PRP and Achilles Tendinopathy
A) Heel lift, topical nitroglycerin
B) Physical therapy, US guided corticosteroid injection
C) NSAIDS, US guided PRP injection
D) Activity modification, physical therapy
Today we are going to review a paper by Kearney et al investigating the use of PRP for Achilles tendinopathy. Kearney, Rebecca S., et al. “Effect of Platelet-Rich Plasma Injection vs Sham Injection on Tendon Dysfunction in Patients With Chronic Midportion Achilles Tendinopathy: A Randomized Clinical Trial.” JAMA 326.2 (2021): 137-144.
Image 1. The pathogenesis of tendinopathyFu, SC., Rolf, C., Cheuk, YC. et al. Deciphering the pathogenesis of tendinopathy: a three-stages process. BMC Sports Sci Med Rehabil 2, 30 (2010).
The Bottom Line
Best answer is D. The runner should discontinue or cut back on running volume and begin physical therapy. The emphasis should be on stretching and eccentric exercises. A slow return to play/ sport can begin if the symptoms resolve. NSAIDS are reasonable initially, but PRP doesn’t help and corticosteroid injections should be avoided. Both heel lift and topical nitroglycerin can be useful in refractory cases, but should not be initiated early in the treatment course.
|↑1||Lysholm J, Wiklander J. Injuries in runners. Am J Sports Med. 1987 Mar-Apr;15(2):168-71|
|↑2||Paavola M, Kannus P, Paakkala T, Pasanen M, Järvinen M. Long-term prognosis of patients with achilles tendinopathy: an observational 8-year follow-up study. Am J Sports Med 2000;28:634–642.|
|↑3||Moraes, Vinícius Y., et al. “Platelet‐rich therapies for musculoskeletal soft tissue injuries.” Cochrane Database of Systematic Reviews 4 (2014).|
|↑4||Fu, SC., Rolf, C., Cheuk, YC. et al. Deciphering the pathogenesis of tendinopathy: a three-stages process. BMC Sports Sci Med Rehabil 2, 30 (2010).|
|↑5||de Vos RJ, Weir A, van Schie HT, et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA 2010;303:144–149|
|↑6||Sadoghi P, Rosso C, Valderrabano V, Leithner A, Vavken P. The role of platelets in the treatment of achilles tendon injuries. J Orthop Res 2013;31:111–118|