PLATELET RICH PLASMA TREATMENT FOR CHRONIC ACHILLES TENDONOSIS

Abstract

Chronic Achilles tendonosis is a common but difficult condition to successfully treat. Platelet rich plasma (PRP), a concentrated bioactive component of autologous blood that is rich in cytokines and other growth factors, was examined in this study to assess its ability to promote healing in severe cases of Achilles ten-donosis resistant to traditional non-operative treatment paradigms. Twenty-seven patients (16 males 11 females) with an average age of 46 (36–66) and who had failed an average of 8 months (6–10) of standard non-operative management for Achilles tendonosis (rest, heel lifts, PT, NSAIDS, cam walker / cast immobilization, night splinting, local modalities) were prosepectively included in the study. All patients had pre-treament MRI and ultrasound studies and clinical scoring was completed using the AOFAS hindfoot scoring system. Patients were treated by injecting a single dose of 4 cc of unbuffered PRP under local anesthesia directly into the injured zone of the Achilles tendon using ultrasound probe guidance. All patients were then immobilized fully weight bearing in a cam walker for 48 hours and then allowed to return to normal activites as tolerated and without support. Pre-treatment AOFAS scores averaged 34 (26–60), all patients had MRI and ultrasound evidence of chronic tendonosis and 9/27 had partial tears of the Achilles. All patients were considering operative intervention due to clinical dissatisfaction. Post-treatment AOFAS scores improved to 84 (80–87), at 1 month, 87 (84–90), at 2 months, 88 (87–100) at 3 months, and 92 (90–100) at 6 months with resolution of abnormalities seen in 25/27 post treatment MRI and ultrasound studies. All patients except one were clinically satisfied with their clinical results and no complications were reported. This study suggests that platelet rich plasma can be effective in the treatment of severe achilles tendonosis refractory to traditional non-operative management.