Case Diagnosis: 20 year old male collegiate football placekicker with an acute quadriceps strain.

Case Description: A 20 year old male right foot dominant NCAA Division 1 football placekicker presented to clinic with right anterior thigh pain. He first experienced discomfort during warm-ups a few weeks prior that persisted despite electrical muscle stimulation, massage, icing, stretching, and naproxen. Ultrasound (US) showed a partial rectus femoris tear with a 30 mL hematoma which was aspirated. After one week of rest and indomethacin, he returned to minimal kicking with definite clinical improvement but repeat US showed a 41 mL hematoma which was again aspirated. An MRI confirmed partial tearing of the rectus femoris, and despite long periods of rest and treatment, symptoms continued to recur with increasing activity. The athlete received an US guided platelet-poor plasma (PPP) injection to areas of the quadriceps with defects on US.

Setting: Outpatient collegiate varsity athlete clinic.Assessment/

Results: For the week post-PPP injection, the athlete rested the right quadriceps and was continued on indomethacin for prevention of heterotopic ossification. Seven days post-injection, US showed no fluid, and the athlete stated that his leg felt the best it had since the initial injury and was able to start kicking without issues. One month post-PPP injection, MRI showed a resolving strain, and the athlete felt that his right quadriceps was back to normal.

Discussion: The use of platelet-rich plasma (PRP) for treatment in acute muscle strain injuries has shown conflicting results. This may be attributed to the variable amount of growth factors, some of which may play a damaging role by promoting inflammation, fibrosis, and molecular degradation. Studies have found increased inflammation in leukocyte-rich PRP, which has led to the idea of utilizing leukocyte-poor PRP and PPP instead.

Conclusion: This is the first case report on the successful treatment of an acute muscle strain with PPP.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/use-of-platelet-poor-plasma-in-acute-quadriceps-muscle-strain-in-a-division-i-football-placekicker-a-case-report/