Ultrasound-Guided Injection Therapy of Achilles Tendinopathy With Platelet-Rich Plasma or Saline: A Randomized, Blinded, Placebo-Controlled Trial

Thøger P. Krogh, Torkell Ellingsen, Robin Christensen, Pia Jensen, Ulrich Fredberg

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: Achilles tendinopathy (AT) is a common and difficult to treat musculoskeletal disorder.

PURPOSE: To examine whether 1 injection of platelet-rich plasma (PRP) would improve outcomes more effectively than placebo (saline) after 3 months in patients with AT.

STUDY DESIGN: Randomized controlled trial; Level of evidence, 1.

METHODS: A total of 24 patients with chronic AT (median disease duration, 33 months) were randomized (1:1) to receive either a blinded injection of PRP (n = 12) or saline (n = 12). The primary endpoint was improvement in Victorian Institute of Sports Assessment-Achilles (VISA-A) score at 3 months. Secondary outcomes were pain at rest, pain while walking, pain when tendon was squeezed, ultrasonographic changes in tendon thickness, and color Doppler activity. Patients were informed that they could drop out after 3 months if they were dissatisfied with the treatment.

RESULTS: After 3 months, all 24 patients were reassessed (no dropouts). No difference between the PRP and the saline group could be observed with regard to the primary outcome (VISA-A score: mean difference [MD], -1.3; 95% CI, -17.8 to 15.2; P = .868). Secondary outcomes were pain at rest (MD, 1.6; 95% CI, -0.5 to 3.7; P = .137), pain while walking (MD, 0.8; 95% CI, -1.8 to 3.3; P = .544), pain when tendon was squeezed (MD, 0.3; 95% CI, -0.2 to 0.9; P = .208), color Doppler activity (MD, 0.3; 95% CI, -0.2 to 0.8; P = .260), and tendon thickness (MD, 0.8 mm; 95% CI, 0.1 to 1.6 mm; P = .030). After the 3-month follow-up, a large dropout was observed: 75% of patients in the PRP group and 33% in the saline group.

CONCLUSION: PRP injection did not result in an improved VISA-A score over a 3-month period in patients with chronic AT compared with placebo. The only secondary outcome demonstrating a statistically significant difference between the groups was change in tendon thickness; this difference indicates that a PRP injection could increase tendon thickness compared with saline injection. The conclusions are limited to the 3 months after treatment owing to the large dropout rate.

Original languageEnglish
JournalAmerican Journal of Sports Medicine
Volume44
Issue number8
Pages (from-to)1990-1997
ISSN0363-5465
DOIs
Publication statusPublished - 2016

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Platelet-Rich Plasma
Placebos
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Randomized Controlled Trials

Keywords

  • Journal Article

Cite this

@article{099ad8fec07444c4aa3f797f21ef4ba9,
title = "Ultrasound-Guided Injection Therapy of Achilles Tendinopathy With Platelet-Rich Plasma or Saline: A Randomized, Blinded, Placebo-Controlled Trial",
abstract = "BACKGROUND: Achilles tendinopathy (AT) is a common and difficult to treat musculoskeletal disorder.PURPOSE: To examine whether 1 injection of platelet-rich plasma (PRP) would improve outcomes more effectively than placebo (saline) after 3 months in patients with AT.STUDY DESIGN: Randomized controlled trial; Level of evidence, 1.METHODS: A total of 24 patients with chronic AT (median disease duration, 33 months) were randomized (1:1) to receive either a blinded injection of PRP (n = 12) or saline (n = 12). The primary endpoint was improvement in Victorian Institute of Sports Assessment-Achilles (VISA-A) score at 3 months. Secondary outcomes were pain at rest, pain while walking, pain when tendon was squeezed, ultrasonographic changes in tendon thickness, and color Doppler activity. Patients were informed that they could drop out after 3 months if they were dissatisfied with the treatment.RESULTS: After 3 months, all 24 patients were reassessed (no dropouts). No difference between the PRP and the saline group could be observed with regard to the primary outcome (VISA-A score: mean difference [MD], -1.3; 95{\%} CI, -17.8 to 15.2; P = .868). Secondary outcomes were pain at rest (MD, 1.6; 95{\%} CI, -0.5 to 3.7; P = .137), pain while walking (MD, 0.8; 95{\%} CI, -1.8 to 3.3; P = .544), pain when tendon was squeezed (MD, 0.3; 95{\%} CI, -0.2 to 0.9; P = .208), color Doppler activity (MD, 0.3; 95{\%} CI, -0.2 to 0.8; P = .260), and tendon thickness (MD, 0.8 mm; 95{\%} CI, 0.1 to 1.6 mm; P = .030). After the 3-month follow-up, a large dropout was observed: 75{\%} of patients in the PRP group and 33{\%} in the saline group.CONCLUSION: PRP injection did not result in an improved VISA-A score over a 3-month period in patients with chronic AT compared with placebo. The only secondary outcome demonstrating a statistically significant difference between the groups was change in tendon thickness; this difference indicates that a PRP injection could increase tendon thickness compared with saline injection. The conclusions are limited to the 3 months after treatment owing to the large dropout rate.",
keywords = "Journal Article",
author = "Krogh, {Th{\o}ger P.} and Torkell Ellingsen and Robin Christensen and Pia Jensen and Ulrich Fredberg",
note = "{\circledC} 2016 The Author(s).",
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Ultrasound-Guided Injection Therapy of Achilles Tendinopathy With Platelet-Rich Plasma or Saline : A Randomized, Blinded, Placebo-Controlled Trial. / Krogh, Thøger P.; Ellingsen, Torkell; Christensen, Robin; Jensen, Pia; Fredberg, Ulrich.

