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Platelet-Rich Plasma for Achilles tendon pain

Discussion in 'General Issues and Discussion Forum' started by srfoot, Mar 22, 2007.

  1. srfoot

    srfoot Welcome New Poster

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    I recently saw a patient with bilateral achilles tendon pain with the left greater than the right of about 7 months duration. Physical therapy has been tried. She states that she could not wear the night splint throughout the night. The discomfort is approximately 2.5cm proximal to the calcaneus.

    She came to see me for information as to my more conservative care known by her friend.

    PRP has been recommended to her (not covered by her insurance) with non weight bearing for a period of time. Then, as a last resort, surgery of the tendon.

    There is no apparent rupture of the tendon, negative initial trauma, MRI's were done with no major findings.

    I do not perform this procedure and will not be doing so but would like to learn more about it and gather statistical information as to any long term studies using it.

    Any comparisons between this and autologous blood injections with an anesthetic?

    We discussed the fact that the non-weight bearing and longer term of immobility followed by physical therapy may result in a positive result as well.

    I am interested in discussion on this and the fact that there have been advertisements in local papers as to "PRP" treatment can help your heel pain. Call today!
  2. Drftpd

    Drftpd Welcome New Poster

    I am a first year podiatry student, so I cannot fully answer your question. But I did do a report on the usage of platelet rich plasma in general. Also, one of my undergrad professors was doing research on the subject. Feel free to ask any questions, if I cannot answer them, I will try to find it out for you.
  3. drsarbes

    drsarbes Well-Known Member

    Hi SRFOOT: I am familiar with the use of PLP for wound treatment, and it works fairly well. Apparently it has also been used for various enthesopathies, from plantar fasciitis to achilles tendinoses to tennis elbow.
    PLP is injected, alone or mixed with other purported useful cocktail ingredients, into the affected area. One can use Dx ultrasound to document placement and possibly effectiveness of treatment (as rated by decreasing thickness of the tendon or fascia)
    There is a fair amount of "case studies" and sites promoting its use, however, I think you'll find very few scientific studies showing high success rates.
    Hope that helps.........BTW: insurances do not normally cover its use (except in wounds treatments and after jumping through various hoops - some flaming) so there is $ to be made via cash paying patients who want to try it.
    Hope I haven't insulted anyone who is promoting this!
  4. darlovw

    darlovw Welcome New Poster

    I have done 4 of these for Achilles tendonitis . These all did very well and the patients were happy with the results. They shold be done under ultrasund guidance.
  5. admin

    admin Administrator Staff Member

  6. hrein

    hrein Welcome New Poster

    I am very interested in learning more about PRP therapy. Please tell me where I can get the training.Thanks
  7. Envo2010

    Envo2010 Member

    Autologous blood injections for tendinopathy

    I am starting to offer my patients this treatment. An orthopaedic colleage has recently done 165 of these with mid 90% success rate on Tib Post, pl fascia and Achilles problems. No complications but a few found it painful even with local so I am considering doing it under general or at least giving the patient the option. I am going to use the Biomet platelet recovery system which seems really simple to use.

    Are many others doing this procedure - and if so I have a few queries below.

    The NICE guidelines talk about dry needling beforehand but I've heard of a few cases of rupture, especially with pl fascia so I'm currently mulling over whether to offer this, especial;ly in sporty patients.

    Also some colleagues use image guidance and some don't. You generally are putting in about 5mls and it would appear that just getting the blood in the vicinity of the area is fine. I tend to use image guidance for steroids and I might try it for this new technique but interested to get other peoples views who might be alread doing this.


    Bob Fleck
  8. Griff

    Griff Administrator

    Re: Autologous blood injections for tendinopathy

    Hi Bob,

    Another thing you may want to consider in your sporty patients (if competing professionals) is that I'm pretty sure autologous blood injections are on the prohibited list of WADA (although not sure how they could prove it in any case!)

  9. Envo2010

    Envo2010 Member

    Hi Ian

    Thanks - Yes I was aware of that and I think if the technique becomes more popular it will need further discussion with the relevent bodies.


  10. NewsBot

    NewsBot The Admin that posts the news.

    Platelet rich plasma injection grafts for musculoskeletal injuries: a review.
    Sampson S, Gerhardt M, Mandelbaum B.
    Curr Rev Musculoskelet Med. 2008 Dec;1(3-4):165-74
  11. NewsBot

    NewsBot The Admin that posts the news.

    Medical News Today are reporting:
    Platelet-Rich Plasma: Does It Work?
    Full story
  12. Paul Bowles

    Paul Bowles Well-Known Member

    Some more references for those interested.....

    I have had some patinets have this in the UK - onset of pain reduction was around the 5-6 week mark. At the 8 week mark some reported improvement of 50% on pain alone. This all means nothing statistically, but clinically it is nice to know. It also shouldn't be too hard to perform on patients.....

    Edwards S, Calandruccio J: Autologous blood injections for refractory lateral epicondylitis. J Hand Surg 28A (2):272-278, 2003.

