Saturday, June 26, 2010

Platelet-Rich Plasma Shows Effectiveness in Severe Achilles Tendinosis

During a presentation at the EFORT (European Ferederation of National Associations of Orthopedics and Traumatology) Congress, Dr. Raymond Monto, M.D. reported that Platelet-Rich Plasma showed effectiveness in patients with severe Achilles tendinosis who failed conventional treatments.

Dr. Monto's investigation was conducted in Madrid, Spain and focused on 27 patients who failed non-surgical treatments for 8 consecutive months. Patients' pretreatment average AOFAS (American Orthopedic Foot and Ankle Society) score was 34 and all patients had evidence of chronic tendinosis, with 9 having partial tears of the Achilles.

Using ultrasound guidance, Dr. Monto injected 4 ccs of PRP into the site of injury, then had patients fully immobilized removing stress from the Achilles for 48 hours. The most dramatic results came in AOFAS scores: 1 month after receiving PRP treatment, patients' scores increased to 84 . After 2 months, scores increased to 87. After 6 months, scores again increased to 92 with resolution of abnormalities found through MRI and ultrasound in 25 patients.

Another recent study conducted in The Netherlands concluded PRP was no more effective in treating moderate Achilles tendinosis than non-surgical, conventional methods at 12-24 week (3-6 month) follow-up. This 54 patient study was published in JAMA (Journal of the American Medical Association) at its midpoint in January, 2010.

Importantly, the difference between the two studies are: following injection Dr. Monto's patients were fully immobilized for 48 hours; Dr. Monto seemed to indicate his platelet count to an area of 2 million platelets and focused on patients with severe cases who failed conventional treatments for 8 consecutive months; The Netherlands study accepted all patients with chronic tendinosis; The Netherlands study involved more patients, yet did not indicate whether patients were immobilized or platelet concentration levels.

This is important as optimal healing has occurred when stress was removed from the injury following PRP therapy.

Dr. Monto concluded his presentation by saying, "PRP is an effective treatment for patients with severe Achillies tendinosis, with relatively no risk...there were no complications in our series...and potentially high benefits."

Reference: Monto R. Platelet-rich plasma treatment for chronic Achilles tendinosis. Paper #F264. Presented at the EFORT Congress 2010. June 2-5, 2010. Madrid.

JAMA Article review