Treatment of chronic tendinopathy with ultrasound-guided needle tenotomy and platelet-rich plasma injection.

OBJECTIVE: To determine whether ultrasound (US)-guided percutaneous needle tenotomy followed by a platelet-rich plasma (PRP) injection would result in pain reduction, functional improvement, or structural alterations in patients with chronic, recalcitrant tendinopathy. DESIGN: Part A was a retrospective observational study. Part B was a prospective observational study. SETTING: Outpatient academic sports medicine center. PARTICIPANTS: Patients were required to have chronic (>3 months), recalcitrant tendinopathy treated with US-guided percutaneous tenotomy and PRP injection between January 2007 and October 2009. Fifty-one subjects met the inclusion criteria. Forty-one (80%) participated in part A of the study, whereas 34 subjects (67%) participated in part B. METHODS: In part A, subjects completed a survey obtaining anthropomorphic, demographic, pain, and functional data. Subjects' platelet, hemoglobin, and white blood cell concentrations from their whole-blood and PRP samples were also obtained. In part B, subjects returned to the clinic after US-guided percutaneous needle tenotomy and PRP injection for a diagnostic US, which was compared with their preprocedure diagnostic US. MAIN OUTCOME MEASURES: The main outcome measures included changes in pain, function, and tendon characteristics. RESULTS: The tendinopathy location was in the upper extremity in 10 subjects (24.4%), was in the lower extremity in 31 subjects (75.6%), and had been present for a mean of 40 months. The mean postprocedure follow-up was 14 months, and the maximum benefits occurred 4 months postprocedure. There were mean functional and worst-pain improvements of 68% and 58%, respectively. Eighty-three percent of subjects were satisfied with their outcomes and would recommend the procedure to a friend. Although no tendons demonstrated a normal sonographic appearance after the procedure, 84% of subjects had an improvement in echotexture, 64% had a resolution of intratendinous calcifications, and 82% had a decrease in intratendinous neovascularity. None of the variables analyzed in this study demonstrated a significant correlation with pain or functional outcome measures. CONCLUSIONS: In this case series, we found US-guided percutaneous needle tenotomy followed by PRP injection to be a safe and effective treatment for chronic, recalcitrant tendinopathy, and this treatment was associated with sonographically apparent improvements in tendon morphology. However, because of the intrinsic limitations of the study design and the heterogeneity of treated tendons, further research is required to corroborate our findings.

Use of an autologous blood recovery system during emergency pericardiocentesis in the electrophysiology laboratory.

INTRODUCTION: Emergency pericardiocentesis during electrophysiology procedures is often associated with significant aspiration of pericardial blood, requiring transfusion. We sought to assess the feasibility of urgent use of an autologous blood recovery system in the electrophysiology laboratory to autotransfuse blood aspirated from the pericardium. METHODS AND RESULTS: We retrospectively analyzed Mayo Clinic electrophysiology records for patients who had ablation procedure-related pericardial effusions requiring emergency pericardial drainage during an 8-month period. An autologous blood recovery system was used during pericardiocentesis to separate and clean packed red blood cells from the pericardial aspirate. These cells were returned acutely to the patient intravenously. The procedural safety, aspirated and autotransfused volumes, and efficacy of this approach were evaluated. During the study period, nine patients underwent pericardial drainage with autotransfusion using a cell-salvage instrument during electrophysiology procedures. The mean aspirated volume was 1,078 mL, with a mean autotransfused volume of 390 mL. For four patients, all with aspirated volumes of 1,100 mL or less, autotransfusion alone was sufficient to maintain hemodynamic stability and avoid allogeneic transfusion. One patient required surgical intervention because of ongoing pericardial bleeding. The ablation procedure was completed after aspiration in two patients. No procedural complications related to the use of the cell-salvage system occurred. CONCLUSION: Autologous blood recovery during pericardiocentesis is safe, convenient, and feasible. With early use it may decrease or eliminate the need for allogeneic blood transfusion and, in selected cases, may permit completion of the ablation procedure.