JOURNAL ARTICLE
RANDOMIZED CONTROLLED TRIAL

Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial

Robert J de Vos, Adam Weir, Hans T M van Schie, Sita M A Bierma-Zeinstra, Jan A N Verhaar, Harrie Weinans, Johannes L Tol
JAMA: the Journal of the American Medical Association 2010 January 13, 303 (2): 144-9
20068208

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.

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