SLR - August 2012 - Jared M. Maker
Reference: Monto RR. Platelet Rich Plasma Treatment for Chronic Achilles Tendinosis. Foot & Ankle International, 33(5), 379-384; 2012.
Scientific Literature Review
Reviewed by: Jared M. Maker, DPM
Residency Program: The Western Pennsylvania Hospital, Pittsburgh, PA
Podiatric Relevance:
For the foot and ankle surgeon chronic Achilles tendinosis is known to be a difficult pathology in which to care. Common non-operative treatments include rest, immobilization, non-steroidal and steroidal anti-inflammatories, and physical therapy. When non-operative management fails, surgical intervention usually follows. The authors report results of a prospective longitudinal case series of the use of platelet rich plasma (PRP) on patients with chronic Achilles tendinosis following failed non-operative care.
Methods:
This study was a prospective longitudinal case series. The authors looked at 30 patients who had failed a minimum of six months of non-operative care for chronic Achilles tendinosis. All patients spent at least eight weeks in a CAM walker boot and were also evaluated with either an MRI or ultrasound (US). PRP was prepared and a total of 4cc was directly injected into the injured zone under US. Patients were placed in a CAM walker boot for 48 hours and allowed to resume daily activities as tolerated with a home eccentric exercise program. AOFAS hindfoot scores and physical examination were done prior to and at months one, two, three, six, 12, and 24 following treatment. MRI or US were repeated and compared to images prior to treatment.
Results:
Preoperative AOFAS averaged 34. Following PRP injection, AOFAS scores improved to 84 at one month, 87 at two months, 88 at three months, 92 at six months, 90 at 12 months, and 88 at 24 months. Post-treatment MRI and/or US were repeated at six months in 29 of 30 patients. Findings demonstrated interval healing of the treated injury zones in 27 of 29 patients. Nine of 10 patients that were unable to work returned to their occupations. Eighteen of 22 patients that were unable to participate in sports returned to their previous levels in competition. Two patients that were dissatisfied left the trial study after the six-month follow-up and had surgical intervention with good clinical results.
Conclusions:
Local PRP injection successfully treated chronic Achilles tendinosis in patients with failed non-operative care. Strengths include it being a prospective longitudinal study, two-year length follow-up, and high retention rate of patients. One weakness of the study includes the absence of a placebo group. The author states that success of PRP injection therapy in this study may be due to the aggressive injection technique, use of US for accurate placement, early weightbearing and active motion and high levels of growth factors noted with the PRP harvesting system used.