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Platelet-Rich Plasma for Achilles tendon pain

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  #1  
Old 22nd March 2007, 04:38 PM
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Default Platelet-Rich Plasma for Achilles tendon pain

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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!
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Old 2nd August 2007, 04:31 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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.
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Old 6th August 2007, 11:27 AM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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
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Old 7th August 2007, 08:58 AM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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!
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  #5  
Old 21st September 2007, 03:30 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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
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Old 9th March 2009, 08:10 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

I am very interested in learning more about PRP therapy. Please tell me where I can get the training.Thanks
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Old 30th April 2009, 12:04 AM
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Default 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.

Thanks

Bob Fleck
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Old 30th April 2009, 12:33 AM
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Default Re: Autologous blood injections for tendinopathy

Quote:
Originally Posted by Bob Fleck View Post
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!)

Ian
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Old 30th April 2009, 12:38 AM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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.

regards

Bob
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Old 27th May 2009, 04:04 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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
Quote:
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.
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  #11  
Old 1st October 2009, 08:46 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

Medical News Today are reporting:
Platelet-Rich Plasma: Does It Work?
Quote:
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.
Full story
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  #12  
Old 2nd October 2009, 03:04 AM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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
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  #13  
Old 2nd October 2009, 09:10 AM
W J Liggins W J Liggins is offline
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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

Bill Liggins
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  #14  
Old 2nd October 2009, 10:43 AM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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.

www.cricinfo.com/engvaus2009/content/story/416167.html



So is an ultra-sound required before an injection treatment or blood nerve supply op path taken?
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  #15  
Old 14th January 2010, 12:42 AM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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.
Quote:
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.
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Old 26th March 2010, 07:33 AM
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Default Plaetlet Rich Plasma

Optimism persists about platelet rich plasma despite RCT findings . Is it too good to be true. Check out the piece in LER. http://lowerextremityreview.com/news...rehabilitation
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  #17  
Old 26th March 2010, 05:57 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

Quote:
Originally Posted by NewsBot View Post
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.
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:

Quote:
During the first 48 hours after the injection, patients were only allowed to walk short distances indoors. During days 3 to 7 postinjection, walks up to 30 minutes were allowed.

All patients were instructed to avoid weight-bearing sporting activities for the first 4 weeks. After 4 weeks, a gradual return to sports activities was encouraged. The intensity of sportsactivities could be increased when there was only mild pain (maximum score of 3 on a scale from 0-10, with 0 representing no pain and 10 representing maximum pain) and no increase in morning stiffness.
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?
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Old 15th April 2010, 02:52 AM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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
Quote:
Background
If conservative treatment for chronic plantar fasciitis fails, often a corticosteroid injection is given. Corticosteroid injection gives temporarily pain reduction, but no healing. Blood platelets initiate the natural healing rate. Recover (TM) gives an eightfold concentrate platelets of patients own blood. Injection of these platelets in the attachment of the fascia to the os calcis might induce a healing rate. Methods and design: A randomized controlled multi centre trial will be performed. The study population consists of 120 patients of 18 years and older. Patients with chronic plantar fasciitis will be allocated randomly to have a steroid injection or an autologous platelet concentrate injections. Data will be collected before the procedure, 4,8,12,26 weeks and 1 year after the procedure. The main outcome measures of this study are pain and function measured with questionnaires.

