Characteristics of L-PRP preparations for treating Achilles tendon rupture within the PATH-2 study

Harrison, Paul; Didembourg, Marie; Wood, Alex J.; Devi, Amarpreet; Dinsdale, Robert J.; Hazeldine, Jon; Alsousou, Joseph; Keene, David; Hulley, P A; Wagland, Susan; Parsons, Scott; Thompson, Jacqueline; Byrne, Christopher D.; Schlüssel, Michael Maia; O’Connor, Heather; Dutton, Susan; Lamb, Sarah E; Willett, Keith

doi:10.1080/09537104.2020.1849604

Cited by 8 publications

(7 citation statements)

References 33 publications

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“…Injections were delivered a mean 5.3 days (SD 3.0) post-injury. Further detail on PRP analysis is available elsewhere; 17 in summary, the PRP prepared had 4.1-fold (95% confidence interval (CI) 3.6 to 4.5) greater platelet concentrations and 2.2-fold (95% CI 2.0 to 2.5) greater leucocyte concentrations than whole blood. Platelet quality measurements showed that PRP was not activated during preparation.…”

Section: Resultsmentioning

confidence: 99%

“…however, this contrasts with the Achilles-specific symptoms and function assessed by the ATRS, which indicates deficits at two years. There were no pre-injury atrs scores, which limits interpretation, but it could be anticipated that further recovery is possible after two years given the recovery at seven years reported by brorsson et al 27 One important feature of the PATH-2 trial was the quality control measurements of all the prp preparations that were injected into all participants, 10,17 in line with modern guidelines. 28,29 These quality control analyses revealed that the treated patients received a single injection of good-quality leucocyte-rich prp (l-prp), all prepared by the same methodology and device (maG 200 maGellan) across all trial centres.…”

Section: Discussionmentioning

confidence: 99%

“…further details on prp preparation and analysis are available elsewhere. 10,11,17 participants had the routine local non-surgical management for acute achilles tendon rupture, apart from the standardized rehabilitation protocol. The rehabilitation requirements for the trial were that the ankle needed to be initially immobilized in an equinus position for at least three weeks post-injection, and avoidance of full-time ankle immobilization or nonweightbearing for longer than six weeks.…”

Section: Introductionmentioning

confidence: 99%

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Platelet-rich plasma injection for acute Achilles tendon rupture

Keene

Alsousou

Harrison

et al. 2022

The Bone & Joint Journal

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Aims To determine whether platelet-rich plasma (PRP) injection improves outcomes two years after acute Achilles tendon rupture. Methods A randomized multicentre two-arm parallel-group, participant- and assessor-blinded superiority trial was undertaken. Recruitment commenced on 28 July 2015 and two-year follow-up was completed in 21 October 2019. Participants were 230 adults aged 18 years and over, with acute Achilles tendon rupture managed with non-surgical treatment from 19 UK hospitals. Exclusions were insertion or musculotendinous junction injuries, major leg injury or deformity, diabetes, platelet or haematological disorder, medication with systemic corticosteroids, anticoagulation therapy treatment, and other contraindicating conditions. Participants were randomized via a central online system 1:1 to PRP or placebo injection. The main outcome measure was Achilles Tendon Rupture Score (ATRS) at two years via postal questionnaire. Other outcomes were pain, recovery goal attainment, and quality of life. Analysis was by intention-to-treat. Results A total of 230 participants were randomized, 114 to PRP and 116 to placebo. Two-year questionnaires were sent to 216 participants who completed a six-month questionnaire. Overall, 182/216 participants (84%) completed the two-year questionnaire. Participants were aged a mean of 46 years (SD 13.0) and 25% were female (57/230). The majority of participants received the allocated intervention (219/229, 96%). Mean ATRS scores at two years were 82.2 (SD 18.3) in the PRP group (n = 85) and 83.8 (SD 16.0) in the placebo group (n = 92). There was no evidence of a difference in the ATRS at two years (adjusted mean difference -0.752, 95% confidence interval -5.523 to 4.020; p = 0.757) or in other secondary outcomes, and there were no re-ruptures between 24 weeks and two years. Conclusion PRP injection did not improve patient-reported function or quality of life two years after acute Achilles tendon rupture compared with placebo. The evidence from this study indicates that PRP offers no patient benefit in the longer term for patients with acute Achilles tendon rupture. Cite this article: Bone Joint J 2022;104-B(11):1256–1265.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Platelet-rich plasma injection for acute Achilles tendon rupture

Keene

Alsousou

Harrison

et al. 2022

The Bone & Joint Journal

Self Cite

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“…Despite progress in modern medicine, the treatment of ruptured tendons remains a challenge. Various methods, such as ultrasound therapy, platelet-rich plasma injection, local or systemic drug administration, and the supplementation of growth factors targeted at the injured site, have been proposed to treat Achilles tendon rupture [10][11][12][13][14][15][16][17]. Healing efficacy is a key factor to determine the success of tendon repair.…”

