An important study that may help patients suffering from Achilles tendinosis has been revealed.
Published in this month’s American Academy of Orthopaedic Surgeons and titled, “PRP show potential for treating Achilles tendinosis,” the article highlights the recent Platelet-Rich Plasma (PRP) study conducted by Martin J. O’Malley, M.D. At the 2010 annual meeting of the American Orthopaedic Foot & Ankle Society (AOFAS),
Dr. O’Malley reviewed his retrospective study showing the potential success of treating Achilles tendinosis with Platelet-Rich Plasma. Because poor vascularization hinders repair, Dr. Malley pointed out, treatment of this condition should focus on “jump starting tissue repair and regeneration rather than reducing an inflammatory process.” This is exactly the aim of PRP.
Dr. O’Malley said conservative treatment for Achilles tendinosis fails in 25-45 percent of all patients. These methods may include physical therapy, eccentric stretching exercises, corticosteroid injections, and glyceryl nitrate patches. PRP has been shown to boost the body’s natural healing response by delivering a concentrated dose of growth factor-releasing, blood platelets (the components of whole blood used to create and re-grow cells) directly to an injury site. Therefore, using PRP, Dr. O’Malley treated 34 patients with Achilles tendinosis, all with symptoms lasting more than 6 months. All patients had failed conventional therapy methods, had persisting symptoms for an average of 15 months and were candidates for surgery.
While other studies have not reported specific and valuable procedural information, Dr. O’Malley is thorough to report treatment details. Patients were instructed to stop taking non-steroidal anti-inflammatory drugs 2 weeks prior to the procedure. The PRP injection was performed by one surgeon under ultrasound guidance, with local anesthesia. Following the initial PRP injection, the patients were prescribed 2 weeks in a protective boot and conventional exercise and stretches were instructed. All patients had a follow-up examination at 4 weeks.
RESULTS: The journal article reports, “After PRP, 10 patients (4 with insertional and 6 with noninsertional tendinosis) reported complete relief of symptoms. Eight patients who were not satisfied with the results from a single injection received a second one. At final follow-up, a total of 19 patients (8 with insertional and 11 with noninsertional tendinosis) had improved and no longer required medical treatment (Fig. 1). Five patients (3 with insertional and 2 with noninsertional tendinosis) underwent surgery at an average of 59 days after the last injection.”
While the shortcomings of the study lie in the absence of a placebo group, Dr. O’Malley said further randomized controlled trials are warranted because most clinical studies have shown “encouraging outcomes.” This is an important study as it furthers the notion that Orthopaedic surgeons should offer PRP to patients who have failed conventional treatment methods.
non-insertional: occurs proximal to retrocalcaneal bursa; generally responds well to non-operative treatment; heel cord stretching (mild cases); short period of immobilization followed by gradual mobilization w/ temporary avoidance of repetitive activities (running).
Insertional tendinitis: tenderness is localized to calcaneal tendon insertion; pain is related to contact between posterior calcaneus and Achilles tendon; Haglund’s deformity may be related to this condition
(Definitions from Wheeless’ Textbook of Orthopaedics)