SLR - September 2020 - Andy Archuleta
Reference: Boesen AP, Boesen MI, Hansen R, et al. Effect of Platelet-Rich Plasma on Nonsurgically Treated Acute Achilles Tendon Ruptures: A Randomized, Double-Blinded Prospective Study. Am J Sports Med. 2020;48(9):2268-2276. doi:10.1177/0363546520922541Scientific Literature Review
Reviewed By: Andy Archuleta, DPM
Residency Program: SSM Health DePaul Hospital – St Louis, MO
Podiatric Relevance: Surgical vs non-surgical repair for acute Achilles tendon ruptures can still be up for a debate among foot and ankle surgeons. Furthermore, the use of platelet-rich plasma has been popularized as of recently for boosting healing potential in musculotendinous injuries. One possible complication shown with non-surgical treatment is a higher re-rupture rate. If the PRP injections can reduce these rates of complications it may provide further support for non-surgical treatment. The aim of the study was to compare effects of multiple PRP and placebo injections on clinical and functional outcomes in patients with non-surgically treated acute Achilles tendon ruptures and the authors hypothesized the multiple PRP injections improve functional outcomes.
Methods: A double-blinded, randomized prospective trial included a total of 40 patients with acute Achilles tendon ruptures due to related sports activity that were divided into either multiple PRP injection groups or placebo. All patients underwent non-surgical treatment in CAM walker with three 1.5-centimeter wedges with ankle fixed in plantarflexion for eight weeks. The ankle was gradually brought to neutral position by removal of one wedge every two weeks. Patients were weight bearing as tolerated during treatment period and received home exercise instructions starting week nine. For the PRP injection group, 10 milliliters of blood was drawn which provided 4 milliliters of plasma. The patients underwent four total injections in the rupture gap, at baseline and in two-week intervals after that. Ten milliliters of blood was also drawn from patients in the placebo group to ensure that they were blinded to the treatment. Outcome measures were assessed using Achilles tendon total rupture scores (ATRS) and other musculoskeletal examinations.
Results: ATRS scores improved in both groups at every follow up and gradually increased from eight weeks to the 12 month follow up. There was no significant difference between groups for heel-rise work and height, in Achilles tendon length, or ankle range of motion. Mean time for return to running was 21 weeks in the PRP group and 23 weeks in the placebo and return to pre-injury level in PRP group was 32 percent of patients compared to 26 percent of placebo group. There were two patients with re-rupture due to reported patient non-compliance and required surgical intervention.
Conclusions: The authors concluded that treatment with multiple PRP injections for nonsurgically treated Achilles tendon ruptures did not seem to stimulate tendon healing or improve patient-reported outcomes, functional outcomes, or clinical outcomes. There are studies that show PRP injections can improve healing in surgically treated ruptures and other musculotendinous injuries, however this study shows that at least with nonsurgical treatment of Achilles tendon ruptures there is no added benefit to PRP injections. Although there may be a place for PRP injection therapy in foot and ankle surgery, more research like this randomized trial can further guide practitioners in the best, most efficacious standard of care.