SLR - January 2024 - Baxter
Title: Effect of Platelet-Rich Plasma Augmentation on Endoscopy-Assisted Percutaneous Achilles Tendon Repair.Reference: Hung, Chun-Yu, et al. "Effect of platelet-rich plasma augmentation on endoscopy-assisted percutaneous Achilles tendon repair." Journal of Clinical Medicine 11.18 (2022): 5389.
Level of Evidence: III
Scientific Literature Review
Reviewed By: Nicole Baxter
Resident Program: Emory Decatur Residency, Decatur, GA
Podiatric Relevance: Platelet rich plasma has grown popular over the past decade as an alternative healing modality; however, studies are inconclusive. This article is interesting because it shows significant data on tendon repair using PRP. The results of the study show PRP does not enhance healing time, return to activities or long-term benefits for long term follow up, but may show some benefit at 6 months. The authors were attempting to see if PRP does in fact enhance healing potential in achilleas tendon ruptures.
Methods: 62 patients with an acute Achilles tendon rupture were divided into two groups; one group for repair with PRP and another group repair without PRP between the years 2014-2018 by one single surgeon. All patients underwent an endoscopic assisted Achilles tendon repair, the ones with PRP had it injected on the day of surgery. Then two weeks later they received another injection under ultrasound guidance. Both patient groups underwent the same post op recovery protocol. Outcomes that were specifically measured were ankle ROM, time to return to sports, calf diameter, time to return to play, Achilles Tendon Total Rupture Score, and complications. The patients were all followed for up to 2 years.
Results: A total of 62 patients were included in the study, 32 into the PRP group and 30 in the non-PRP group. At 12 weeks, 96.9% of PRP patients returned to work and 96.7% of non-PRP returned to work. 100% patients returned to work at 24 weeks. The ATRS score showed no difference between the two groups at 6, 12, 18 and 24 month follows ups (0.271, 0.106, 0.164, 0.804). There was no difference in calf circumference at 12, 18 and 24 month follow up between PRP and non-PRP (0.336, 0.294, 0.131). The PRP group had better ankle dorsiflexion at 6, 12 and 18 month follow ups (0.003, 0.024, 0.01); however, at 24 months both groups had similar ankle dorsiflexion (p 0.071). One patient in the PRP group and two in the non-PRP group had wound complications that delayed their recovery. At follow up at 24 months, all patients had excellent ATRS scores.
Conclusions: PRP when used as an augmentation for repair of Achilles tendon repair showed no significant benefit over non-PRP repair for long term follow up. For short term follow up (6 months) there was a benefit of ankle dorsiflexion. PRP did not show superior healing rates or decreased risk of infection. The authors concluded that PRP is not beneficial and should not be used with Achilles tendon repairs until more evidence proves efficacy. The article shows PRP helps in the short term with ankle dorsiflexion; benefit; it is beneficial for those wishing to return to actives faster. It is crucial to inform patients and tell them about the results with PRP. Many times, PRP is not covered by insurance and is an out-of-pocket payment.