Treatment of Achilles Tendionopathy Not Improved with PRP Injections

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Achilles tendon injuries frequently lead to sport cessation for long periods and interfere with daily living activities. Conservative treatment is often disappointing with 25% to 45% of patients eventually require surgery.

The recent introduction of platelet-rich plasma (PRP) injections in the treatment of Achilles tendinopathy has raised high expectations in non-surgical treatment. The theory behind the practice is that the platelets derived from the patient’s blood lead to a release of growth factors that participate in tissue repair.

A Dutch study published in the Jan 13 issue of the Journal of the American Medical Association found that the use of PRP along with eccentric exercise therapy for chronic Achilles tendinopathy gave no better results than exercise alone.

Robert de Vos, MD and colleagues performed the first randomized, placebo-controlled trial of the PRP therapy. The researchers enrolled 54 patients being treated at The Hague Medical Center for chronic tendinopathy two to seven centimeters above the Achilles tendon insertion.

The patients were randomly assigned to get injections of PRP or a saline placebo done using three ultrasound-guided punctures to inject five small depots of fluid into the damaged tendon. All patients received 12 weeks of eccentric exercises along with their injections.

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All patients completed a questionnaire consisting of standardized outcome measures at baseline and after 6, 12, and 24 weeks. The primary outcome measure was the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire, which quantifies the pain and activity level.

No significant difference in secondary outcome measures was found. Both groups improved significantly from baseline through 24 weeks. The PRP group improved by 21.7 points, while the saline placebo group improved by 20.5 points.

There was no significant difference between the groups at 24 weeks or at any other evaluation time point, the researchers found. No complications (infections, hematomas, or ruptures) were reported after the treatments.

Achilles tendinopathy is inflammation, irritation, and swelling of the Achilles tendon (the tendon that connects the muscles of the calf to the heel). The most common causes are overuse or arthritis, although inflammation can also be associated with trauma, infection, or the use fluoroquinolones.

Tendinitis due to overuse is most common in younger individuals and can occur in walkers, runners, or other athletes, especially in sports like basketball that involve jumping. Tendinitis from arthritis is more common in the middle aged and elderly population.

Achilles tendinitis is best prevented, treated, and maintained by preserving good ROM in the heel cord complex. Such motion can be gained with the use of an incline board, wall leans, or the "foot on chair" stretching exercises. Application of moist heat or compresses before workouts and at night are beneficial. Cold modalities should be used following strenuous activities to provide pain relief and anti-inflammatory effects.

Source
De Vos RJ, et al "Platelet-rich plasma injection for chronic achilles tendinopathy: A randomized controlled trial" JAMA 2010; 303(2): 144-49.

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