Regarding "Rupture of the Patellar Tendon after Platelet-Rich Plasma Treatment: A Case Report"

We are grateful for sending us the comment of Malanga et al. about our publication “Rupture of the Patellar Tendon After Platelet-Rich Plasma Treatment: A Case Report”. Regarding their observation about the size of the needle, we would like to specify that to the best of our knowledge, the size of the needle has never had a documented effect on the efficacy/risk of any type of infiltrative treatment. Secondly, regarding the number of PRP treatments performed, we would like to point out that various protocols report multiple numbers of infiltrations; it is commonly reported in the medical literature that multiple infiltrations are performed in case of chronic tendinopathies not limiting to just a single administration of PRP1,2. Moreover, regarding the leukocyte count argument, the preparation we performed was rich in leukocytes (corresponding to a concentration three times higher than baseline), and the kit carried about four to five times the baseline platelet concentration. It is known that the treatment of chronic tendinopathies with leukocyte-rich PRP is commonly performed, and there is no scientific evidence to demonstrate its inferiority compared to treatments with leukocyte-poor PRP 3,4. Our final consideration concerns the purpose of the case-report; as it is well known, these are reports of sporadic and obviously rare cases that acquire clinical relevance only if other authors report further similar cases. Our beliefs lay with the recent scientific literature regarding the efficacy of PRP in the treatment of chronic tendinopathies. This is also proven by our case report, in which the athlete taken into consideration returned to carry out his sporting activity with considerably lower amounts of painful symptoms soon after the treatment. It was certainly not our intention to prove nor identify a precise cause/effect relationship between the rupture of the patellar tendon and the infiltration with leukocyte-rich PRP. Our aim of the publication was to demonstrate not that the PRP is ineffective or harmful but simply that it does not guarantee a protective effect on possible future injuries. However, we thank Malanga et al. for the attention given to our publication.