No benefits seen with PRP injection in patients with acute Achilles tendon ruptures

Issue: November 2018

ORLANDO, Fla. — Results of a double-blind, multicenter, randomized, placebo-controlled trial presented at the Orthopaedic Trauma Annual Meeting suggest platelet-rich plasma injection offered no patient benefits in the management of acute Achilles tendon ruptures.

Perspective from Nicola Maffulli, MD, PhD, FRCS; Onur Bilge, MD

Joseph Alsousou

“So, I suggest that the use of [platelet-rich plasma] PRP in soft tissue injuries and possibly chronic injuries is not supported, unless we have more studies similar to this trial with [a] positive effect to justify using PRP in these patients,” Joseph Alsousou, PhD, said during his presentation.

Alsousou and colleagues randomized 230 patients with Achilles ruptures who started non-surgical management within 12 days of surgery and were treated at 19 trauma units. There were 114 patients assigned to receive PRP injection. Overall, 103 patients received PRP injection and 116 patients received placebo. At 4, 7, 13 and 24 weeks, blinded outcome assessments were performed. The primary outcome was muscle-tendon friction assessed at 24 weeks by heel-rise endurance test and limb symmetry index. Other outcomes included the Achilles tendon rupture score, quality of life measured with SF-12, and pain and goal attainment. Whole blood and PRP samples were assessed at a central laboratory.

Results showed that at 24 weeks, 201 of the 230 patients completed the heel-rise endurance test and 214 patients had patient-reported outcomes. At 24 weeks, no difference was seen between patients treated with PRP and those treated with placebo with regard to limb symmetry index, SF-12 and pain or goal attainment. Also, at 4, 7 and 13 weeks, there was no difference between the treatment groups with regard to patient-reported outcomes. Complications were similar between treatment groups. – by Monica Jaramillo

Reference:

Keene D, et al. Paper 142. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 18-20, 2018; Orlando, Florida.

Disclosure: Alsousou reports no relevant financial disclosures.

Perspective

Nicola Maffulli, MD, PhD, FRCS

The use of orthobiologics has been enriched by another extremely well performed, pragmatic, multicenter study with large enough cohorts and appropriate clinically relevant and scientifically valid outcome measures. It demonstrates conclusively that, despite what we would have liked, PRP biological interventions, when tested by independent researchers from reputed academic centers with no ties to companies, do not work. I can almost hear the remonstrations from those who are convinced such approaches are wonderful, and whose career and reputation are based on the use of orthobiologics. The reality from great studies such as this one, presented by Dr. Alsousou, is we must become accustomed to going where the scientific evidence brings us. In this instance, it carries us away from PRP.

Nicola Maffulli, MD, PhD, FRCS

Centre for Sports and Exercise Medicine, Barts

London School of Medicine and Dentistry

United Kingdom

Disclosures: Maffulli reports no relevant financial disclosures.

Perspective

Onur Bilge, MD

As one of the popular, injectable orthobiologics, PRP has been increasingly used to ameliorate tendon healing by providing a regenerative stimulus, theoretically. The present prospective, randomized, multicentric study objectively challenged the ameliorative effect of PRP, which has been used by many orthopedic surgeons worldwide.

As the last, but not least, message for orthopedic surgeons today: PRP does not ameliorate healing in the Achilles tendon in the specific clinical setting of rupture.

There is not any evidence of this. In this context, we believe the future of the use of PRP and other orthobiologics for the treatment of soft tissue injuries, including Achilles tendon ruptures, will be guided by “real” studies with high levels of evidence, such as this challenging, great study by Alsousou and colleagues, which was conducted independent of the pressures and influences of industry.

Onur Bilge, MD

Konya N.E. University,

Department of orthopaedics & trauma

Department of sports medicine

Konya, Turkey

Mahmut N. Doral, MD, PhD

Hacettepe University

Department of orthopaedics & traumatology

Ankara, Turkey

Disclosures: Bilge and Doral report no relevant financial disclosures.