CORR Insights®: Is Platelet-rich Plasma Injection Effective for Chronic Achilles Tendinopathy? A Meta-analysis.

Abstract

Over the last decade, many researchers and clinicians have been intrigued by platelet-rich plasma (PRP) as an adjunct to try to improve the healing potential of musculoskeletal injuries. As we have learned more about the possible clinical applications of PRP, and with positive reports in the lay media [8, 13], patients have become eager to try PRP and are willing to pay out of pocket for this procedure. The price range for PRP in Cleveland, OH, USA is USD 500 to USD 1000. Physicians can market PRP for clinical use due to a high market demand, a safe user profile, and potential financial benefit. Because of this interest, it is important for the clinician to understand the state of the science when offering PRP treatments to their patients. Obtained from autologous blood, PRP might provide clinical benefit by modulating proinflammatory cytokines and cell migration seen in healing [2, 6, 11]. It appears that PRP stimulates a robust healing response in chronically inflamed tenocytes [3]. While the basic science is promising, the clinical benefits remain unproven. Clinicians have attempted to harness the potential of PRP to treat a variety of musculoskeletal issues including sprained ligaments, torn tendons, injured muscles, and osteoarthritis. Although many studies have not shown clinical benefit [9, 12], there are examples of modest gains in limited situations. A large meta-analysis assessing PRP in ligament and tendon injuries found a reduction in pain specifically for lateral epicondylitis and rotator cuff injures [7]. When evaluating the use of PRP specifically in treating Achilles tendinopathy, the results have been mixed. Researchers attempted to supplement the standard nonsurgical approach of eccentric calf muscle training with PRP to expedite healing time and improve functional outcomes. While some randomized controlled trials demonstrated improvement in pain and function compared to placebo, others have shown no advantage to injecting with normal saline [5, 10]. The authors of the current study [14] attempted to reconcile these differences noted in the randomized control trials. The meta-analysis of four high-quality randomized control trials yielded 170 patients, and found no difference between normal saline and PRP injections when measuring VISAA, tendon thickness, and tendon blood flow with laser Doppler flowmetry.