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

Recent JAMA Platelet Rich Plasma article

A new PRP study from researchers in the Netherlands declared platelet-rich plasma is ineffective in healing moderate Achilles tendinopathy. Researchers had 54 patients gauge pain levels at 6, 12 and 24 weeks following treatment. One patient group was given a PRP injection and the other, a saline injection (placebo). The study published in JAMA (Journal of the American Medical Association) by de Vos et al, concluded PRP was no more effective than the saline injection when both groups added therapeutic exercises into their recovery routines.

The study has received extensive media coverage and has been quick to cite PRP as ineffective. It is important to view the controls of the study before conclusions are made however.

This study's data does support PRP's ineffectiveness after a 6 month period in only moderate Achilles tendinopathy. It does not include either minor or severe cases. This study was published at its midpoint. Researchers will follow up on patients' recovery in 12 months and it is possible PRP patients will continue to improve and the placebo group will not.

Importantly, no data is available on platelet concentrations given to the PRP group. As this study is one of many to come determining the proper use of PRP, platelet concentration levels in PRP groups will be crucial to disclose. If patients received too low a platelet concentration in their injection, results would likely vary in higher doses. This will be a vital component of determining the optimal formula of PRP.

Patients receiving PRP to treat plantar fasciitis and Achilles tendinopathy have been benefited by the use of a boot following therapy. This allows the injury time to heal without chronic tension and permits the growth factors to work without continued trauma. There is no data in this study on whether boots were used.

Legitimate studies are very important to further the understanding of PRP's effectiveness and uses and this study should be recognized as such. The study is however, incomplete. This must be taken into account before significant conclusions are drawn about PRP's effectiveness.