Autologous blood injection for tendinopathy

Autologous blood injection for tendinopathy is claimed to promote healing through the action of growth factors

• can be performed using either autologous whole blood or platelet-rich plasma. The latter aims to deliver a greater concentration of growth factors
• procedure:
  • a variable amount of blood is withdrawn from the patient by standard venesection. Sometimes the blood is centrifuged to produce a platelet-rich sample
  • about 2-3 ml of whole blood or platelet-rich plasma is injected into the plantar fascia, sometimes with ultrasound guidance. Local anaesthetic is usually used
  • 'dry needling' (repeatedly passing a needle through the tissue to disrupt the fibres and induce bleeding) may be performed before injection of the blood
  • a 'peppering' technique is sometimes used to inject the autologous blood; this involves inserting the needle into the fascia, injecting some of the blood, withdrawing without emerging from the skin, slightly redirecting and reinserting
  • after the procedure, patients are usually advised to avoid high-impact activities for a few weeks, and to follow a programme of stretching exercises. The procedure may be repeated if needed

NICE states (1):

• evidence on autologous blood injection for plantar fasciitis raises no major safety concerns. The evidence on efficacy is inadequate in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research

Notes:

• 'tendinopathy' describes a range of conditions that affect tendons, causing pain, weakness and stiffness
  • symptoms are usually associated with overuse
  • sites commonly involved are the extensor (elbow), Achilles (heel) and patellar (knee) tendons
  • tendinopathy also has other names - for example, tendonosis and tendonitis - and it encapsulates a range of pathologies, including inflammatory, non-inflammatory and degenerative changes

Reference:

• NICE (January 2013). Autologous blood injection for tendinopathy