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Use of Micronized Lipoaspirate with Platelet-rich Plasma Injection and 3D Tenotomy for Treatment of a Longitudinal Peroneal Brevis Tear

Journal: The AAO Journal Date: 2023/06, 33(2):Pages: 26. doi: Subito , type of study: case report

Full text    (https://meridian.allenpress.com/aaoj/article/33/2/20/493544/LBORC-NUFA-Poster-Abstracts-2023-Students)

Keywords:

ankle [33]
case report [514]
fibula [10]
OMT [2951]
osteopathic manipulative treatment [2973]
peroneus brevis [1]
platelet-rich plasma [2]
tendinopathy [7]
tenotomy [1]

Abstract:

Introduction/Background: Lateral ankle instability is associated with posterolateral ankle pain and ligamentous laxity. Longitudinal tears of peroneus brevis can occur with repeated sheering due to the sharp, posterior boarder of the fibula. Standard surgical treatment may involve lateral ankle complex reconstruction. Micro-fragmented adipose tissue (MFAT) with platelet-rich plasma (PRP) is a novel regenerative treatment for tendinopathy. Case: A patient with left>right chronic knee pain was referred to our integrated osteopathic neuromusculoskeletal (NMM) and sports medicine clinic from an out-of-state NMM physician. History included numerous traumas, moderate-severe bilateral genu valgus with instability, and multi-joint degenerative joint disease (DJD). A nonsurgical approach was taken to address mobility and pain, including Osteopathic Manipulative Treatment (OMT), physical therapy (PT) and regenerative medicine. The patient then presented with right ankle pain and instability, and a right peroneus brevis tendon longitudinal split tear was found on diagnostic ultrasound. Primary treatment included 3D tenotomy with PRP of peroneal brevis tendon, multiple ankle ligaments, and ankle/subtalar joints, combined with PRP/MFAT injection into tendon tear. Post-procedural care has included bimonthly OMT and weekly physical therapy. Results: The patient’s multiple conditions have continued to improve over a 6-month period resulting in significant functional improvement. Patient telehealth follow-up showed adequate recovery with progression in right ankle weight-bearing, mobility, stability, and pain reduction. Discussion: This case demonstrates the use of regular OMT and PRP/MFAT injectate as a promising treatment paradigm for the management of chronic severe tendinopathy, tendon split tear and DJD. Patient satisfaction and self-reported improvement of ankle stability support its efficacy. Limitations include pending follow-up physical exam and repeat ultrasound for tendon imaging. Future research should include prospective assessment of PRP/MFAT injectate combinations with and without OMT simultaneously.


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