Is there structural change on MRI in gluteal tendinopathy after treatment? Single outcome measure extension of an RCT

Georgia Carney; Jane Fitzpatrick

doi:10.1186/s12880-023-01150-y

Is there structural change on MRI in gluteal tendinopathy after treatment? Single outcome measure extension of an RCT

BMC Med Imaging. 2023 Nov 8;23(1):179. doi: 10.1186/s12880-023-01150-y.

Authors

Georgia Carney^{1

2}, Jane Fitzpatrick^{3

4

5}

Affiliations

¹ Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia.
² Joint Health Institute, Richmond, Melbourne, Australia.
³ Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia. jane.fitzpatrick@unimelb.edu.au.
⁴ Joint Health Institute, Richmond, Melbourne, Australia. jane.fitzpatrick@unimelb.edu.au.
⁵ Australasian College of Sports and Exercise Physicians, Melbourne, Australia. jane.fitzpatrick@unimelb.edu.au.

Abstract

Background: The etiology of tendinopathy remains controversial and it is unknown whether degenerative structural changes in tendinopathies are reversible.

Hypothesis: There will be no structural change on magnetic resonance imaging (MRI) taken > 2-years after treatment for gluteal tendinopathy.

Study design: Extension of a single site, double-blind, prospective randomized-controlled trial to analyze the additional outcome measure; MRI changes.

Methods: University of Melbourne ethics approval number: 1852900, trial registration: ACTRN12613000677707. Participants with gluteal tendinopathy who had previously received a leukocyte-rich platelet-rich plasma injection (LR-PRP) or a corticosteroid injection (CSI) had a post treatment MRI between at least 2-years and up to 7 years following trial completion. A blinded, senior musculoskeletal radiologist graded all de-identified MRI scans using the Melbourne Hip Score (MHIP). The primary outcome measure was the change in overall pre- and post-treatment score.

Results: Participants (n = 20) underwent MRI at mean time of 4.15 (SD 1.11; range 2-7) years after their initial treatment. There was no change in the overall mean MHIP score for the CSI group (Pre 4.3 (SD 2.3) Post 4.3 (SD 1.1), p = 1.00). Although there was an improvement in the LR-PRP group mean MHIP score (Pre 5.3 (SD 3.0) Post 4.77 (SD 2.5), p = 0.56) it was not statistically significant. However, in the LR-PRP intervention group, five out of nine of participants' MHIP score improved, with four of these improving by 2-4 points.

Conclusion: The hypothesis that there would be no improvement in MHIP scores following treatment of gluteal tendinopathy was supported. Findings of improvement in the LR-PRP group at 4 years would support further studies powered to look for structural improvement. These findings suggest that structural change following treatment for tendinopathy may be possible supporting the inclusion of MRI as a core outcome for future studies.

Clinical relevance: The study suggests that degenerative structural changes in tendons may be reversible.

Keywords: Ortho-biologics; Platelet-rich plasma; Regenerative medicine; Sports medicine.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Hormones
Humans
Magnetic Resonance Imaging
Outcome Assessment, Health Care
Prospective Studies
Tendinopathy* / diagnostic imaging
Tendinopathy* / therapy

Substances

toliprolol
Adrenal Cortex Hormones

Associated data

ANZCTR/ACTRN12613000677707