New Achilles Tendon Treatment Falls Short of Hype

Jan. 12, 2010 -- Injecting injured Achilles tendons with platelet-rich
plasma (PRP) is no more effective than dummy injections when it comes to
alleviating pain and improving activity levels, according to a new study in the
Jan. 13 issue of the Journal of the American Medical Association.
Much hope has been pinned on the use of these injections to heal tendon
injuries without surgery. PRP injections involve taking some of the patient’s
blood and isolating the platelet-rich plasma, which contains proteins and other
substances that play a role in healing. This PRP is then injected into the
tendon area to speed the healing process, reduce pain, and improve
function.
But the new study suggests that PRP is not living up to the hype, at least
in the treatment of chronic Achilles tendinopathy, a painful tendon injury
related to overuse that can severely restrict activity.
“These findings are important and clinically relevant as PRP is thought to
be growing in popularity and recent reviews supported its use for chronic
tendon disorders,�? write the study authors including Robert J. de Vos, MD,
of Erasmus University Medical Center in Rotterdam, Netherlands. “We do not
recommend this treatment.�?
The new study included 54 people with chronic Achilles tendinopathy who
participated in an exercise program to stretch their tendon while contracting
their calf muscle. The exercise program was coupled with either a PRP injection
or a saline (dummy) injection. Researchers measured pain and activity levels
using a standardized tool at baseline, 6, 12, and 24 weeks.
Although there was an improvement seen among individuals treated with PRP
after 24 weeks, it was no different than what was seen among those who received
the placebo injection.
Don’t jump to any conclusions based on one study, says Brian Halpern, MD, an
associate attending physician at the Hospital for Special Surgery in New York
City, who routinely uses PRP to treat tendon problems.
Although he is happy to see this treatment being studied in such a rigorous
manner, the new study did not use imaging to see if the PRP injections changed
the structure and helped to regenerate the damaged tendon.
Perhaps, just needling the tendon - which was done with both PRP and saline
injection - stimulates the body’s own platelets to congregate in the injured
area and speed the healing process. “The saline may look good because of the
needling,�? he says.
Still, “the improvement is not as great as I would have expected,�? he says.
“For me, the jury is still out and we need to do more studies and take it from
there.�?
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