PRP (Platelet Rich Plasma) For Achilles Tendon Pathology
PRP For Achilles Tendon Pathology
Current Literature on PRP for Achilles Tendon Injury
Recent studies have shown that PRP can positively affect gene expression within tendon cells. Tendon injury leads to a cascade of degeneration that eventually may lead to rupture. These include reduced blood flow, repetitive micro-trauma, which can then lead to tissue degeneration and weakness of the tendon. Platelet-rich plasma (PRP) theoretically reverses the effects of tendon degeneration by stimulating increased blood flow and improving healing at a cellular level.
Initially adhesions can form within the tendon. Following on from this the tendon can undergo degenerative changes within the substance of the tendon as well as inflammation. It is hypothesised that the introduction of PRP into the problematic tendon will aid in the repair and remodelling of the tendon.
One study used PRP on the Achilles tendon of rats against a control group injected with saline. They found a significant increase in regeneration in the PRP group in comparison to the control group during the first two weeks of the healing process. The study also noted a number of newly formed vessels in the PRP group. It was also observed that the orientation of collagen fibres in the PRP group was better organised.
Another study performed a prospective study on 15 patients with Achilles tendonitis. After following patients for 18 months, they found improvement in reduced pain. It was concluded that PRP is a viable treatment alternative for Achilles tendonitis.
A recent double-blind, randomised study by de Vos looked at PRP injection in patients with chronic Achilles tendinopathy involving 54 patients evenly divided into the PRP group and control group. Study authors injected a non-disclosed amount of PRP into five sites along the injured tendon. Patients were only allowed to walk short distances indoors in the first 48 hours. In days three to seven, patients were allowed walks up to 30 minutes. After one week, patients started an exercise routine with one week of stretching and a 12-week daily eccentric exercise program with heel drops off a step. The study authors allowed no weightbearing sports activities for four weeks followed by a gradual return to those activities. The results were based on patient questionnaires that quantified pain and activity level. The results showed an improvement in 24 weeks by 21.7 points in the PRP group and 20.5 points in the placebo group. The authors concluded there was no significant difference between the groups.
In one study, surgically transected tendons treated with PRP showed a 42 percent increase in their force to failure, a 61 percent increase in ultimate stress and a 90 percent increase in energy after two weeks in comparison to the control. In another study, those tendons treated with PRP had a 30 percent increase in strength and stiffness after one week.
Pertinent Insights From Our Clinical Experience With PRP
PRP has been used for the treatment of chronic Achilles issues and rupture repair in many cases. The treatment protocol is very similar to that of plantar fasciitis. Patients who have failed to conservative therapies after three months are good candidates. In addition to pain, decreased activity and loss of function, most patients present with nodular thickening within the substance of the tendon.
We have seen a significant reduction in pain, a decrease in the size of fibrous nodules within the tendon, and an earlier return to regular and sporting activity after using PRP. Most patients have been able to return to increased exercise and activity within two months of the injection. Again, some patients have benefited from a second injection about six weeks after the first.
Regenerative medicine has been increasingly studied in the field of tendon injury and PRP is becoming a popular application to stimulate the release of growth factors. In our experience, PRP has offered promising results in the treatment of Achilles tendonitis in terms of decreased pain, faster recovery and reduced fibrous nodules within the tendon. More well designed prospective and retrospective studies are needed to measure the further effectiveness of PRP.
Here at Dynamic Regenerative Medicine in Solihull and Birmingham we believe in the beneficial effects of PRP treatment and offer this treatment for a wide range of conditions whether it be related to sports injury of general occupation.
For further information please contact us email@example.com or 01564 330 773.
Dr. Soomekh is a Fellow of the American College of Foot and Ankle Surgeons, and a Diplomate of the American Board of Podiatric Surgery. He is on the faculty of the University Foot and Ankle Institute in Santa Monica, Calif.
Dr. Yau is a Fellow at the University Foot and Ankle Institute in Los Angeles.
Dr. Baravarian is an Assistant Clinical Professor at the UCLA School of Medicine. He is the Chief of Foot and Ankle Surgery at the Santa Monica UCLA Medical Center and Orthopedic Hospital. Dr. Baravarian is the Director of the University Foot and Ankle Institute in Los Angeles. He is a Fellow of the American College of Foot and Ankle Surgeons.