    Barrett, S.L. , Erredge, S.E. Growth Factors for Chronic Plantar Fasciitis? Podiatry Today Vol.17-Issue 11- pages: 36-42 , November 2004

    Scioli, M. Treatment of recalcitrant enthesopathy of the hip with Platelet rich Plasma- A report of Three Cases COSNEWS, An Official Publication of The Clinical Orthopaedic Society, Spring 2006.

    Mishra, A, Pavelko, T Treatment of Chronic Elbow Tendinosis with Buffered Platelet-Rich Plasma. The Am J of Sports Med 34:1774-1778, 2006.

    Kiter, et al Comparison of Injection Modalities in the Treatment of Plantar Heel Pain A Randomized Controlled Trial JAPMA. 96, No.4, 2983-296, 2006
  13. W J Liggins

    W J Liggins Well-Known Member

    Our colleague, Martin Harvey, has used this technique widely in the English midlands. He is available via the Institute web site.

    Bill Liggins
  14. does anyone know how they decide who would get good results with the Platelet-Rich Plasma injections ?

    The reason I ask this is it appears that some go under the knife to get some nerve and blood supply removed ie Kevin Peiterson, the ECB flew a Swedish guy out to do the op. His research I beleive shows that the pain is not coming from the tendon but nerve and blood supply around the tendon.

    here is a small discription of the op.


    So is an ultra-sound required before an injection treatment or blood nerve supply op path taken?
  15. NewsBot

    NewsBot The Admin that posts the news.

    Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy
    A Randomized Controlled Trial

    Robert J. de Vos, MD; Adam Weir, MBBS; Hans T. M. van Schie, DVM, PhD; Sita M. A. Bierma-Zeinstra, PhD; Jan A. N. Verhaar, MD, PhD; Harrie Weinans, PhD; Johannes L. Tol, MD, PhD
    JAMA. 2010;303(2):144-149.
  16. LER

    LER Active Member

  17. Kent

    Kent Active Member

    I personally don't do PRP injections but I'd be interested to hear from people that do re a few things I picked up from after a quick scan of this paper:

    1. They only did one injection. Is this standard in practice?
    2. I think the results are probably not much different to eccentirc loading exercises alone though obvioulsy it's hard to compare across different trials.
    3. The post-injection protocol was quite strict:

    Are other people who do these injections implementing a similar protocol? In the short-term I think it would have made pain/VISA-A scores look better than what they really were - i.e. if the patient isn't using it much, they'll feel less pain. In the long-term, I think it may increase healing time. We know that no load is harmful and too much load is harmful so getting that appropriate load right at the right time for the patient can sometimes be the tricky thing with managing these tendons. If the tendon has very little load for 4 weeks post-injection, I would suspect the 6 week follow-up to be pretty good. Could it be a tortise and hare scenario? What are your thoughts? What sort of instructions do you give to patients post-injection?
  18. NewsBot

    NewsBot The Admin that posts the news.

    Use of platelet rich plasma to treat plantar fasciitis: design of a multi centre randomized controlled trial
    Joost C Peerbooms, Wilbert van Laar, Frank Faber, Hans M Schuller, Henk van der Hoeven and Taco Gosens
    BMC Musculoskeletal Disorders 2010, 11:69doi:10.1186/1471-2474-11-69
  19. NewsBot

    NewsBot The Admin that posts the news.

    Treatment of Achilles Tendinopathy with Platelet-Rich Plasma.
    Gaweda K, Tarczynska M, Krzyzanowski W.
    Int J Sports Med. 2010 Jun 9. [Epub ahead of print]
  20. NewsBot

    NewsBot The Admin that posts the news.

    OrthoSuperSite are reporting:
    Ruptured Achilles tendons’ mechanical properties unaltered by concentrated PRPs
    Full Story
  21. NewsBot

    NewsBot The Admin that posts the news.

    Platelet-Rich Plasma Releasate Promotes Differentiation of Tendon Stem Cells Into Active Tenocytes
    Jianying Zhang & James H.-C. Wang
    American Journal of Sports Medicine (released online)
  22. NewsBot

    NewsBot The Admin that posts the news.

    No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achilles tendinopathy
    R J de Vos, A Weir, J L Tol, J A N Verhaar, H Weinans, H T M van Schie
    Br J Sports Med doi:10.1136/bjsm.2010.076398
  23. NewsBot

    NewsBot The Admin that posts the news.

    Autologous Platelets Have No Effect on the Healing of Human Achilles Tendon
    Ruptures: A Randomized Single-Blind Study

    Thorsten Schepull, Joanna Kvist, Hanna Norrman, Marie Trinks, Gosta Berlin,
    and Per Aspenberg
    Am J Sports Med published 3 November 2010,
  24. NewsBot

    NewsBot The Admin that posts the news.

    Platelet-rich plasma for chronic achilles tendinopathy: a double-blind randomised controlled trial with one year follow-up
    S de Jonge, R J de Vos2, A Weir, H T M van Schie, et al
    Br J Sports Med 2011;45:e1 doi:10.1136/bjsm.2010.081554.40
  25. NewsBot

    NewsBot The Admin that posts the news.

