SLR - February 2022 - Joelaki J. Cartman
Reference: Kearney R, Ji C, Warwick J, Parsons N, Brown J, Harrison P, Young J, Costa M. Effect of Platelet-Rich Plasma Injection vs Sham Injection on Tendon Dysfunction in Patients with Chronic Midportion Achilles Tendinopathy: A Randomized Clinical Trial. Journal of the American Medical Association. 2021 July 13Level of Evidence: 1
Scientific Literature Review
Reviewed By: Joelaki J. Cartman, DPM
Residency Program: East Liverpool City Hospital – East Liverpool, OH
Podiatric Relevance: Achilles tendinopathy is a common condition treated by podiatrists. Achilles tendinopathy is a common injury associated with overuse, which can lead to a sudden injury. The condition can be described as either insertional or mid-portion. Current therapies include orthotics, electrotherapy, and injections. Currently there are multiple options for injection therapy; with Platelet-Rich Plasma (PRP) gaining more interest of recent. PRP is believed to promote tendon growth due to high concentrations of growth factor that are administered directly to the site of the injury. Currently there’s a limitation to randomized trial evidence for PRP use in midportion tendinopathy. The aim of this paper is to compare the effects of a single PRP injection with a SHAM injection on pain, function and quality of life in patients with chronic midportion Achilles tendinopathy.
Methods: A randomized multicenter clinical trial was conducted at 24 UK hospitals in the National Health Service. Patients were randomized in 1:1 ratio of single PRP injection vs SHAM injections. All participants had 9ml of whole blood drawn from the antecubital fossa and received either injection 30 minuteslater. PRP injection consisted of a single injection through one portal and 5 penetrations into the tendon, while the SHAM injection consisted of 1 injection under the skin but not in the tendon. Primary outcome was measured using the Victorian Institute of Sport Assessment-Achilles score (VISA-A) questionnaire at 6 months. The secondary outcome was measured using the VISA-A questionnaire at three months, the 5-level Euroqol questionnaire (EQ-5D-5L) for quality of life at three and six months and a visual analog for pain at two weeks, three and six months.
Results: For the primary outcome there was no significant difference in VISA-A between the PRP group and the SHAM groups at 6 months following treatment. For the secondary outcome there was no significant difference between the two groups at three months using the VISA-A questionnaire. There was no significant difference in quality of life or pain at two weeks, three or six months.
Conclusions: This paper showed that there was no significant difference between a single PRP injection and a SHAM subcutaneous injection at 6 months post-treatment. There are limitations to this study such as the injection not being ultra-sound guided, and only one PRP injection being administered. These findings do not support the use of PRP for midportion Achilles tendinopathy.