SLR - July 2011 - Mark Chase
Reference: Vos, R.J. (2010). Platelet-rich plasma injection for chronic Achilles tendinopathy. JAMA, 303(2), 144-149.
Scientific Literature Review
Reviewed by: Mark Chase, DPM
Residency Program: Roxborough Memorial Hospital
Podiatric Relevance:
Achilles tendinopathy is a common condition encountered in the podiatric community. Treatment options vary greatly with many modalities to choose from, including surgical and non-surgical options. This article reviews a relatively non-invasive surgical option.
Methods:
The study design consisted of a double-blind, randomized control trial which examined 54 patients with an age range from 18-70 years with a diagnosis of chronic tendinopathy 2-7cm above the Achilles insertion. Two groups of 27 patients each were randomized, with one group to receive a saline (placebo) injection at baseline and one group to receive a platelet-rich plasma (PRP) injection at baseline. Each group was injected in 3 different puncture locations with a 22-gauge needle into the degenerative area. All patients were given detailed rehabilitation programs, including short distance walking during first 48 hours, 30 minutes of walking within 3-7 days post-injection, then 1 week of stretching, and finally 12 weeks of daily eccentric exercise.
All patients completed a questionnaire consisting of standardized measures at baseline, 6, 12, and 24 weeks. The outcome measure used was the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire, ranging from 0-100, with 0 denoting no activity and maximal pain, and 100 denoting maximal activity and no pain.
Results:
No significant difference was found between the two treatment groups on 6, 12, 24 week follow-up with VISA-A scores. However, VISA-A scores improved significantly in the PRP group (21.7 points) and the placebo group (20.5 points), pointing to possible early active range-of-motion as a positive contributor to healing.
Conclusions:
Results of this study do not support the use of PRP injection as a sole treatment for the management of chronic Achilles tendinopathy.