    One-year Follow-up of Platelet-Rich Plasma Treatment in Chronic Achilles Tendinopathy: A Double-Blind Randomized Placebo-Controlled Trial
    Suzan de Jonge, Robert J. de Vos, Adam Weir, Hans T. M. van Schie, Sita M. A. Bierma-Zeinstra,
    Jan A. N. Verhaar, Harrie Weinans, and Johannes L. Tol
    Am J Sports Med May 21, 2011
  26. DaVinci

    DaVinci Well-Known Member

    Spot the difference? Looks suspicious?
  27. NewsBot

    NewsBot The Admin that posts the news.

    angryorthopod has a view on this:
    PRP: Pure Rubbish, People!
    link to article
  28. NewsBot

    NewsBot The Admin that posts the news.

    Injection Techniques of Platelet-Rich Plasma Into and Around the Achilles Tendon
    A Cadaveric Study

    Johannes I. Wiegerinck et al
    Am J Sports Med August 2011 vol. 39 no. 8 1681-1686
  29. NewsBot

    NewsBot The Admin that posts the news.

    Growth Factor and Catabolic Cytokine Concentrations Are Influenced by the Cellular Composition of Platelet-Rich Plasma
    Emily A. Sundman et al
    Am J Sports Med August 16, 2011 0363546511417792
  30. NewsBot

    NewsBot The Admin that posts the news.

  31. NewsBot

    NewsBot The Admin that posts the news.

    A Systematic Review of the Use of Platelet-Rich Plasma in Sports Medicine as a New Treatment for Tendon and Ligament Injuries
    Taylor, Drew W; Petrera, Massimo; Hendry, Mike; Theodoropoulos, John S
    Clinical Journal of Sport Medicine: July 2011 - Volume 21 - Issue 4 - pp 344-352
  32. NewsBot

    NewsBot The Admin that posts the news.

    Web-based portrayal of platelet-rich plasma injections for orthopedic therapy.
    Deren ME, Digiovanni CW, Feller E.
    Clin J Sport Med. 2011 Sep;21(5):428-32.
  33. NewsBot

    NewsBot The Admin that posts the news.

    Clinical and magnetic resonance imaging outcomes following platelet rich plasma injection for chronic midsubstance Achilles tendinopathy.
    Owens RF Jr, Ginnetti J, Conti SF, Latona C.
    Foot Ankle Int. 2011 Nov;32(11):1032-9.
  34. NewsBot

    NewsBot The Admin that posts the news.

    Platelet-rich plasma for managing calcaneus tendon tendinopathy and plantar fasciitis
    López-Gavito E, Gómez-Carlín LA, Parra-Téllez P, Vázquez-Escamilla J.
    Acta Ortop Mex. 2011 Nov-Dec;25(6):380-5.
  35. NewsBot

    NewsBot The Admin that posts the news.

    A Prospective Series of Patients with Chronic Achilles Tendinopathy Treated with Autologous-conditioned Plasma Injections Combined with Exercise and Therapeutic Ultrasonography
    Victoria M. Deans, Alison Miller, James Ramos,
    Jnl Foot & Ankle Surg (Article in Press)

  36. NewsBot

    NewsBot The Admin that posts the news.

    Healio are reporting:
    PRP accelerates Achilles tendon healing, functional recovery
    Full story
  37. NewsBot

    NewsBot The Admin that posts the news.

    Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy
    G. Ferreroa, E. Fabbroa, D. Orlandia, C. Martinia, F. Lacellib, G. Serafinib, E. Silvestric, L.M. Sconfienzad
    Journal of Ultrasound; 8 October 2012
  38. NewsBot

    NewsBot The Admin that posts the news.

    This was posted in the achilles tendon rupture thread:

    Effect of platelet-rich plasma injection on early healing of Achilles tendon rupture in rats
    Xiong X, Wu L, Xiang D, Ni G, Zhao P, Yu B.
    Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Apr;26(4):466-71.
  39. NewsBot

    NewsBot The Admin that posts the news.

    Histological Study of the Influence of Plasma Rich in Growth Factors (PRGF) on the Healing of Divided Achilles Tendons in Sheep
    J. Andrés Fernández-Sarmiento, DVM; Juan M. Domínguez, DVM, PhD; María M. Granados, DVM, PhD; Juan Morgaz, DVM, PhD; Rocío Navarrete, DVM, PhD; José M. Carrillo, DVM, PhD; Rafael J. Gómez-Villamandos, DVM, PhD; Pilar Muñoz-Rascón, DVM; Juana Martín de las Mulas, MD, PhD; Yolanda Millán, DVM, PhD; Montserrat García-Balletbó, MD, PhD; Ramón Cugat, MD, PhD
    J Bone Joint Surg Am. 2013 Feb 06;95(3):246-255.

  40. NewsBot

    NewsBot The Admin that posts the news.

    Outcomes After Ultrasound-Guided Platelet-Rich Plasma Injections for Chronic Tendinopathy: A Multicenter, Retrospective Review
    Kenneth Mautner et al
    PM&R; Available online 8 February 2013

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