1. Mehta S, Watson JT. Platelet rich concentrate: basic science and current clinical applications. J Orthop Trauma. 2008;22(6):432-438.
2. Calleja, M and Connell D. The Achilles Tendon. Semin Musculoskelet Radiol. 2010;14(3):307-322.
3. Pierre-Jerome C, Moncayo V, and Terk MR. MRI of the Achilles tendon: a comprehensive review of the anatomy, biomechanics, and imaging of overuse tendinopathies. Acta Ridiologica 2010; 51(4):438-454.
4. Wijesekera NT, Calder JD, and Lee JC. Imaging in the assessment and management of achilles tendinopathy and paratendinitis. Semin Musculoskelet Radiol. 2011;15(1):89-100.
5. Heckman DS, Gluck GS, Parekh SG. Tendon disorders of the foot and ankle, part 2: Achilles tendon disorders. Am J Sports Med. 2009;37(6):1223-1234.
6. Schepsis AA, Jones H, Haas AL. Achilles tendon disorders in athletes. Am J Sports Med. 2002;30(2):287-305.
7. Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy. 1998;14(8):840-3.
8. Alfredson H, Cook J. A treatment algorithm for managing Achilles tendinopathy: new treatment options. Br J Sports Med. 2007; 41(4):211-216.
9. Rompe JD, Furia JP, Maffulli N. Mid-portion Achilles tendinopathy – current options for treatment. Disability Rehabilitation 2008;30(20-22):1666-1676.
10. Maffulli N, Longo UG, Denaro V. Novel approaches for the management of tendinopathy. J Bone Joint Surg Am. 2010; 92(15):2604-2613.
11. De Vos RJ, Weir A, van Schie HTM, Bierma-Zeinstra SMA, Verhaar JA, Weinans H, Tol JL. Platelet rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010;303(2);144-149.
12. De Jonge S, de Vos RJ, Weir A, van Schie HTM, Bierma-Zeinstra SMA, Verhaar JA, Weinans H, Tol JL. One-year follow-up of platelet rich plasma treatment in chronic Achilles tendinopathy: a double-blind randomized placebo-controlled trial. Am J Sports Med. 2011;39(8):1623-9.
13. Kampa RJ and Connell DA. Treatment for tendinopathy: is there a role for autologous whole blood and platelet rich plasma injection? Int J Clin Pract. 2010; 64(13):1813-1823.
14. Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37(11):2259-2272.
15. Alfredson H, Lorentzon R. Chronic Achilles tendinosis: recommendations for treatment and prevention. Sports Med. 2000;29(2):135-146.
16. Lyras DN, Kazakos K, Verettas D, et al. The influence of platelet-rich plasma on angiogenesis during the early phase of tendon healing. Foot Ankle Int. 2009;30(11):1101-1106.
17. Gaweda K, Tarczynska M, Krzyzanowski W. Treatment of Achilles tendinopathy with platelet-rich plasma. Int J Sports Med. 2010;31(8):577-83.
18. Virchenko O, Aspenberg P. How can one platelet injection after tendon injury lead to a stronger tendon after 4 weeks? Interplay between early regeneration and mechanical stimulation. Acta Orthop. 2006;77(5):806-812.
19. Virchenko O, Grenegard M, Aspenberg P. Independent and additive stimulation of tendon repair by thrombin and platelets. Acta Orthop. 2006;77(6):960-966.
20. Aspenberg P, Virchenko O. Platelet concentrate injection improves Achilles tendon repair in rats. Acta Orthop Scand. 2004;75(1):93-99.
21. Sanchez M, Anitua E, Azofra J, Andia I, Padilla S, Mujika I. Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices. Am J Sports Med. 2007;35(2):245-251.
22. Sarrafian TL, Wang H, Hackett ES, et al. Comparison of Achilles tendon repair techniques in a sheep model using a cross-linked acellular porcine dermal patch and platelet-rich plasma fibrin matrix for augmentation. J Foot Ankle Surg. 2010;49(2):128-134.