Ruptured Achilles tendons’ mechanical properties unaltered by concentrated PRPs

Thorsten Schepull

OSLO — Following Achilles tendon rupture there were no differences in patients treated with platelet-rich plasma and controls for the usual parameters used to assess such cases, however some of the control group’s outcomes exceeded those in the treated group, according to a randomized study performed by investigators from Linköping, Sweden.

Thorsten Schepull, MD, and colleagues enrolled 30 consecutive patients with Achilles tendon ruptures in their study. They all underwent the platelet-rich plasma (PRP) preparation process, were operated on with an open suture-repair technique and had four metal Roentgen stereophotogrammetric markers placed in the tendon. Randomization to the PRP or control group – 16 patients and 4 patients respectively – occurred just prior to skin closure.

Schepull said in a presentation at the 2010 ESSKA Congress, here, that based on examinations at 7, 19 and 52 weeks postoperative, “Using this design, we could not show any difference between the PRP and the control group when it comes to the mechanical properties, strain per force, transverse area and modulus of elasticity.”

Functional evaluation

Investigators could not account for why they detected no difference between the groups.

Patients were blinded to whether they received the PRP as was the independent physiotherapist who scored their functional outcomes.

The postoperative casting, weight-bearing and physical therapy was identical for all patients, according to Schepull.

“[With] the heel raise, interestingly, we could actually see better results in the control group when it comes to the Achilles tendon rupture score,” he said.

Assuming the platelets used were all activated, investigators theorized that possibly immobilization from casting for 7 weeks did not provide the necessary local stimulation that other studies have shown is needed in this type of healing situation.

Reference:

Schepull T, Kvist J, Trinks M, et al. No effect of autologous platelets (PRP) on the healing of human Achilles tendon ruptures. Paper #FP20-1057. Presented at the 14th ESSKA Congress. June 9-12, 2010. Oslo.

This is a well thought out and important work. Our ongoing work evidenced, too, that long follow-up would not show major differences between treated and untreated groups. I would assume that PRP would yield most of its beneficial effect in the short term and thus might be most important when treating professional athletes, in this view, bringing them back to play earlier and in better tendon status.

There were some possible downsides to the study. The high concentration of platelets may have actually had an inhibitory effect as has been mentioned in the literature. Also, regardless of PRP usage, I think sutured Achilles tendons should be mobile and bear weight quite fast in order to let the tendon heal via some sort of physiological strain. This would be even more important when the healing process is assumed to be sped up (or shortened) by the PRP.

Overall it is good that many centers study this same entity as we can learn a lot from the similarities and differences in our results.

– Omer Dan-Mei, MD
Department of Orthopedic Surgery, Meir University Hospital
Kfar-Saba, Israel

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