Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: A Randomized Controlled Trial

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...

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Published in:JAMA : the journal of the American Medical Association 2010-01, Vol.303 (2), p.144-149
Main Authors: de Vos, Robert J, Weir, Adam, van Schie, Hans T. M, Bierma-Zeinstra, Sita M. A, Verhaar, Jan A. N, Weinans, Harrie, Tol, Johannes L
Format: Article
Language:English
Subjects:
Achilles Tendon
Adult
Biological and medical sciences
Clinical outcomes
Diseases of the osteoarticular system
Double-Blind Method
Exercise Therapy
Female
General aspects
Humans
Injections
Juxtaarticular diseases. Extraarticular rhumatism
Male
Medical disorders
Medical sciences
Medical treatment
Middle Aged
Pain Measurement
Plasma
Platelet-Rich Plasma
Tendinopathy - therapy
Tendons
Treatment Outcome
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Summary: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. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00761423
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.2009.1986