Conclusion
Recent literature show positive effects for the treatment of tendinosis with autologous platelet injections. The forthcoming trial will compare treatment for chronic plantar fasciitis with a steroid injection versus an autologous platelet injection. Our results will be published as soon as they become available
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Old 11th June 2010, 01:00 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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]
Quote:
Non-insertional Achilles tendinopathy commonly impedes the functioning of active persons. Treatment methods vary, as do their results. The aim of the study was to evaluate the effectiveness of non-insertional Achilles tendinopathy treatment with autologous platelet-rich plasma (PRP). Autologous PRP was injected into the affected Achilles tendon of 14 prospectively selected patients (15 Achilles tendons). Before PRP administration, all patients were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scale for the hind foot, and the Victorian Institute of Sport Assessment - Achilles (VISA-A) scale. Ultrasonography (US) and Power-Doppler ultrasonography (PDUS) of the area was also performed. Identical physical and imaging evaluations were performed at 6 weeks, and at 3, 6, and 18 months after injection. During follow up, a significant improvement was observed in the clinical and imaging results. The AOFAS scale improved from a baseline median of 55 points to 96 points at 18 months (p=0.000655), while the VISA-A scale improved from a baseline of 24 to 96 (p=0.000655) in the final evaluations. During the final evaluation, one subject experienced minor pain following prolonged daily activity, while another subject complained of pain following overloading activity. Local, accurate PRP administration improved symptoms of non-insertional Achilles tendinopathy.
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Old 22nd June 2010, 12:34 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

OrthoSuperSite are reporting:
Ruptured Achilles tendons’ mechanical properties unaltered by concentrated PRPs
Quote:
Following Achilles tendon rupture there were no differences in patients treated with platelet-rich plasma and controls for the usual parameters used to assess such cases, however some of the control group’s outcomes exceeded those in the treated group, according to a randomized study performed by investigators from Linköping, Sweden.

Thorsten Schepull, MD, and colleagues enrolled 30 consecutive patients with Achilles tendon ruptures in their study. They all underwent the platelet-rich plasma (PRP) preparation process, were operated on with an open suture-repair technique and had four metal Roentgen stereophotogrammetric markers placed in the tendon. Randomization to the PRP or control group – 16 patients and 4 patients respectively – occurred just prior to skin closure....
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Old 27th August 2010, 11:11 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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)
Quote:
Background: Platelet-rich plasma (PRP) has been used to enhance tendon healing in clinical settings. However, the cellular mechanisms underlying PRP treatment of injured tendons remain unclear. The aim of this study was to determine the effects of PRP, in the form of PRP-clot releasate (PRCR), on tendon stem cells (TSCs), a newly discovered cell population in tendons.

Hypothesis: The PRCR treatment promotes differentiation of TSCs into tenocytes that are activated to proliferate quickly and increase collagen production.

Study Design: Controlled laboratory study.

Methods: After PRCR treatment, cell morphology, expression of stem/progenitor cell marker nucleostemin, and population doubling time were examined. In addition, gene and protein analyses were performed using reverse transcription-polymerase chain reaction, immunocytochemistry, and Western blot to characterize the type of cells that had differentiated after PRCR treatment.

Results: The TSCs without PRCR treatment were small and exhibited an irregular shape, whereas with increasing PRCR dosage, TSCs became large, well spread, and highly elongated with downregulation of nucleostemin expression. The PRCR treatment also markedly enhanced TSC proliferation, tenocyte-related gene and protein expression, and total collagen production, all of which indicated that PRCR treatment induced differentiation of TSCs into activated tenocytes.

Conclusion: The PRCR treatment promotes differentiation of TSCs into active tenocytes exhibiting high proliferation rates and collagen production capability.

Clinical Relevance: The findings of this study suggest that PRP treatment of injured tendons is “safe” as it promotes TSC differentiation into tenocytes rather than nontenocytes, which would compromise the structure and function of healing tendons by formation of nontendinous tissues. Moreover, they suggest that PRP treatment can enhance tendon healing because tenocytes induced to differentiate by PRP are activated to proliferate quickly and produce abundant collagen to repair injured tendons that have lost cells and matrix.
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Old 3rd November 2010, 04:02 AM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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
Quote:
Objective To assess whether a platelet-rich plasma (PRP) injection leads to an enhanced tendon structure and neovascularisation, measured with ultrasonographic techniques, in chronic midportion Achilles tendinopathy.

Design Double-blind, randomised, placebo-controlled clinical trial.

Setting Sports medical department of The Hague medical centre.

Patients 54 patients with chronic midportion Achilles tendinopathy were included.

