Sports Medicine Physician Sports Medicine South Lawrenceville, Georgia, United States
Case Diagnosis: Left Hip Labrum Tear L3-4 Interspinous Ligament Tear
Case Description: A 21-year old collegiate gymnast presented to our sports clinic with a three-month history of recurrent left-sided groin pain associated with clicking and low back pain worsened with extension, rated at 5/10 on the pain scale. The pain improved with rest but worsened with tumbling and running. There was no specific injury reported. The athlete had a long history of athletic-associated hip and low back pain that worsened throughout the season. She failed ultrasound-guided lumbar intramuscular injection of platelet-rich plasma (PRP), medications, and physical therapy. MRI revealed an anterior hip labral tear and L3-4 Interspinous ligament tear. The patient underwent fluoroscopy-guided left hip and L3-4 interspinous ligament/facet PRP injection followed by four-weeks of physical therapy with complete pain resolution and returned to gymnastics.
Discussions: There is increasing data that shows the efficacy of PRP for orthopedic and musculoskeletal complaints, especially knee osteoarthritis and lateral epicondylitis. However, emerging evidence of patient improvements in a myriad of conditions including tendinopathy, ligament tears, and other joints. In a pilot study on hip PRP injections for labral tears, De Luigi et al. reported statistically significant functional and pain improvements. Additionally, a 2018 systematic review showed PRP as efficacious for long-term hip pain relief, and a 2017 prospective study deemed facet PRP provides longer pain relief than corticosteroid injections. This study highlights the utility of PRP in decreasing pain and time out of sports.
Conclusions: More data is required in the regenerative medicine field for the exact dosage, usage, and efficacy of PRP. This case highlights that PRP is a reasonable and effective treatment for athletes with intraarticular-mediated pain from joints such as the facets and hip joint. This allows for the patient to utilize natural healing mechanisms, quick return to play, and avoid possible deleterious effects of corticosteroids.