Platelet Rich Plasma(PRP) Treatment Takes a Hit – Doesn’t Work For Achilles Tendonopathy or Maybe It Does…

Recent Study in JAMA found PRP didn’t work more than saline injections for Achilles midportion tendonopathy.

JAMA. 2010 Jan 13;303(2):144-9.
Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized
controlled trial.
de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Tol JL.
abstract here

• stratified by activity level to control for that confounder
• block-randomized
• double-blind
• placebo-controlled
• trial at a single centre
• each involved in eccentric exercise program
• “The mean VISA-A score improved significantly after 24 weeks in the PRP group by 21.7 points (95% confidence interval [CI], 13.0-30.5) and in the placebo group by 20.5 points (95% CI, 11.6-29.4).” – not significantly different

Prolotherapy to Mid Tendon Achilles Tendonopathy – Only Mildly Better Results When Compared to Eccentric Loading Exercises – How Could That Be Better? link here

Addendum – when you don’t do a randomized control trial, results look a lot different: The following looks a lot better so I don’t know what to think now…

Int J Sports Med. 2010 Jun 9. [Epub ahead of print]
Treatment of Achilles Tendinopathy with Platelet-Rich Plasma.
Gaweda K, Tarczynska M, Krzyzanowski W.
Medical University of Lublin, Orthopaedic Surgery, Lublin, Poland.  abstract here

Non-insertional Achilles tendinopathy commonly impedes the functioning of active persons. Treatment methods vary, as do their results. The aim of the study was to evaluate the effectiveness of non-insertional Achilles tendinopathy treatment with autologous platelet-rich plasma (PRP). Autologous PRP was injected into the  affected Achilles tendon of 14 prospectively selected patients (15 Achilles
tendons). Before PRP administration, all patients were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scale for the hind foot, and the Victorian Institute of Sport Assessment – Achilles (VISA-A) scale. Ultrasonography (US) and Power-Doppler ultrasonography (PDUS) of the area was also performed. Identical physical and imaging evaluations were performed at 6 weeks, and at 3, 6, and 18 months after injection. During follow up, a significant improvement was observed in the clinical and imaging results. The AOFAS scale improved from a baseline median of 55 points to 96 points at 18 months (p=0.000655), while the VISA-A scale improved from a baseline of 24 to 96  (p=0.000655) in the final evaluations. During the final evaluation, one subject experienced minor pain following prolonged daily activity, while another subject complained of pain following overloading activity. Local, accurate PRP administration improved symptoms of non-insertional Achilles tendinopathy.

Addendum – recent study found injection with Platelet Rich plasma did not change the neovascularization or tendon strength:

Br J Sports Med 2011;45:387-392.
No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achilles tendinopathy
R J de Vos1, A Weir2, J L Tol2, J A N Verhaar1, H Weinans1, H T M van Schie   abstract here

Last word has been:

J Sport Rehabil. 2011 Nov 16. [Epub ahead of print]
Autologous Blood Injection for Treatment of Achilles Tendinopathy? A Randomised Controlled Trial.
Pearson J, Rowlands D, Highet R.  abstract here

“There is some evidence for small short-term symptomatic improvements with the addition of autologous blood injection to standard treatment for Achilles tendinopathy.”

Am J Sports Med. 2011 Aug;39(8):1623-9. Epub 2011 May 21.
One-year follow-up of platelet-rich plasma treatment in chronic Achilles tendinopathy: a double-blind randomized placebo-controlled trial.
de Jonge S, de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Tol JL.  abstract here

“CONCLUSION: This randomized controlled trial showed no clinical and ultrasonographic superiority of platelet-rich plasma injection over a placebo injection in chronic Achilles tendinopathy at 1 year combined with an eccentric training program.”

Comment – hate to say, but the fact it doesn’t work is a relief for me. This treatment requires special equipment and is overly expensive. Prolotherapy and eccentric exercises seem to be the ticket here, although I do discuss how that could be improved..

Past week I saw a hopeless case of chronic midtendon achilles tendonitis. I have done 20 minutes deep frictioning the first day and 10 minutes 5 days later. She had some skin tenderness more anterior that I took out with 5% dextrose (D%W) superficial injections (Neuroprolotherapy). Within a week she is over 50% better and no longer feels doomed. People must think Cyriax developed these deep frictional techniques for nothing – they actually do work – I feel people are just too lazy and uneducated to do them (It is very hard too do…)