Interventions Patients were randomised to eccentric exercise therapy with either a PRP injection (PRP group) or a saline injection (placebo group).

Main outcome measurements Tendon structure was evaluated by ultrasonographic tissue characterisation, a novel technique which quantifies tendon structure into four echo-types: echo-types I+II represent organised tendon bundles, whereas echo-types III+IV represent a disorganised tendon structure. Colour Doppler ultrasonography was used to measure the degree of neovascularisation. Follow-up was at 6, 12 and 24 weeks.

Results A significant improvement in echo-types I+II was found after 24 weeks within both the PRP group (n=27) and the placebo group (n=27), but there was no significant between-group difference (95% CI −1.6 to 7.8, p=0.169). After 6 weeks, the neovascularisation score increased within the PRP group (p=0.001) and the placebo group (p=0.002), but there was no significant between-group difference in change in neovascularisation score at any point in time.

Conclusion Injecting PRP for the treatment of chronic midportion Achilles tendinopathy does not contribute to an increased tendon structure or alter the degree of neovascularisation, compared with placebo.
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Old 4th November 2010, 07:23 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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,
Quote:
Background: Animal studies have shown that local application of platelet-rich plasma (PRP) stimulates tendon repair. Preliminary results from a retrospective case series have shown faster return to sports.

Hypothesis: Autologous PRP stimulates healing of acute Achilles tendon ruptures.

Study Design: Randomized controlled trial; Level of evidence, 2.

Methods: Thirty patients were recruited consecutively. During surgery, tantalum beads were implanted in the Achilles tendon proximal and distal to the rupture. Before skin suture, randomization was performed, and 16 patients were injected with 10mL PRP (10 times higher platelet concentration than peripheral blood) whereas 14 were not. With 3-dimensional radiographs (roentgen stereophotogrammetric analysis; RSA), the distance between the beads was measured at 7, 19, and 52 weeks while the patient resisted different dorsal flexion moments over the ankle joint, thereby estimating tendon strain per load. An estimate of elasticity modulus was calculated using callus dimensions from computed tomography. At 1 year, functional outcome was evaluated, including the heel raise index and Achilles Tendon Total Rupture Score. The primary effect variables were elasticity modulus at 7 weeks and heel raise index at 1 year.

Results: The mechanical variables showed a large degree of variation between patients that could not be explained by measuring error. No significant group differences in elasticity modulus could be shown. There was no significant difference in heel raise index. The Achilles Tendon Total Rupture Score was lower in the PRP group, suggesting a detrimental effect. There was a correlation between the elasticity modulus at 7 and 19 weeks and the heel raise index at 52 weeks.

Conclusion: The results suggest that PRP is not useful for treatment of Achilles tendon ruptures. The variation in elasticity modulus provides biologically relevant information, although it is unclear how early biomechanics is connected to late clinical results.
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Old 20th January 2011, 12:40 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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
Quote:
Introduction Chronic Achilles tendinopathy occurs frequently and is very hard to treat. The disease involves local degeneration of tendon tissue, of which regeneration may be improved by injecting platelet-rich plasma (PRP), an increasingly used therapy for releasing growth factors into degenerative tendon. However, high-quality randomised clinical trials on this topic are lacking. The aim of this study was to evaluate the effect of a PRP injection in patients with chronic Achilles tendinopathy.

Methods In this stratified, block randomised, double-blind, placebo-controlled trial at single center 54 patients aged 18–70 years were randomised in two treatment groups. Next to an eccentric training program the patients received a blinded injection containing either PRP group or saline (placebo group). Primary outcome, the objective and validated Victorian Institute of Sports Assessment-Achilles (VISA-A) score, was assessed and ultrasound examination was performed at baseline and all follow-up appointments.

