Comparison of Surgically Repaired Achilles Tendon Tears Using Platelet-Rich Fibrin Matrices

TLDR

Platelet‑rich fibrin matrices deliver a natural mix of growth factors that are believed to facilitate tendon healing, and their use during Achilles tendon surgery may improve functional recovery. The study investigates whether autologous PRGF improves healing and functional outcomes after open Achilles tendon repair. Six athletes received open suture repair with intra‑operative PRGF and were compared to a matched conventional repair group, with outcomes assessed by range of motion, functional recovery, complications, ultrasound imaging, and laboratory measurement of platelet and growth factor concentrations. PRGF‑treated tendons showed less cross‑sectional area increase, earlier range‑of‑motion recovery, no wound complications, faster return to running and training, and growth factor levels correlated with platelet counts, indicating enhanced healing.

Abstract

Platelet-rich fibrin matrices release a natural mixture of growth factors that play central roles in the complex processes of tendon healing.Application of autologous platelet-rich matrices during Achilles tendon surgery may promote healing and functional recovery.Case-control study and descriptive laboratory study; Level of evidence, 3.Twelve athletes underwent open suture repair after complete Achilles tendon tear. Open suture repair in conjunction with a preparation rich in growth factors (PRGF) was performed in 6 athletes and retrospectively compared with a matched group that followed conventional surgical procedure. The outcomes were evaluated on the basis of range of motion, functional recovery, and complications. Achilles tendons were examined by ultrasound at 50 +/- 11 months in retrospective controls and 32 +/- 10 months in the PRGF group. In the laboratory portion of the study, PRGF treatment was characterized by the number of platelets and concentration of insulin (IGF-I), transformed (TGF-beta1), platelet-derived (PDGF-AB), vascular endothelial (VEGF), hepatocyte (HGF), and epidermal (EGF) growth factors in patients affected by musculoskeletal traumatic injuries.Athletes receiving PRGF recovered their range of motion earlier (7 +/- 2 weeks vs 11 +/- 3 weeks, P = .025), showed no wound complication, and took less time to take up gentle running (11 +/- 1 weeks vs 18 +/- 3 weeks, P = .042) and to resume training activities (14 +/- 0.8 weeks vs 21 +/- 3 weeks, P = .004). The cross-sectional area of the PRGF-treated tendons increased less (t = 3.44, P = .009). TGF-beta1 (74.99 +/- 32.84 ng/mL), PDGF-AB (35.62 +/- 14.57 ng/mL), VEGF (383.9 +/- 374.9 pg/mL), EGF (481.5 +/- 187.5 pg/mL), and HGF (593.87 +/- 155.76 pg/mL) significantly correlated with the number of platelets (677 +/- 217 platelets/microL, P < .05).The operative management of tendons combined with the application of autologous PRGF may present new possibilities for enhanced healing and functional recovery. This needs to be evaluated in a randomized clinical trial.