Long-term beneficial effects of platelet-rich plasma for non-insertional Achilles tendinopathy

• Non-insertional Achilles tendinopathies are over-use injuries difficult to treat.
• A few long-term follow-up studies are available about PRP in Achilles tendinopathies.
• Literature data is controversial about the use of PRP in Achilles tendinopathies.
• There are many PRP formulations, and L-PRP also contains increased concentrations of leukocytes.
• A single L-PRP injection has proven to be beneficial in long term within CRAT's treatment.

BackgroundThe aim of this retrospective study is evaluating the long-term clinical outcome in patients affected by mid-portion Chronic Recalcitrant Achilles Tendinopathies (CRAT) treated with administration of single platelet-rich plasma (PRP).MethodsA total of 83 tendons (73 patients, 59 males and 14 females; age 43 ± 17.5 years) affected by non-insertional CRAT were treated with single PRP injection. These were evaluated with the Victorian Institute of Sport Assessment – Achilles (VISA-A) questionnaire, Blazina score and satisfaction index at baseline at intervals of 3 weeks, 3 months, 6 months. Final follow-up was carried out at a mean of 50.1 months (range, 24–96).ResultsBaseline VISA-A was 45 ± 15. Results relative to the final follow-up improved significantly to a mean of 88 ± 8 (p < 00.1). Blazina was used for patients practicing sports (54 tendons out of 46 different patients): 37 tendons were grade IIIa, 11 II, and 6 IIIbis. Final follow-up Blazina scores improved for 45 grade 0, 5 I, 4 II (p < 00.5). Seventy-six tendons (91.6%) were rated as satisfactory and patients would repeat the treatment. Seven tendons (8.4%) were classified as unsatisfactory at the 6 months follow-up and underwent a second PRP injection. In addition to this, patients reported no Achilles tendon rupture.ConclusionsThe study shows beneficial effects and low complication rate following of single PRP injections on a large cohort of patients with mid-long-term follow-up. No cases reported Achilles tendon rupture, in contrast to literature, which described CRAT as one of the most common risk factors. The use of a single PRP injection can therefore be a safe and attractive alternative in the treatment of non-insertional CRATs.