A Closer Look At Platelet-Rich Plasma For Achilles Tendon Pathology

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Author(s): 
David Soomekh, DPM, Sydney K. Yau, DPM, and Bob Baravarian, DPM, FACFAS

   When it comes to patients who have an associated retrocalcaneal exostosis, we have also used PRP for these patients with varying results. One would confirm the diagnosis with ultrasound and/or MRI. Place a local anesthetic block well above the site of injection. Prepare the PRP at the desired concentration from the whole blood collection and activate it with calcium citrate. Proceed to inject between 6 and 10 cc of PRP within the substance of the tendon beginning at the site of pathology (pain and any bulbous mass).

   In regard to the medial or lateral aspect of the tendon, one should approach under ultrasound guidance with the patient in a prone position. Using a 25-guage needle, inject several pulsed (peppered) doses of about 0.25 cc at a time in order to fenestrate the tendon. Then have the patient use a walking boot and crutches for up to one week. Subsequently, the patient may proceed to weightbearing in the boot for the next one to three weeks. One can then transition the patient into an athletic shoe with a slow increase in weightbearing activity over a four-week period.

   We have seen a significant reduction in pain, a decrease in the size of fibrous nodules within the tendon, and an earlier return to regular and sporting activity after using PRP. Most patients have been able to return to increased exercise and activity within two months of the injection. Again, some patients have benefited from a second injection about six weeks after the first.

In Conclusion

Regenerative medicine has been increasingly studied in the field of tendinopathy and PRP is becoming a popular application to stimulate the release of growth factors. There have been many studies in the area of PRP and they have shown mixed results in terms of the benefit of PRP. In our experience, PRP has offered promising results in the treatment of Achilles tendinosis in terms of decreased pain, faster recovery and reduced fibrous nodules within the tendon. More well designed prospective and retrospective studies are needed to measure the true effectiveness of PRP.

   Dr. Soomekh is a Fellow of the American College of Foot and Ankle Surgeons, and a Diplomate of the American Board of Podiatric Surgery. He is on the faculty of the University Foot and Ankle Institute in Santa Monica, Calif.

   Dr. Yau is a Fellow at the University Foot and Ankle Institute in Los Angeles.

   Dr. Baravarian is an Assistant Clinical Professor at the UCLA School of Medicine. He is the Chief of Foot and Ankle Surgery at the Santa Monica UCLA Medical Center and Orthopedic Hospital. Dr. Baravarian is the Director of the University Foot and Ankle Institute in Los Angeles. He is a Fellow of the American College of Foot and Ankle Surgeons.

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