflammatory medications for any reason.
Resting the knee is also important. When pain is no longer present while resting, a gradual increase in activity is allowed as long as
your pain does not come back.
Physical therapy may help decrease pain and inflammation in the early stages of quadriceps tendinitis. Ice massage, electrical stimulation, and ultrasound are other treatment options that limit pain and swelling associated with this condition. Your therapist may advise stretching and strengthening exercises in order to correct muscle imbalances. You may also use braces and wrap tape around the injury. Bracing and taping the patella can help you do the exercises and activities you want with less pain.
If physical activity is accompanied with pain or swelling, icing of the area should be done. Icing should be limited to no more than 20 minutes. Heat may be used in cases of chronic tendinosis to stimulate blood circulation and promote tissue healing.
Proper footwear for certain sports is important. Your therapist can help you design a special insert for the shoe. It will improve your knee alignment and function of the patella.
Modifications of extrinsic and intrinsic causes of Quadriceps tendonitis is also an important management intervention.
PRP for Quadricep Tendonitis / Tendinosis
PRP (Platelet Rich Plasma) therapy is gaining a reputation as one of the fastest and most effective ways to treat soft tissue and bone injuries. Utilized by some of the world’s best athletes, it has quickly become popular among weekend warriors and those who suffer from chronic tendon and muscle injuries. Platelet Rich Plasma therapy is a simple but very effective way to heal muscles, tendons and even bone. It utilizes a person’s own platelets to speed up the healing process. A person with chronic quadriceps tendonitis/tendinosis may benefit from PRP therapy’s ability to facilitate an accelerated rate of healing.
Tendonitis is the inflammation of the tendon while tendinosis is the prolonged degeneration of the tissue. A person with tendinosis may also have small tears in the tendon. Both conditions are very painful and can be slow healing. PRP therapy may be able to noticeably speed up the healing process using the body’s own healing abilities. Concentrated amounts of growth factors, found in the body’s own platelets, are injected directly into the Quadricep tendon. Growth factors are healing proteins which promote cell and tissue growth, bone regeneration, blood vessel development, plus much more.
To obtain the body’s platelets, a small amount of the patient’s blood is drawn. It is placed in a centrifuge, where the blood components are separated. The blood is made up of plasma, red blood cells, white blood cells and platelets. Platelets are rich in growth factors which help to promote healing. After the platelets are extracted from the rest of the aforementioned blood components, they are injected into the site of the injury, in this instance, the Quadricep.
A physician might recommend that a patient undergo PPR therapy when traditional treatment methods, such as the use of anti-inflammatory medications, rest, ice massage, bracing or physical therapy, have not been effective. Some people’s injury will not respond to the above therapies or may be slow in doing so. In lieu of surgery, a doctor may suggest that a patient undergo PRP therapy instead.
Individuals interested in undergoing a new, semi-experimental form of treatment which has been effectively utilized by top athletes, amongst them, Alex Rodriguez, Hines Ward and Troy Polamalu, may request PRP therapy. It is not necessary that this form of treatment be a last resort. Doctors that believe in it, might prescribe it for their patients right away.
PRP Therapy may be considered a superior treatment option when a patient needs or wants accelerated relief. Ice massages, rest, bracing, physical therapy, etc., require time to take effect. A person who either doesn’t have the time to wait around or who would prefer not to, might find PRP to be the best option for them. It might also be a good choice for those who want to forgo surgery.
PRP Therapy may or may not be covered by an individual’s insurance company. Some companies will pay for, others will not, largely because it is considered by some to be a semi-experimental therapy. That may soon change as a slew of studies are currently being done. As more evidence is released which supports the effectiveness and medical integrity of PRP, more insurance companies will likely begin to offer coverage for it. PRP injections cost between $500 and $1000. In some areas, they are a little more expensive.
PRP Injection Protocol and Procedures
FAQ’s: Be Sure To Ask Your Doctor These Questions
1. Is PRP Therapy right for me?
2. How much does your office charge for PRP injections?
3. How many PRP injections do I need?
4. Is PRP therapy safe?
5.Why is PRP therapy considered semi-experimental?
Complications
If left untreated, it can lead to further damage to the tendon. There can be intense pain leading to significant morbidity.
Complications depend on the initial severity of injury and rehabilitation protocol. Prolonged rest can lead to more fibrosis.
Usually managed by long-term physiotherapy. Minimal role for surgical management.
Prognosis
Most people return to their normal occupation in a couple weeks.
Prevention
Education is the key to prevent further injuries. You must stretch your muscles and tendons before any strenuous activity. Some experts recommend a cool down and stretching after exercise as well. You should know your limits and never over do the exercise.
Questions a physician may ask you about your condition on your first doctor visit
- Did you have any recent injury or accident?
- Can you explain to me how the accident happened?
- Is the pain getting worse day by day?
- Have you tried any treatments at home? If yes, has it helped?
- Are there any limitations in your day-to-day activity?
- Do you experience warmth or burning in/around knee?
