Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy

TLDR

Tendon disorders account for 30–50 % of activity‑related injuries, and chronic degenerative tendinopathy is common and hard to treat. The study aimed to determine whether platelet‑rich plasma injections improve outcomes in chronic mid‑portion Achilles tendinopathy. In a stratified, block‑randomized, double‑blind, placebo‑controlled trial of 54 patients, participants received eccentric exercises plus either a PRP or saline injection, with outcomes assessed via the VISA‑A questionnaire at baseline and 6, 12, and 24 weeks. After 24 weeks, both PRP and placebo groups improved similarly on the VISA‑A score (21.7 vs 20.5 points), with no statistically significant difference (adjusted between‑group difference −0.9, 95 % CI −12.4 to 10.6), indicating PRP did not provide additional benefit.

Abstract

Tendon disorders comprise 30% to 50% of all activity-related injuries; chronic degenerative tendon disorders (tendinopathy) occur frequently and are difficult to treat. Tendon regeneration might be improved by injecting platelet-rich plasma (PRP), an increasingly used treatment for releasing growth factors into the degenerative tendon.To examine whether a PRP injection would improve outcome in chronic midportion Achilles tendinopathy.A stratified, block-randomized, double-blind, placebo-controlled trial at a single center (The Hague Medical Center, Leidschendam, The Netherlands) of 54 randomized patients aged 18 to 70 years with chronic tendinopathy 2 to 7 cm above the Achilles tendon insertion. The trial was conducted between August 28, 2008, and January 29, 2009, with follow-up until July 16, 2009.Eccentric exercises (usual care) with either a PRP injection (PRP group) or saline injection (placebo group). Randomization was stratified by activity level.The validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire, which evaluated pain score and activity level, was completed at baseline and 6, 12, and 24 weeks. The VISA-A score ranged from 0 to 100, with higher scores corresponding with less pain and increased activity. Treatment group effects were evaluated using general linear models on the basis of intention-to-treat.After randomization into the PRP group (n = 27) or placebo group (n = 27), there was complete follow-up of all patients. The mean VISA-A score improved significantly after 24 weeks in the PRP group by 21.7 points (95% confidence interval [CI], 13.0-30.5) and in the placebo group by 20.5 points (95% CI, 11.6-29.4). The increase was not significantly different between both groups (adjusted between-group difference from baseline to 24 weeks, -0.9; 95% CI, -12.4 to 10.6). This CI did not include the predefined relevant difference of 12 points in favor of PRP treatment.Among patients with chronic Achilles tendinopathy who were treated with eccentric exercises, a PRP injection compared with a saline injection did not result in greater improvement in pain and activity.clinicaltrials.gov Identifier: NCT00761423.