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

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.

• Authors: Georgia Carney, Jane Fitzpatrick
• Journal: BMC medical imaging (BMC Med Imaging) Vol. 23 Issue 1 Pg. 179 (11 08 2023) ISSN: 1471-2342 [Electronic] England
• PMID: 37940869 (Publication Type: Randomized Controlled Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2023. The Author(s).

Chemical References

• toliprolol
• Adrenal Cortex Hormones

Topics

• Humans
• Prospective Studies
• Tendinopathy (diagnostic imaging, therapy)
• Magnetic Resonance Imaging
• Adrenal Cortex Hormones
• Outcome Assessment, Health Care