Platelet-rich plasma injections for the treatment of refractory Achilles tendinopathy
The Regenerative Clinic's view on this research
Mr Nima Heidari “Achilles tendinopathy is a condition of inflammation and abnormalities within the Achilles tendon. This can have profound effects on the quality of life and the function of individuals who suffer with this. Many treatments have been suggested for this including physiotherapy, injections of various substances and surgical intervention. Unfortunately, there are a group that become what is described as recalcitrant, which means that they are resistant to many forms of treatment. This elegant paper has looked at a group of individuals, 27 in total, many of whom had a number of treatments for their Achilles tendinopathy and their symptoms had lasted more than three months. They used the technique to concentrate the platelets within the plasma and they also included a type of PRP which also has white cells within it. They performed a series of three injections that were separated by two weeks. Their results demonstrate a dramatic improvement within the group, with a reduction in pain and an improvement in function. It is interesting that the initial improvement within the first two months continues at the six-month period, with further improvements at the six months and continued improvements at the final review, which on average, is about four years. This paper ends with a detailed review of all of the literature at the time of its publications with regards to the treatment of Achilles tendinopathy with the use of PRP, demonstrating that the vast majority of the current literature demonstrates a positive effect for the treatment of Achilles tendon problems with the use of PRP.”
Background: Chronic Achilles tendinopathy is responsible for a severe reduction in physical performance and persistent pain. There is currently a number of therapeutic options and the local administration of growth factors is an emerging treatment strategy. In particular, platelet-rich plasma (PRP) is a widely used way to provide a local regenerative stimulus for tendon healing. The aim of this study was to document the mid-term results obtained after treating recalcitrant Achilles tendinopathy with injections of high concentrate, leucocyte-rich PRP.
Materials and methods: Twenty-seven patients (mean age: 44.6 years; 22 men and 5 women) affected by chronic mid-portion Achilles tendinopathy (7 bilateral, for a total of 34 tendons), refractory to previous treatments, were enrolled. Patients were treated with three ultrasound-guided intra-tendinous injections of PRP at 2-week intervals. Patients were prospectively evaluated at baseline, and then at 2, 6, and up to a mean of 54.1 months of follow-up (minimum 30 months), using the following tools: Blanzina, VISA-A, EQ-VAS for general health, and Tegner scores.
Results: The VISA-A score showed a significant improvement: the baseline score of 49.9±18.1 increased to 62.9±19.8 at 2 months (p=0.002), with a further improvement at 6 months (84.3±17.1, p<0.0005), and stable results at 4.5 years (90.0±13.9). The EQ-VAS score also showed a similar positive trend. An evaluation of the activity level confirmed these findings, showing a significant improvement in the Tegner score over time (p=0.017 for the final evaluation). The longer duration of symptoms before treatment was associated with a slower return to sport (p=0.041).
Discussion: PRP injections produced good overall results for the treatment of chronic recalcitrant Achilles tendinopathy with a stable outcome up to a medium-term follow-up. Longer symptom duration was related with a more difficult return to sporting activity.