Here we present the abstract of the research published in the Journal of the American Medical Association and a clinical case from Ross Hauser, M.D.
Vos RJ, Weir AW, vanSchie HTM, Bierma-Zeinstra SMA, Verhaar JAN, Weinans H, Tol J. Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: A randomized controlled trial. JAMA 2010 303(2):144-148.
CONTEXT: Tendon disorders comprise 30% to 50% of all activity-related injuries; chronic degenerative tendon disorders (tendinopathy) occur frequently and are difficult to treat. Tendon regeneration might be improved by injecting platelet-rich plasma (PRP), an increasingly used treatment for releasing growth factors into the degenerative tendon.
OBJECTIVE: To examine whether a PRP injection would improve outcome in chronic midportion Achilles tendinopathy.
DESIGN, SETTING, AND PATIENTS: A stratified, block-randomized, double-blind, placebo-controlled trial at a single center (The Hague Medical Center, Leidschendam, the Netherlands) of 54 randomized patients aged 18 to 70 years with chronic tendinopathy 2 to 7 cm above the Achilles tendon insertion. The trial was conducted between August 28, 2008, and January 29, 2009, with follow-up until July 16, 2009.
INTERVENTION: Eccentric exercises (usual care) with either a PRP injection (PRP group) or saline injection (placebo group). Randomization was stratified by activity level.
MAIN OUTCOME MEASURES: The validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire, which evaluated pain score and activity level, was completed at baseline and 6, 12, and 24 weeks. The VISA-A score ranged from 0 to 100, with higher scores corresponding with less pain and increased activity. Treatment group effects were evaluated using general linear models on the basis of intention-to-treat. RESULTS: After randomization into the PRP group (n = 27) or placebo group (n = 27), there was complete follow-up of all patients. 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). The increase was not significantly different between both groups (adjusted between-group difference from baseline to 24 weeks, –0.9; 95% CI, –12.4 to 10.6). This CI did not include the predefined relevant difference of 12 points in favor of PRP treatment.
CONCLUSION: Among patients with chronic Achilles tendinopathy who were treated with eccentric exercises, a PRP injection compared with a saline injection did not result in greater improvement in pain and activity. Trial Registration clinicaltrials.gov Identifier: NCT00761423
Platelet Rich Plasma Speeds Healing in Achilles Tendons
Ross Hauser, M.D.
PRP involves drawing your blood & extracting the platelet containing growth factors to be used for injection.
Oftentimes the smallest areas of the body can cause the largest amounts of pain. The Achilles tendon is one of those areas. This tendon connects the heel to the muscles in the lower leg and is responsible for the plantar flexion of the foot. Overuse injuries are common in athletes and standard therapies include bracing and physical therapy. Surgery is needed in 25% of Achilles tendon injuries. Thankfully Prolotherapy is an effective alternative therapy that results in quick results and avoids surgery.
Achilles Tendon Patient: One patient, Stan, discovered just how effective Prolotherapy was after he was healed with just one Prolotherapy treatment. His pain began in July of 2010 when he increased the intensity of his workouts. The pain started in his lower calves and eventually made its way to both Achilles tendons. At rest the pain was constant and nagging, but once he started walking or running the pain and stiffness became severe. Although he had a desk job that did not require much activity, he loved to run and workout to stay in shape. At the age of 42 he knew that exercise was an important element in keeping healthy.
Initial Treatment: He went to another physician who diagnosed him with small tears in both Achilles tendons as well as tendonosis. Stan stopped all exercise and began physical therapy twice a week. After a few months of physical therapy Stan reported very little improvement. His physical therapist was familiar with Prolotherapy and recommended that Stan come to Caring Medical in Oak Park, IL for evaluation and possible treatment. Although Caring Medical was a four-hour drive from Stan’s town, his physical therapist told him it would be best if he could see Dr. Hauser.
Prolotherapy for the Achilles: Stan made the trip to Oak Park and was evaluated by our Prolotherapy physician, Dr. Ross Hauser, who confirmed tendinosis in both Achilles tendons. His recommended course of treatment was Prolotherapy using platelet rich plasma (PRP) as the proliferant. PRP is plasma with enriched levels of platelets relative to whole blood. Platelets contain powerful growth factors that are proposed to substantially aid the healing of soft tissue structures such as tendons. PRP is one of the available proliferants used at Caring Medical for Prolotherapy.
One and Only Treatment: Since he had traveled a ways to get to Oak Park, Stan wanted to begin treatment on his first visit. Dr. Hauser was able to treat both tendons with 30 Prolotherapy injections of a standard Prolotherapy solution to each side along with 12cc of PRP drawn from Stan’s blood. He left with instructions to avoid any jumping or running and to swim as a form of exercise and as a way to provide motion and blood flow to the area. He was also instructed to use mild heat daily and return in about six weeks for another Prolotherapy treatment as needed.
Long Term Results:Three months went by and we did not see Stan for his second treatment. When we called to see how he was doing he told us that he was completely pain free after one PRP Prolotherapy treatment and that he was feeling his best since he had initially injured his Achilles tendons eight months earlier. He had since stopped physical therapy as his therapist told him he was confident the PRP and Prolotherapy had helped with his healing. Stan was slowly getting back into exercise and was optimistic about beginning a running routine soon. He was thrilled with the results and was grateful that his physical therapist had recommended him to Caring Medical.
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