Platelet-rich plasma for chronic achilles tendinopathy: a double-blind randomised controlled trial with one year follow-up

Abstract

Introduction Chronic Achilles tendinopathy occurs frequently and is very hard to treat. The disease involves local degeneration of tendon tissue, of which regeneration may be improved by injecting platelet-rich plasma (PRP), an increasingly used therapy for releasing growth factors into degenerative tendon. However, high-quality randomised clinical trials on this topic are lacking. The aim of this study was to evaluate the effect of a PRP injection in patients with chronic Achilles tendinopathy. Methods In this stratified, block randomised, double-blind, placebo-controlled trial at single center 54 patients aged 18–70 years were randomised in two treatment groups. Next to an eccentric training program the patients received a blinded injection containing either PRP group or saline (placebo group). Primary outcome, the objective and validated Victorian Institute of Sports Assessment-Achilles (VISA-A) score, was assessed and ultrasound examination was performed at baseline and all follow-up appointments. Results After randomisation into the PRP group (n=27) and the placebo group (n=27) there was a complete follow-up. After one year, the mean VISA-A score improved in both the PRP-group and the placebo group. There was no significant difference in increase between both groups (adjusted between-group difference, 5.5; 95% CI, −4.9 to 15.8, p=0.292). Ultrasonographic tendon structure improved significantly in both groups, but not significant different between both groups (adjusted between-group difference, 1.2 %, 95% CI, −4.1 to 6.6, p=0.647) Conclusion One-year follow-up analysis of the world’s first randomised controlled trial showed no evidence for the use of platelet-rich plasma injection in chronic Achilles tendinopathy. These findings are in line with our 6 months results (De Vos et al JAMA 2010).

Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy

“…However, other studies of large series have reported that PRP treatment of tendinopathy is no more effective than placebo [44,45]. Thus, this issue remains challenging and requires further studies to clearly define the effectiveness of PRP therapy.…”

Neovascularization in Achilles tendinopathy: have we been chasing a red herring?

“…The potential effect of PRP on neovessels has only been studied once in Achilles tendinopathy [4,5,8,12,14,15,29,40]. It is hypothesized that the formation of neovessels is related to the release of vascular endothelial growth factor (VEGF), a potent stimulator of angiogenesis [7].…”

Tendon and Ligament Tissue Engineering, Healing and Regenerative Medicine

“…Perhaps, preparation method of PRP, its concentration, source (e.g. auto-alloand xenogenic base) and its constitutions (platelet or platelet with buffy coat) are suggested to be different between several studies [30,[101][102][103]. As a general rule, effective PRP is prepared via two steps centrifugation with the combination of platelets and buffy coats (inflammatory cells) and has a 6 to 7 times more platelets than the circulating blood [30].…”