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Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy A Randomized Controlled Trial
Robert J. de Vos, MD Adam Weir, MBBS Hans T. M. van Schie, DVM, PhD Sita M. A. Bierma-Zeinstra, PhD Jan A. N. Verhaar, MD, PhD Harrie Weinans, PhD Johannes L. Tol, MD, PhD JAMA. 2010;303(2):144-149
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, placebocontrolled
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 betweengroup
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