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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!
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.
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!
DrSArbes
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.
Quote:
Originally Posted by srfoot
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!
There was just a post on the use of on the use of intralesional autologous blood injection for heel pain in the thread on Injection thereapy for heel pain
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.
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.
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!)
In Europe and the United States, there is an increasing prevalence of the use of autologous blood products to facilitate healing in a variety of applications. Recently, we have learned more about specific growth factors, which play a crucial role in the healing process. With that knowledge there is abundant enthusiasm in the application of concentrated platelets, which release a supra-maximal quantity of these growth factors to stimulate recovery in non-healing injuries. For 20 years, the application of autologous PRP has been safely used and documented in many fields including; orthopedics, sports medicine, dentistry, ENT, neurosurgery, ophthalmology, urology, wound healing, cosmetic, cardiothoracic, and maxillofacial surgery. This article introduces the reader to PRP therapy and reviews the current literature on this emerging treatment modality. In summary, PRP provides a promising alternative to surgery by promoting safe and natural healing. However, there are few controlled trials, and mostly anecdotal or case reports. Additionally the sample sizes are frequently small, limiting the generalization of the findings. Recently, there is emerging literature on the beneficial effects of PRP for chronic non-healing tendon injuries including lateral epicondylitis and plantar fasciitis and cartilage degeneration (Mishra and Pavelko, The American Journal of Sports Medicine 10(10):1-5, 2006; Barrett and Erredge, Podiatry Today 17:37-42, 2004). However, as clinical use increases, more controlled studies are needed to further understand this treatment.
Platelet -rich plasma (PRP) is currently used as an alternative treatment method for several common orthopaedic-related sports medicine conditions. According to a new study in the October issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), early outcomes of PRP appear promising; however, larger clinical studies are still needed to determine the benefits of its use.
"Some believe that PRP may catalyze the body's repair mechanisms at areas of injury, improve healing and shorten recovery time," said study co-author Michael Hall, MD, a senior orthopaedic surgery resident at the NYU Hospital for Joint Diseases in New York. "However, there currently is minimal evidence of this clinically and more research must be performed."
A Simple Process and Procedure
- Obtaining and utilizing PRP is a relatively simple process: a patient's own blood is placed into a centrifuge that rotates at high speed.
- This procedure separates the red blood cells from the platelets, which are blood cells that release growth factors that help the body heal itself.
- Next, the physician takes the platelet-rich portion of this blood (PRP) and injects it directly into the patient's injured area and the treatment is complete.
PRP Used Primarily for Chronic Conditions
PRP treatments have been used for the past two decades to improve wound healing and bone grafting procedures by plastic and maxillofacial (mouth, jaw and neck) surgeons. It is only in recent years that orthopaedic surgeons and sports medicine specialists have utilized this technology.
PRP use in sports medicine primarily has been for the treatment of chronic tendon conditions, but also for acute muscle injuries and for the augmentation of tendon repair in the operating room.
The most common applications include:
- tennis elbow (lateral epicondylitis);
- Achilles tendonitis (inflammation and swelling of the Achilles tendon);
- patellar tendonitis (inflammation of the patellar tendon, also called "Jumper's Knee"); and
- rotator cuff tendonopathy.
For anyone based in London and interested there is a free talk about this next week (see attached documents). Only thing you have to do is email and book yourself on - and they'll feed you there as well.
Also I spoke to Dr Ralph Rogers a few days ago (one of the only guys to currently perform PRP injections in London as far as I'm aware) and he said it has just been sanctioned by WADA. Anyone else heard this?
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
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.
Platelet-Rich Plasma for Achilles tendon pain
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