Treatment of Achilles Tendinopathy With Platelet Rich Plasma: A Prospective Cohort Study

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INTRODUCTION: Platelet rich plasma (PRP) use in midsubstance and insertional Achilles tendinopathy lacks prospective evidence. Our study aimed to prospectively evaluate the response of midsubstance and insertional Achilles tendinopathy to PRP injection in patients who failed conservative treatment.

METHODS: 17 patients with midsubstance or insertional Achilles tendinopathy (1 bilateral) were prospectively enrolled for autologous PRP injection into the pathologic area of their Achilles tendon. Patients were followed for 1 year and evaluated at 0, 4, 8, 12, 24, and 52 weeks after injection using the Victoria Institute of Sport Assessment for Achilles tendinopathy (VISA-A) as the primary outcome measure. Secondary outcome measures included the 12-Item Short Form Survey (SF-12) and the visual analogue score (VAS).

RESULTS: 12 of 17 patients (13 of 18 injections) completed the 52-week follow-up. Mean VISAA score improved significantly at 4 weeks from 27.3 to 42.2 (p=0.007) and continued to improve by 52 weeks with a mean score of 60.8 (p<0.001). The VAS improved from an initial score of 5.68 to 3.45 by 4 weeks (p < 0.001) and remained significantly improved at 52 weeks at 2.12 (p < 0.001). The SF-12 physical showed significant improvement at all time points compared to the initial time point, improving from 35.6 to 45.5 at 52 weeks (p=0.002). No complications were reported. 3 patients underwent re-injection, 2 at 9 months and 1 at 18 months. Two of the 5 patients not completing 52 weeks of follow-up elected to undergo surgery, and 3 were lost to follow-up.

DISCUSSION AND CONCLUSION: Treatment of midsubstance and insertional Achilles tendinopathy with PRP injection is a reasonable and relatively safe minimally invasive treatment option prior to the decision for surgery in patient’s refractory to conservative management.