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Scientific literature review of PRP (Platelet Rich Plasma) in the treatment of Achilles tendinitis

PRP has an excellent track record in the treatment of many tendon overuse conditions like tennis elbow and patellar tendinitis. The scientific evidence for the use of PRP in Achilles tendinitis however is slightly more mixed. While some publications demonstrate obvious improvements in pain and function, other published research has been less enthusiastic about the possible benefits of PRP. At the Orthobiologics Clinic we would therefore encourage patients strongly to maximise all other treatment options first, including shock wave therapy, before considering treatment with PRP. While there is no doubt that PRP is safe to use, patients should be made aware that the chances of success when using PRP in the Achilles tendon may not be quite as good as in other tendons. Based on some of the research available, we recommend using a course of 2 or 3 PRP injections to maximise the chances of success. There is also the issue that there are many different PRP preparations on the market and therefore it is not always possible to compare one PRP with another PRP preparation. Our experts are more than happy to discuss this in more detail during a consultation.

Platelet-rich plasma injections for the treatment of refractory Achilles tendinopathy: results at 4 years

Giuseppe Filardo, Elizaveta Kon, Berardo Di Matteo, Alessandro Di Martino, Giulia Tesei, Patrizia Pelotti, Annarita Cenacchi, and Maurilio Marcacci, 2018

The authors of this publication treated 27 patients (34 tendons) with chronic Achilles tendinitis. Patients underwent 3 PRP injections in 2-weekly intervals and were then followed up for an average of just over 4 years. The authors observed that pain improved for the first 6 months following treatment and then remained stable until the final follow up. A similar pattern of improvement was noticed for function. Return to sport was 55% after 6 months and 89% after 15 months. No complications or adverse events occurred. The authors also noticed that a longer duration of symptoms resulted in a slower return to sport. The authors concluded that Repeated intra-tendinous injections of autologous PRP produced good results in the treatment of chronic recalcitrant Achilles tendinopathy, with a stable clinical improvement maintained up to a mid-term follow-up.

At the Orthobiologics Clinic we were pleased to see the benefits of repeated PRP injections in patients with chronic Achilles tendinitis. While the results are encouraging, we would like to see similar research with the inclusion of a control group undergoing placebo treatment.

Is Platelet-rich Plasma Injection Effective for Chronic Achilles Tendinopathy? A Meta-analysis

Yi-Jun Zhang MD, San-Zhong Xu MD, Peng-Cheng Gu MD, Jing-Yu Du MD, You-Zhi Cai MD, Chi Zhang MD, Xiang-Jin Lin MD, 2018

The authors analysed four randomised trials comparing treatment with PRP injections vs treatment with Saline injections in patients with chronic Achilles tendinitis. The authors found no difference in pain levels, tendon thickness and function between the two treatment groups. They concluded that Larger randomized trials are needed to confirm these results, but until or unless a clear benefit has been demonstrated in favour of the new treatment, we cannot recommend it for general use.

At the Orthobiologics Clinic we were disappointed to see that the benefits of PRP were not as obvious as in other publications or as in other tendon conditions in the body. Quite clearly PRP should not be used as a first line of treatment in patients with chronic Achilles tendinitis. For patients who have exhausted all other non-operative treatment methods however it is still worthwhile considering PRP as a treatment of last resort before going down the route of surgical treatment.

Platelet-rich plasma for chronic Achilles tendinopathy: a double-blind randomised controlled trial with one-year follow-up

S de Jonge, R J de Vos, A Weir, H T M van Schie, S M A Bierma-Zeinstra, J A N Verhaar, H Weinans, J L Tol, 2011

The authors of this trial randomly allocated 54 patients with chronic Achilles tendinitis to treatment with either a single PRP injection, or a single Saline injection. They noticed an improvement in symptoms in both groups, but no difference between the groups. The authors concluded that one-year follow-up analysis of the world's first randomised controlled trial showed no evidence for the use of platelet-rich plasma injection in chronic Achilles tendinopathy.

At the Orthobiologics Clinic we noticed the findings, but based on other publications we feel that a course of 2 or 3 PRP injections is preferable. But clearly this needs to be discussed carefully with the patient.

Long-term beneficial effects of platelet-rich plasma for non-insertional Achilles tendinopathy

Guelfi M, Pantalone A, Vanni D, Abate M, Guelfi MG, Salini V, 2015

The researchers reviewed 73 patients who previously underwent treatment with a single PRP injection for chronic Achilles tendinitis. The average follow-up was 50 months. Pain scores improved from 45 to 88. 91.6% of the tendons were rated as satisfactory, the remainder underwent a second PRP injection. There were no Achilles tendon ruptures. The authors concluded that the use of a single PRP injection can therefore be a safe and attractive alternative in the treatment of non-insertional chronic Achilles tendinopathies.

At the Orthobiologics Clinic we were pleased to see the good outcomes with high satisfaction levels. We did however notice that this was a retrospective review without a control group, and it is therefore impossible to tell how beneficial the use of PRP is compared to other treatments or treatment with a placebo.

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