Rehabilitation and return to activity after platelet-rich plasma injections in chronic tendinopathies: Consensus from international experts.

BACKGROUND

The effectiveness of platelet-rich plasma (PRP) injections in chronic tendinopathies remains debated. Although the product's characteristics play a role, the impact of postinjection recommendations remains poorly investigated.

OBJECTIVE

To establish principles and guidelines for post-PRP injection rehabilitation and return to activity/sports.

DESIGN

We conducted a Delphi survey based on a "recommendations by formal consensus" methodology. Three clinicians and researchers of the GRIIP (International Research Group on Platelet Injections), experts in sports medicine and rehabilitation, performed a comprehensive literature review of MEDLINE, searching for (1) rehabilitation protocols after PRP injection for chronic tendinopathy and (2) fundamental studies of tendon healing. This review highlighted the main points to be clarified to establish a standardized post-PRP injection protocol. Fourteen points were identified, grouped into three dimensions (immediate postprocedure, rehabilitation, and follow-up and resumption of sports/activity). With a modified Delphi method, the propositions were submitted to a panel of 23 experts from five French-speaking countries. The recommendations were classified as appropriate or not appropriate, with strong or relative agreement, or uncertain when consensus was not reached.

RESULTS

Ten recommendations (postprocedure avoidance of nonsteroidal anti-inflammatory drugs, rehabilitation principles and timeline, follow-up) were classified as appropriate: six with strong and four with relative agreement; four propositions regarding immediate postprocedure were deemed uncertain.

CONCLUSION

Agreement was reached for 10 of the 14 recommendations but with low level of evidence, mainly based on experts' opinion. This work should help standardize a post-PRP injection protocol for chronic tendinopathies, which will minimize bias due to variations in rehabilitation protocols in further studies.