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Platelet-rich plasma injection does not improve chronic Achilles tendinopathy

Clinical Question:
Does injection with platelet-rich plasma reduce pain and improve activity in adults with chronic Achilles tendinopathy?

Bottom Line:
Local tendon injection with platelet-rich plasma (PRP) does not significantly reduce pain or improve activity compared with placebo saline injection in adults with chronic Achilles tendinopathy. (LOE = 1b)

Reference:
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(2):144-149.  [PMID:20068208]

Study Design:
Randomized controlled trial (double-blinded)

Allocation:
Concealed

Setting:
Outpatient (specialty)

Synopsis:
Platelets release growth factors promoting tissue repair that may reduce pain and improve function in patients with chronic tendon injuries. These investigators identified 54 adults, aged 18 years to 70 years, meeting standard diagnostic criteria for chronic midportion Achilles tendinopathy (pain located approximately 2 cm to 7 cm proximal to insertion on the calcaneus, present for at least 2 months). Eligible patients randomly received (concealed allocation assignment) a PRP or matched saline placebo injection through 3 different puncture locations along the Achilles tendon. Afterwards all patients received standard instructions for an exercise rehabilitation program. Patients masked to treatment group assignment self-assessed outcomes at baseline and after 6, 12, and 24 weeks using a previously validated questionnaire quantifying pain and activity level due to Achilles tendinopathy. Complete follow-up occurred for all patients. Using intention-to-treat analysis, pain and activity improvement scores were similar in both treatment groups. In addition, no significant differences in scores occurred between the 2 groups after controlling for potential confounding variables, including baseline pain scores and duration of symptoms, in overall patient satisfaction ratings or number of patients returning to sport activities. The study was 80% powered to detect a predetermined clinically significant difference between the 2 treatment groups.

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