Results After randomisation into the PRP group (n=27) and the placebo group (n=27) there was a complete follow-up. After one year, the mean VISA-A score improved in both the PRP-group and the placebo group. There was no significant difference in increase between both groups (adjusted between-group difference, 5.5; 95% CI, −4.9 to 15.8, p=0.292). Ultrasonographic tendon structure improved significantly in both groups, but not significant different between both groups (adjusted between-group difference, 1.2 %, 95% CI, −4.1 to 6.6, p=0.647)

Conclusion One-year follow-up analysis of the world’s first randomised controlled trial showed no evidence for the use of platelet-rich plasma injection in chronic Achilles tendinopathy. These findings are in line with our 6 months results
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Old 21st May 2011, 06:32 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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
Quote:
Background: Achilles tendinopathy is a common disease among both athletes and in the general population in which the use of platelet-rich plasma has recently been increasing. Good evidence for the use of this autologous product in tendinopathy is limited, and data on longer-term results are lacking.

Purpose: To study the effects of a platelet-rich plasma injection in patients with chronic midportion Achilles tendinopathy at 1-year follow-up.

Study Design: Randomized controlled trial; Level of evidence,1.

Methods: Fifty-four patients, aged 18 to 70 years, with chronic tendinopathy 2 to 7 cm proximal to the Achilles tendon insertion were randomized to receive either a blinded injection containing platelet-rich plasma or saline (placebo group) in addition to an eccentric training program. The main outcome was the validated Victorian Institute of Sports Assessment–Achilles score. Patient satisfaction was recorded and ultrasound examination performed at baseline and follow-up.

Results: The mean Victorian Institute of Sports Assessment–Achilles score improved in both the platelet-rich plasma group and the placebo group after 1 year. There was no significant difference in increase between both groups (adjusted between-group difference, 5.5; 95% confidence interval, –4.9 to 15.8, P = .292). In both groups, 59% of the patients were satisfied with the received treatment. Ultrasonographic tendon structure improved significantly in both groups but was not significantly different between groups (adjusted between-group difference, 1.2%; 95% confidence interval, –4.1 to 6.6, P = .647).

Conclusion: This randomized controlled trial showed no clinical and ultrasonographic superiority of platelet-rich plasma injection over a placebo injection in chronic Achilles tendinopathy at 1 year combined with an eccentric training program.
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Old 21st May 2011, 06:35 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

Quote:
Originally Posted by NewsBot View Post
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
Quote:
Originally Posted by NewsBot View Post
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
Spot the difference? Looks suspicious?
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Old 16th June 2011, 02:39 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

angryorthopod has a view on this:
PRP: Pure Rubbish, People!
Quote:
I get angry when I see people falling for flashy procedures that fool them into thinking they’re fixing their problems
Quote:
There’s one minor problem with PRP: there’s no evidence it actually works.
Quote:
The docs I personally know who are using PRP regularly aren’t very good at what they do, so this provides them the extra DB (doctor bling). Making matters worse is that large othoapaedic companies are pushing PRP more and more. It’s a real shame that the popularity of this treatment is seemingly driven more by office reps than evidence based medicine, which really pisses me off.
link to article
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  #28  
Old 2nd August 2011, 05:48 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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
Quote:
Background: Platelet-rich plasma (PRP) injections are used to treat (Achilles) tendinopathies. Platelet-rich plasma has been injected at different locations, but the feasibility of PRP injections and the distribution after injection have not been studied.

Purpose: To evaluate (1) the feasibility of ultrasound-guided PRP injections into the Achilles tendon (AT) and in the area between the paratenon and the AT and (2) the distribution of PRP after injection into the AT and in the area between the paratenon and AT.

Study Design: Descriptive laboratory study.

Methods: Fifteen cadaveric lower limbs were injected under ultrasound guidance with Indian blue–dyed PRP. Five injections were placed into the AT at the midportion level; 5 injections were located anterior between the paratenon and AT and 5 posterior between the paratenon and AT. The limbs were anatomically dissected and evaluated for the presence and distribution of PRP.

