No benefit reported after using platelet concentrate with Achilles tendon ruptures

VIENNA — Although researchers are exploring alternatives like platelet concentrate and stem cells for treating ruptured Achilles tendons, results of a randomized study presented here found the addition of platelet concentrate provided no added healing benefit in these cases.

Thorsten Schepull, MD, of Linköping University, Sweden, presented the results, saying he and his colleagues evaluated this approach in 30 patients casted for 7 weeks postoperatively in their randomized study. It is possible that casting affected the results, he said.

“Using this design in operated patients and using a cast for 7 weeks, we could not show a positive effect of platelet concentrate,” Schepull said at the 10th European Federation of National Associations of Orthopaedics and Traumatology (EFORT) Congress.

“There are animal studies showing the concentrate needs mechanical stimulation to improve tendon healing, and using a cast for 7 weeks might have limited the effect of the platelets.”

Investigators need to study the technique further, he noted.

Prior to surgery, researchers obtained a unit of blood from each patient to produce about 20 ml of platelet concentrate per patient. During open repair surgery, patients were randomized into two groups: 16 patients received the autologous platelet concentrate prior to wound closure and 14 patients did not.

Investigators implanted tantalum beads on either side of the rupture in all patients to help them determine how the tendon was healing mechanically.

Patients were placed in a cast for 7 weeks postoperatively and received identical care.

At follow-up time points of 7, 19 and 52 weeks, Schepull and colleagues evaluated the properties of both groups’ healing tendons using radiostereometric analysis. They also used CT scans to assess tendon elongation and stiffness. The few differences in the groups seen at 7 and 19 weeks’ follow-up were minor.

Complications included one deep infection and one re-ruptured tendon.

“We can exclude that platelets improved the primary variable of elastic modulus at 7 weeks more than 29%. This can be related to the standard deviation of 27% in the controls,” senior author Per Aspenberg, MD, told Orthopaedics Today Europe. “Thus, we can say that a large positive effect of platelet is highly unlikely, but a small moderate effect still is possible.”

Reference:
Schepull T, Aspenberg P, Berlin G, Trinks, M. Platelet concentrate does not improve the mechanical properties of a ruptured Achilles tendon. Paper F12. Presented at the 10th EFORT Congress. 3-6 June 2009. Vienna.