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Autologous Platelets Have No Effect on the Healing of Human Achilles Tendon Ruptures A Randomized Single-Blind Study
Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics.
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0003-3527-5488
Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics.
Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics.
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2011 (English)In: AMERICAN JOURNAL OF SPORTS MEDICINE, ISSN 0363-5465, Vol. 39, no 1, 38-47 p.Article in journal (Refereed) Published
Abstract [en]

Background: Animal studies have shown that local application of platelet-rich plasma (PRP) stimulates tendon repair. Preliminary results from a retrospective case series have shown faster return to sports. Hypothesis: Autologous PRP stimulates healing of acute Achilles tendon ruptures. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Thirty patients were recruited consecutively. During surgery, tantalum beads were implanted in the Achilles tendon proximal and distal to the rupture. Before skin suture, randomization was performed, and 16 patients were injected with 10 mL PRP (10 times higher platelet concentration than peripheral blood) whereas 14 were not. With 3-dimensional radiographs (roentgen stereophotogrammetric analysis; RSA), the distance between the beads was measured at 7, 19, and 52 weeks while the patient resisted different dorsal flexion moments over the ankle joint, thereby estimating tendon strain per load. An estimate of elasticity modulus was calculated using callus dimensions from computed tomography. At 1 year, functional outcome was evaluated, including the heel raise index and Achilles Tendon Total Rupture Score. The primary effect variables were elasticity modulus at 7 weeks and heel raise index at 1 year. Results: The mechanical variables showed a large degree of variation between patients that could not be explained by measuring error. No significant group differences in elasticity modulus could be shown. There was no significant difference in heel raise index. The Achilles Tendon Total Rupture Score was lower in the PRP group, suggesting a detrimental effect. There was a correlation between the elasticity modulus at 7 and 19 weeks and the heel raise index at 52 weeks. Conclusion: The results suggest that PRP is not useful for treatment of Achilles tendon ruptures. The variation in elasticity modulus provides biologically relevant information, although it is unclear how early biomechanics is connected to late clinical results.

Place, publisher, year, edition, pages
American Journal of Sports Medicine , 2011. Vol. 39, no 1, 38-47 p.
Keyword [en]
Achilles tendon, platelet, platelet-rich plasma, tendon healing, biomechanics, roentgen stereophotogrammetric analysis
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-64770DOI: 10.1177/0363546510383515ISI: 000285874200011OAI: oai:DiVA.org:liu-64770DiVA: diva2:394843
Note
Original Publication: Thorsten Schepull, Joanna Kvist, Hanna Norrman, Marie Trinks, Gösta Berlin and Per Aspenberg, Autologous Platelets Have No Effect on the Healing of Human Achilles Tendon Ruptures A Randomized Single-Blind Study, 2011, AMERICAN JOURNAL OF SPORTS MEDICINE, (39), 1, 38-47. http://dx.doi.org/10.1177/0363546510383515 Copyright: American Journal of Sports Medicine http://www.uk.sagepub.com/Available from: 2011-02-04 Created: 2011-02-04 Last updated: 2015-03-24
In thesis
1. Stiffness of the healing human Achilles tendon
Open this publication in new window or tab >>Stiffness of the healing human Achilles tendon
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Achilles tendon ruptures in humans are followed by a long period of immobilisation, rehabilitation and limitations of physical activity and sometimes work also. This prolonged period probably leaves a marginal for improvement in the management of this injury. Animal studies have shown that there are several possibilities to influence and improve tendon healing.

The aim of this thesis was to find a way to examine the mechanical properties of the healing human Achilles tendon and, by using that method, to gain a better understanding of the tissue properties and healing process in these tendons. It was also our aim to use our knowledge from animal studies in an attempt to improve tendon healing in humans.

We developed a radiological method using radiostereophotogrammetric analysis (RSA) and computed tomography (CT), which enabled us to measure the stiffness of the healing Achilles tendon. The results of these measurements, as early as 7 weeks after injury correlated with the late clinical results in all studies. Clinical results were measured using a heel-raise test comparing the injured with the non-injured tendon. We could not find a significant difference in stiffness between patients treated surgically or non-surgically. Neither could we demonstrate that platelet-rich plasma improved the mechanical properties of the healing tendon or the clinical outcome, within the limits of the statistical power. In contrast, patients following a specific training programme with early tension loading of the tendon twice a day developed stiffer tendon tissue later in the healing process.

Since RSA is unsuitable for routine clinical use, we evaluated the possibility to use radiodensity findings from CT as a proxy for healing and its correlation to mechanical and clinical results. Density and mechanical properties correlated strongly when analysing all time points together, but only weakly at each particular point in time. Density may still be useful in describing mechanical properties at a later stage of repair, but this remains to be seen.

In conclusion, these studies show that early mechanical properties correlate to late clinical outcome and that the early use of daily tension loading sessions leads to an improvement in the mechanical properties of the tendon tissue.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 59 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1356
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-91727 (URN)978-91-7519-674-9 (ISBN)
Public defence
2013-06-04, Elsa Brändströmsalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
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Available from: 2013-04-30 Created: 2013-04-30 Last updated: 2013-05-13Bibliographically approved

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Schepull, ThorstenKvist, JoannaBerlin, GöstaAspenberg, Per

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Faculty of Health SciencesOrthopaedicsPhysiotherapyDepartment of Clinical and Experimental MedicineDepartment of Clinical Immunology and Transfusion MedicineOrthopaedics and Sports MedicineDepartment of Orthopaedics Linköping
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