SLR - June 2010 - Joshua P. Daly

Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: A Randomized Controlled Trial

Reference:
de Vos, Robert J  et al. Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: A Randomized Controlled Trial. Journal of American Medical Association, 2010 vol. 303(2) pp. 144-9.

Scientific Literature Reviews

Reviewed by:  Joshua P. Daly, DPM
Residency Program: Florida Hospital East Orlando

Podiatric Relevance:
Foot and ankle surgeons treat patients daily with chronic Achilles tendinopathy.  Platelet rich plasma (PRP) injections are being used to supply the tendon with growth factors in an attempt to improve healing. The objective of this article was to examine if PRP injections would improve results in treating chronic Achilles tendinopathy.

Methods:
A stratified, block-randomized, double-blind, placebo controlled trial was performed with 54 randomized patients aged 18 to 70 years with chronic tendinopathy 2 to 7 cm above the Achilles tendon insertion present for at least 2 months.  The mean duration of symptoms was 36 weeks for the PRP group and 26 for the placebo group.  Half of the subjects received PRP and the other received saline using a ultrasound guided needle by a blinded physician. All patients were restricted to minimal activity for one week, and then a stretching and eccentric exercise program for 12 weeks. Activity was gradually increased after 4 weeks.  The Victorian Institute of Sports Assessment-Achilles was used to access outcome with measures at baseline, 6, 12, and 24 weeks. 

Results: 
The mean VISA-A score improved significantly after 24 weeks within the PRP group by 21.7 points and  the placebo group by 20.5 points.  There was no difference in the ability to return to activity.

Conclusions:
Among patients with chronic Achilles tendinopathy treated with eccentric exercise, PRP injection versus saline injections resulted in no difference in pain or return to activity after 24 weeks.  The authors conclude that treatment with PRP injection is not recommended for chronic Achilles tendinopathy.

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