LONG-TERM EFFICACY OF A SEQUENTIAL MULTIMODAL PROTOCOL (PROLOTHERAPY-PRP-HA) IN CHRONIC SHOULDER TENDINOPATHIES IN FRAIL PATIENTS: A PROSPECTIVE STUDY.

M. De Luca, G. Liguori, L. Bertali, M. Criscuolo, M.J. Sucre | UOC Anestesia Rianimazione Terapia del Dolore Ospedale San Leonardo, Castellammare di Stabia, Italy

Introduction. The treatment of chronic tendinopathies in elderly patients (60-75 years old) with comorbidities requires strategies capable of overcoming the reparative stasis of tendon tissues. This study evaluates the long-term efficacy of a personalized multimodal protocol based on image-guided regenerative medicine.
Methods. Sixty patients (aged 60-75) were enrolled after excluding full-thickness tendon tears and severe osteoarthritis. The protocol included: - [ ] 1. Prolotherapy: 3 sessions (15-day interval) to induce initial cell proliferation. - [ ] 2. PRP (Monocyte-Rich): 2 sessions (25-30 day interval). Unlike intra-articular approaches, a monocyte-rich PRP (M-PRP) was used, aimed at actively modulating the chronic inflammatory environment of the tendon and stimulating tissue repair. - [ ] 3. Viscosupplementation: 1 session of peritendinous linear HA (15-day interval). - All procedures were performed under precision ultrasound guidance. Functional rehabilitation was initiated early. Outcomes (NRS, DASH, ROM) were assessed at 6 months and 1 year.
Results. 90% of patients reported a clinically significant improvement. The 1-year follow-up confirmed the stability of the results, with sustained improvement in active ROM and persistent decrease in DASH and NRS scores. No adverse effects were reported.
Conclusions. The proposed sequential protocol shows excellent long-term results. The choice to use monocyte-rich PRP for tendinopathies, as opposed to leukocyte-poor/monocyte-poor PRP typically reserved for osteoarthritic conditions, underscores the importance of a "biologically targeted" approach. Indeed, monocytes play a key role in the reparative phenotype of dense connective tissues, confirming the superiority of a tailor-made regenerative strategy.