Key Insights On Platelet-Rich Plasma For Soft Tissue Repair

Sean Grambart, DPM, FACFAS

   Four of the six patients improved and have not required further surgery. One of the remaining two felt that the improvement was enough to continue with normal activities and has not proceeded with other treatment. The other patient had open debridement.

   Obviously, the major limitation with this study is that all patients had a gastrocnemius recession, which alone could have led to the improvement. The longest follow-up is three years.

   I have also used PRP to treat chronic plantar fascial pain. While the patients’ usual presentation is typical of plantar fasciitis, they no longer have signs of inflammation consistent with plantar fasciitis. These patients with chronic plantar fascial pain failed conservative treatment with orthotics, steroid injections, nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy.

   Surgical intervention consists of a gastrocnemius recession and a PRP injection into the medial and central band of the plantar fascia origin. The post-op protocol is the same as I mentioned above for Achilles tendinosis.

   I have followed 54 patients over the last three years. Preliminary results have shown a 90 percent success rate. Forty-seven percent of patients needed another PRP injection while five patients have gone on to receive an open plantar fasciotomy. Once again, the major limitation of assessing these results is that patients underwent a gastrocnemius recession.

In Conclusion

The biochemistry behind using PRP for the treatment of soft tissue pathology seems to be clear although there is a lack of well designed studies with high-level evidence to determine the clinical significance.

   At this point, I have had good success with the use of PRP for chronic injuries of ligaments and tendons. One may employ PRP in an attempt to avoid a more invasive surgical procedure.

   Dr. Grambart is the foot and ankle surgeon for Carle Clinic Association, Division of Orthopedics in Champaign, Ill. He is a Clinical Instructor at the University of Illinois School of Medicine. Dr. Grambart is a Fellow and member of the Board of Directors of the American College of Foot and Ankle Surgeons.

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