Injuries to the muscles, ligaments or tendons frequently occur during activities such as sports and may be due to tissue degeneration. These injuries are more common on specific body parts, such as tendons located in the shoulders, elbows, knees, and ankles. There are several techniques used in treating these conditions. In this article, we shall focus on Gluteal Tendinopathy.
What is Gluteal Tendinopathy?
Tendinopathy is an injury to a tendon. Gluteal tendinopathy is, therefore, an injury of the gluteal muscles. There are several tendons around the hip. All may be subject to tendonitis, but gluteal tendinopathy is the most common.
Tendinitis of the hip can occur spontaneously after exercise with an excessive strain on the tendon or in the aftermath of a hip prosthesis. It is more common in women than men and especially in athletes.
PRP treatment of Gluteal Tendinopathy
PRP injection is a new tool in the treatment of gluteal tendinopathy. Its effectiveness has been reported in numerous series published in research materials. Moreover, ultrasound guidance is essential and the injection must be done in consensus with the referring clinician (who verifies the absence of legal contraindications in relation to doping).
What is the course of a PRP injection?
Platelets form part of the blood. They produce growth factors that facilitate tissue repair and regeneration. It is possible that a high concentration of platelets administered at the level of the wound may allow faster healing. The platelet-rich therapy involves the production of a blood fraction of the platelet-rich patient (concentrated). This is then applied by injection at the site of the injury. The ideal process involves;
- Referral of the patient to a biological analysis laboratory for blood sampling.
- Centrifugation and collection of platelet concentrate
- The platelet concentrate is then carried by hand by the biologist to the radiologist who performs the gesture under ultrasound control.
- Inflammatory phase: it lasts about 24 hours. Inflammatory cells (platelets, polymorphonuclear neutrophils, and macrophages) migrate rapidly to the site of injury and secrete vasoactive and chemotactic factors.
- Repair phase: it starts a few days after the trauma and lasts a few weeks. Fibroblasts stimulated by inflammation of the injured site produce collagen and extracellular matrix elements.
- Remodeling phase: At the sixth week, the number of cells and the molecular synthesis decrease. The scar connective tissue changes progressively transforms into tendon tissue around the tenth week. After this period, the fabric continues to change to find its original morphology and mechanical properties.
From a practical point of view, exercises must be avoided during the inflammatory phase (approximately one week) in order to limit the alterations of the primary fragile scar tissue. During the following phases, the tendon mobilization makes it possible to limit the adhesions and to increase the elastic properties.
In general, a blood sample contains 93% red blood cells, 6% platelets and 1% leucocytes. The principle of platelet-rich plasma (PRP) is to reverse these proportions by decreasing the rate of red blood cells that are of little use (5%) to healing and increasing the platelet count.
The pathophysiological hypothesis is that TGF-beta (transforming growth factor beta) and bFGF (basic fibroblast growth factor) that are in the blood act as humoral mediators to trigger the healing process. These growth factors promote stem cell production, increase local vascularization, and directly stimulate collagen production by tendon fibroblasts. Moreover, platelets contain the coagulation and growth factors involved in wound healing.