In: American Journal of Sports Medicine, Vol. 44, No. 8, 2016, p. 1990-1997.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Ultrasound-Guided Injection Therapy of Achilles Tendinopathy With Platelet-Rich Plasma or Saline

T2 - A Randomized, Blinded, Placebo-Controlled Trial

AU - Krogh, Thøger P.

AU - Ellingsen, Torkell

AU - Christensen, Robin

AU - Jensen, Pia

AU - Fredberg, Ulrich

N1 - © 2016 The Author(s).

PY - 2016

Y1 - 2016

N2 - BACKGROUND: Achilles tendinopathy (AT) is a common and difficult to treat musculoskeletal disorder.PURPOSE: To examine whether 1 injection of platelet-rich plasma (PRP) would improve outcomes more effectively than placebo (saline) after 3 months in patients with AT.STUDY DESIGN: Randomized controlled trial; Level of evidence, 1.METHODS: A total of 24 patients with chronic AT (median disease duration, 33 months) were randomized (1:1) to receive either a blinded injection of PRP (n = 12) or saline (n = 12). The primary endpoint was improvement in Victorian Institute of Sports Assessment-Achilles (VISA-A) score at 3 months. Secondary outcomes were pain at rest, pain while walking, pain when tendon was squeezed, ultrasonographic changes in tendon thickness, and color Doppler activity. Patients were informed that they could drop out after 3 months if they were dissatisfied with the treatment.RESULTS: After 3 months, all 24 patients were reassessed (no dropouts). No difference between the PRP and the saline group could be observed with regard to the primary outcome (VISA-A score: mean difference [MD], -1.3; 95% CI, -17.8 to 15.2; P = .868). Secondary outcomes were pain at rest (MD, 1.6; 95% CI, -0.5 to 3.7; P = .137), pain while walking (MD, 0.8; 95% CI, -1.8 to 3.3; P = .544), pain when tendon was squeezed (MD, 0.3; 95% CI, -0.2 to 0.9; P = .208), color Doppler activity (MD, 0.3; 95% CI, -0.2 to 0.8; P = .260), and tendon thickness (MD, 0.8 mm; 95% CI, 0.1 to 1.6 mm; P = .030). After the 3-month follow-up, a large dropout was observed: 75% of patients in the PRP group and 33% in the saline group.CONCLUSION: PRP injection did not result in an improved VISA-A score over a 3-month period in patients with chronic AT compared with placebo. The only secondary outcome demonstrating a statistically significant difference between the groups was change in tendon thickness; this difference indicates that a PRP injection could increase tendon thickness compared with saline injection. The conclusions are limited to the 3 months after treatment owing to the large dropout rate.

AB - BACKGROUND: Achilles tendinopathy (AT) is a common and difficult to treat musculoskeletal disorder.PURPOSE: To examine whether 1 injection of platelet-rich plasma (PRP) would improve outcomes more effectively than placebo (saline) after 3 months in patients with AT.STUDY DESIGN: Randomized controlled trial; Level of evidence, 1.METHODS: A total of 24 patients with chronic AT (median disease duration, 33 months) were randomized (1:1) to receive either a blinded injection of PRP (n = 12) or saline (n = 12). The primary endpoint was improvement in Victorian Institute of Sports Assessment-Achilles (VISA-A) score at 3 months. Secondary outcomes were pain at rest, pain while walking, pain when tendon was squeezed, ultrasonographic changes in tendon thickness, and color Doppler activity. Patients were informed that they could drop out after 3 months if they were dissatisfied with the treatment.RESULTS: After 3 months, all 24 patients were reassessed (no dropouts). No difference between the PRP and the saline group could be observed with regard to the primary outcome (VISA-A score: mean difference [MD], -1.3; 95% CI, -17.8 to 15.2; P = .868). Secondary outcomes were pain at rest (MD, 1.6; 95% CI, -0.5 to 3.7; P = .137), pain while walking (MD, 0.8; 95% CI, -1.8 to 3.3; P = .544), pain when tendon was squeezed (MD, 0.3; 95% CI, -0.2 to 0.9; P = .208), color Doppler activity (MD, 0.3; 95% CI, -0.2 to 0.8; P = .260), and tendon thickness (MD, 0.8 mm; 95% CI, 0.1 to 1.6 mm; P = .030). After the 3-month follow-up, a large dropout was observed: 75% of patients in the PRP group and 33% in the saline group.CONCLUSION: PRP injection did not result in an improved VISA-A score over a 3-month period in patients with chronic AT compared with placebo. The only secondary outcome demonstrating a statistically significant difference between the groups was change in tendon thickness; this difference indicates that a PRP injection could increase tendon thickness compared with saline injection. The conclusions are limited to the 3 months after treatment owing to the large dropout rate.

KW - Journal Article

U2 - 10.1177/0363546516647958

DO - 10.1177/0363546516647958

M3 - Journal article

C2 - 27257167

VL - 44

SP - 1990

EP - 1997

JO - American Journal of Sports Medicine

JF - American Journal of Sports Medicine

SN - 0363-5465

IS - 8

ER -