So I'm from Philadelphia, from Jefferson. I'm a MSK radiologist who specializes in ultrasound-guided procedures. And we work closely with our colleagues and friends at Rothman. So this study was with two of my colleagues, Dr. Sogan Morrison and Steve Cohen from Rothman was a co-author as well. We have no financial disclosures. So the main purpose of this study was really to find the best treatment for grade 2 hamstring strains. And this is a typical clinical scenario here. You see there's a coronal T2-weighted image of a grade 2 strain of the biceps femoris and hamstring muscle. And on the axial, you see the same strain. That's the main biceps femoris strain. This is the semitendinosus and semimembranosus here, which are fairly normal. And you see this T2 hyperintense fluid hematoma around the sciatic nerve. So that oval structure here is the sciatic nerve. And PRP in general, if you look across the country, for most professional athletes, grade 2 strains are treated now with PRP injections. But if you look at the literature, PRP is favored, but it's not a slam dunk. If you look at the papers, about 60% to 70% of papers favor PRP versus just conservative treatments. And there's still 30% to 40% of articles out there that say that there's no difference. So we basically try to find what else can we do to make the treatment with PRP more effective. Because we were not convinced PRP alone is enough. And we focused on that hematoma here. And you can imagine when after a hamstring strain, patients develop that hematoma around the sciatic nerve. That can cause problems. It usually causes scarring of the nerve and the hamstring muscle. And patients have a longer recovery and more frequent recurrent injuries. So our idea was years ago that whenever we have a grade 2 strain and we see the hematoma, and you'll be surprised, most patients with grade 2 strains have this hematoma here between the muscle bellies around the sciatic nerve. We would aspirate the hematoma and then do the PRP. So we didn't want to just do the PRP, but we wanted the aspiration as well. And we thought we would get better results. So that was a study that I will present here. This is just two more pictures on ultrasound of the same pathology. So that sciatic nerve here in MRI corresponds to the sciatic nerve here on ultrasound. And the dark structure around is the hematoma. On long axis, that's the sciatic nerve here. And you see that dark fluid around is the hematoma. So that was the aspiration that we did, was basically taking out that fluid here. And this is another picture on ultrasound. Normal hamstring muscle here in that dark area. That's the grade 2 strain on ultrasound that corresponds to the strain here that we saw on the MRI earlier. And PRP in general, it has been used for 20 to 30 years actually on horses, especially on racehorses. And we had success there, and then it made its way to human medicine and sports medicine. And the idea is, as you know, we do a regular blood draw first, and then after centrifugation we get different layers of blood. And in general, that's how the composition is that we get after the spin in the centrifugation. So we get plated poor plasma, plated rich plasma, and packed red blood cells. And that central portion is what we extract through the tubing and we inject it back into the injury. There are different PRP systems, leukocyte rich, leukocyte poor. I use two different systems, and it depends on the injury what we use, leukocyte poor versus leukocyte rich. So to the study in quick, it was a retrospective study, and we had the grade two hamstring strains in athletes as the patient population. And we were able to get two nice patient groups retrospectively. From 2013 to 2015 in Philadelphia, professional athletes were treated mainly conservatively, so we hadn't really done PRP back then. And we compared that group to 27 athletes from 2016 to 2018 who had the hematoma aspiration and the PRP injection that I earlier mentioned. So we were able to divide patients that way because we started that treatment around 2016. Everything else, the rehab, stayed pretty much the same. And the results were that the average return to play time from those grade two hamstring strains was 32.4 days in the conservative group and 23.5 days in the aspiration PRP group. So you can see it's about a nine-day quicker return, and that makes a big difference. If you think about the NFL, nine days, that's one game less missed. And even more impressive was the recurrence rate. It was 28.6% of fairly high in the conservative treatment group and less than 4% in the aspiration PRP group. So also less risk of recurrent injuries. So the conclusion was from that study that athletes with grade two hamstring strains who were treated with a combination of the hematoma aspiration and the PRP injection had a significantly shorter return to play time and a lower recurrence rate than athletes who received the conservative treatment just with rehab and PT. Thank you very much.

MSK radiologist

ultrasound-guided procedures

grade 2 hamstring strains

PRP injections

hematoma aspiration