Section: Introductionmentioning

confidence: 99%

Tri-Layered Doxycycline-, Collagen- and Bupivacaine-Loaded Poly(lactic-co-glycolic acid) Nanofibrous Scaffolds for Tendon Rupture Repair

Shen

Hsu

et al. 2022

Polymers

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Achilles tendon rupture is a severe injury, and its optimal therapy remains controversial. Tissue engineering scaffolds play a significant role in tendon healing and tissue regeneration. In this study, we developed tri-layered doxycycline/collagen/bupivacaine (DCB)-composite nanofibrous scaffolds to repair injured Achilles tendons. Doxycycline, collagen, and bupivacaine were integrated into poly(lactic-co-glycolic acid) (PLGA) nanofibrous membranes, layer by layer, using an electrospinning technique as healing promoters, a 3D scaffold, and painkillers, respectively. After spinning, the properties of the nanofibrous scaffolds were characterized. In vitro drug discharge behavior was also evaluated. Furthermore, the effectiveness of the DCB–PLGA-composite nanofibers in repairing ruptured Achilles tendons was investigated in an animal tendon model with histological analyses. The experimental results show that, compared to the pristine PLGA nanofibers, the biomolecule-loaded nanofibers exhibited smaller fiber size distribution and an enhanced hydrophilicity. The DCB-composite nanofibers provided a sustained release of doxycycline and bupivacaine for over 28 days in vivo. Additionally, Achilles tendons repaired using DCB-composite nanofibers exhibited a significantly higher maximum load-to-failure than normal tendons, suggesting that the biomolecule-incorporated nanofibers are promising scaffolds for repairing Achilles tendons.

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“…PC are a growth factor source able to promote angiogenesis and tissue healing in consideration of the fact that a blood supply is a prerequisite for tissue healing [ 20 ]. PC were originally introduced by Marx et al [ 20 ], Anitua [ 21 ], and Choukroun [ 22 ] in the early 1990s and their applications are increasing in many medical fields, such as esthetic medicine [ 23 ], orthopedics [ 24 ], wound repair, military drill [ 25 ], ophthalmology [ 26 ] and, of course, in dentistry. PC have been proposed for soft and hard tissue surgery in many different forms as clots reduce in thick membranes to improve the healing of the damaged tissues and the mechanical/ biological behavior of biomaterials and scaffolds [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Autologous Platelet Gel (APG): A Preliminary Evaluation of the Mechanical Properties after Activation with Autologous Thrombin and Calcium Chloride

Bugea

Leo

Oliveira³

et al. 2021

Materials

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The tensional and mechanical behavior of regenerative components, grafts, and blood clots represent an essential condition for the success of bone regeneration protocols. Autologous platelet growth factors represent a useful protocol to enhance the soft and hard tissue healing in several fields of medicine and craniofacial surgery. Different protocols for blood concentrates with and without activation have been proposed in literature. The aim of the present study was to investigate in vitro the mechanical properties of autologous platelet gel (APG) with autologous thrombin and calcium chloride. Materials and Methods: A total of 20 APG samples were evaluated; 10 samples were activated by autologous thrombin and calcium chloride (Group I) and 10 samples were non-activated (Group II). The tensile strength and modulus of elasticity were calculated through a static loading test (Lloyd 30 K, Lloyd Instruments Ltd., Segensworth, UK). Results: Group I (activated) reported a tensile strength of 373.5 ± 14.3 MPa, while Group II showed a significantly lower value of of 360.5 ± 16.3 MPa (p < 0.05). The Young’s modulus was 145.3 ± 10.4 MPa for Group I and 140.3 ± 15.3 MPa for Group II (p < 0.05). Conclusions: The effectiveness of the present in vitro simulation showed that the APG activation protocol is able to increase the mechanical characteristics of the blood derivates and could be clinically useful to enhance regenerative procedures.

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Characteristics of L-PRP preparations for treating Achilles tendon rupture within the PATH-2 study

Abstract: on behalf of the PATH-2 study group.

Cited by 8 publications

References 33 publications

Platelet-rich plasma injection for acute Achilles tendon rupture

Platelet-rich plasma injection for acute Achilles tendon rupture

Tri-Layered Doxycycline-, Collagen- and Bupivacaine-Loaded Poly(lactic-co-glycolic acid) Nanofibrous Scaffolds for Tendon Rupture Repair

Autologous Platelet Gel (APG): A Preliminary Evaluation of the Mechanical Properties after Activation with Autologous Thrombin and Calcium Chloride

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