Results: All injections into the AT showed PRP infiltration in the AT as well as in the area between the paratenon and AT (median craniocaudal spread, 100 mm; range, 75-110 mm); 1 of 5 limbs showed PRP leakage into the Kager fat pad after AT injection. Allanterior and posterior injections showed PRP infiltration in the area between the paratenon and AT (median, 100 mm; range, 75-150 mm). The AT was infiltrated with PRP after 3 of 10 paratenon injections.

Conclusion: The “AT” and “paratenon” injections under ultrasound guidance proved to be accurate. Injections into the AT showed distribution of PRP into the AT as well as in the area between the paratenon and AT. All injections between the paratenon and AT showed PRP distribution in that area, as well as in the Kager fat pad.

Clinical Relevance: Different PRP injection techniques were evaluated. This aids in the optimization of PRP injections in the treatment of midportion Achilles tendinopathy.
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  #29  
Old 16th August 2011, 06:41 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

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
Quote:
Background: Previous studies of bioactive molecules in platelet-rich plasma (PRP) have documented growth factor concentrations that promote tissue healing. However, the effects of leukocytes and inflammatory molecules in PRP have not been defined.

Hypothesis: The hypothesis for this study was that the concentration of growth factors and catabolic cytokines would be dependent on the cellular composition of PRP.

Study Design: Controlled laboratory study.

Methods: Platelet-rich plasma was made from 11 human volunteers using 2 commercial systems: Arthrex ACP (Autologous Conditioned Plasma) Double Syringe System (PRP-1), which concentrates platelets and minimizes leukocytes, and Biomet GPS III Mini Platelet Concentrate System (PRP-2), which concentrates both platelets and leukocytes. Transforming growth factor-β1 (TGF-β1), platelet-derived growth factor–AB (PDGF-AB), matrix metalloproteinase-9 (MMP-9), and interleukin-1β (IL-1β) were measured with enzyme-linked immunosorbent assay (ELISA).

Results: The PRP-1 system consisted of concentrated platelets (1.99×) and diminished leukocytes (0.13×) compared with blood, while PRP-2 contained concentrated platelets (4.69×) and leukocytes (4.26×) compared with blood. Growth factors were significantly increased in PRP-2 compared with PRP-1 (TGF-β1: PRP-2 = 89 ng/mL, PRP-1 = 20 ng/mL, P < .05; PDGF-AB: PRP-2 = 22 ng/mL, PRP-1 = 6.4 ng/mL, P < .05). The PRP-1 system did not have a higher concentration of PDGF-AB compared with whole blood. Catabolic cytokines were significantly increased in PRP-2 compared with PRP-1 (MMP-9: PRP-2 = 222 ng/mL, PRP-1 = 40 ng/mL, P < .05; IL-1β: PRP-2 = 3.67 pg/mL, PRP-1 = 0.31 pg/mL, P < .05). Significant, positive correlations were found between TGF-β1 and platelets (r 2 = .75, P < .001), PDGF-AB and platelets (r 2 = .60, P < .001), MMP-9 and neutrophils (r 2 = .37, P < .001), IL-1β and neutrophils (r 2 = .73, P < .001), and IL-1β and monocytes (r 2 = .75, P < .001).

Conclusion: Growth factor and catabolic cytokine concentrations were influenced by the cellular composition of PRP. Platelets increased anabolic signaling and, in contrast, leukocytes increased catabolic signaling molecules. Platelet-rich plasma products should be analyzed for content of platelets and leukocytes as both can influence the biologic effects of PRP.

Clinical Relevance: Depending on the clinical application, preparations of PRP should be considered based on their ability to concentrate platelets and leukocytes with sensitivity to pathologic conditions that will benefit most from increased platelet or reduced leukocyte concentration.
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Old 17th August 2011, 03:35 PM
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Default Re: Platelet-Rich Plasma for Achilles tendon pain

Limited Evidence Supports the Effectiveness of Autologous Blood Injections for Chronic Tendinopathies (JBJS subscription needed to read)
J Bone Joint Surg Am. 2011; 93:1545-1545
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