The role of platelets in the treatment of Achilles tendon injuries

Abstract

ABSTRACT:To systematically review the current in-vivo evidence for the use of platelet-concentrates (PRP) in the treatment of Achilles tendinopathy and Achilles tendon ruptures in animal models and human applications. A systematic search of PubMed, CINAHL, EMBASE, CCTR, and CDSR was performed for animal and human studies on the effect of platelet-concentrates in the treatment of Achilles tendinopathy and ruptures using the terms ''Achilles tendon and platelet.'' The systematic search revealed a total of 149 papers. After excluding duplicates and cases of overlapping data, studies not focusing on in vivo evidence in terms of treatment or outcome, studies without any intervention, studies with unacceptable high attrition, one Chinese and one Swedish study, the remaining 14 manuscripts were included. The key finding of our study is evidence in support of a statistically significant effect of platelet concentrates in the treatment of Achilles tendon ruptures in vivo in animal models and human application, consistent with a medium to large sized effect. This effect is most likely attributable to fastened and enhanced scar tissue maturation. There was no evidence for a beneficial effect of platelets in Achilles tendinopathy. Keywords: achilles tendon; platelet; PRP; evidence-based medicine; meta-analysis Ligament and tendon healing is an important topic in orthopedics and orthopedic sports medicine.1 Among the most promising approaches is the use of platelet concentrates such as platelet-rich plasma (PRP). Platelets are a source of a plethora of growth factors that stimulate healing and provide a temporary matrix that fills defects sites and serves as a matrix for cell migration and tissue remodeling. 2-4The Achilles tendon is one of the most vulnerable tendons of the human body 5,6 and it is estimated that Achilles tendon injuries are involved in 30-50% of all sports-related injuries.7 About 7-10 ruptures are reported per 100,000, typically occurring in men aged 30-50. 7 The diagnosis of Achilles tendinopathy and tears can be made easily in the presence of a painful, swollen tendon with impaired function, which is evaluated using the Simmonds-Thompson test.8 Platelets have been used to fix Achilles tendon ruptures and Achilles tendinopathy in in vivo settings.9,10 However, the benefit of platelets in regeneration of Achilles tendinopathy and Achilles tendon tears is still elusive as this is a relatively new treatment option and their effectiveness is still not comprehensively analyzed and described.The objectives of this meta-analysis and systematic review were twofold. The first objective was to systematically review the current in vivo evidence for the use of plateletes for the treatment of Achilles tendon rupture and perform a meta-analysis. The secondary objective was to systematically review the current in vivo evidence for the use of platelet-concentrates for the treatment of Achilles tendinopathy and perform a meta-analysis. MATERIALS AND METHODSThis systematic review was performed in accordance to the PRISMA ...

Freeze-Thaw Cycles Enhance Decellularization of Large Tendons

“…1,2 Tissue engineering has become an important discipline in this field, aiming to improve the currently available therapeutic approaches that, until today, are often not evidence-based and fail to prevent re-injuries effectively. [2][3][4][5][6] For treatment of tendinopathy, approaches in the sense of in vivo tissue engineering are currently under investigation, among others the local application of stem cells or growth factors, [7][8][9] although the underlying mechanisms are not yet completely understood. Tendon or ligament ruptures, however, often require surgical replacement and thus a graft based on autologous, allo-or xenogeneic biological, or synthetic materials.…”

Long-term outcomes of muscle volume and Achilles tendon length after Achilles tendon ruptures

“…Experts agree that in active patients, surgical treatment of acute Achilles tendon ruptures is superior to non-operative treatment because it allowed an anatomical reconstruction [1,17,20,26,29,36]. However, to date, there is still lack of long-term data concerning muscle atrophy--both in volume and cross-sectional area--and fatty infiltration after different types of Achilles tendon rupture treatment, and it is unclear how such tissue degeneration would affect muscle force and clinical outcomes.…”

Ultrasound-guided intervention in the ankle and foot

“…The autologous blood or platelet rich plasma (PRP) treatment has been used extensively in conjunction with a dry needling technique. [25][26][27] Therefore, we do not know whether it is the dry needling that has the beneficial effect or whether the autologous blood or PRP is the main benefactor. [25][26][27] In view of the excitement in the use of autologous blood therapy, especially in the sporting world, the National Institute of Clinical Excellence (NICE, UK) has issued a statement which includes information on actions that should be taken by the performing clinicians.…”

“…51,52 Regarding PRP and autologous blood therapies, despite the initial enthusiasm on the technique from the sporting world, there are a number of recent met-analyses which have questioned the role of such therapies in Achilles tendinosis. [25][26][27] We are therefore left with a conundrum as to which is the most effective treatment for Achilles tendinosis. There is also lack of good quality long-term blinded studies to assess each technique individually, as mixing techniques and injectable agents have led to confusion.…”