The Effect of Autologous Platelet Rich Plasma in the Treatment of Achilles Tendon Ruptures: An Experimental Study on Rabbits

No significant impact of platelet-rich plasma on recovery after Achilles tendon surgery: A double-blind randomized controlled trial

Purpose

Double-blind, randomized, placebo-controlled trials evaluating the efficacy and safety of Platelet-rich plasma (PRP) in the treatment of Achilles tendon rupture (ATR) have been scant. This study examines the therapeutic impact of PRP injection 3 weeks after surgery in middle-aged males.

Methods

This double-blind, randomized, placebo-controlled trial included consecutive ATR patients who satisfied the inclusion criteria and was conducted from 5 September 2018 to 24 June 2021. Three weeks after surgery using the side-locking loop technique, PRP or saline was injected at the suture site under ultrasound guidance. Evaluations were conducted at predetermined intervals (6, 10, 12, 16 and 24 weeks and 1 and 2 years) after surgery. The primary outcome was the period needed to perform a bilateral heel raise, and the important secondary outcomes were the periods needed to perform a single heel raise and 20 unilateral heel raises, respectively.

Results

There were seven participants in the PRP group and seven in the saline group. Demographically, both groups exhibited comparable characteristics. No complications were reported. At 6 weeks after surgery, all participants achieved bilateral heel raise. The PRP and saline groups averaged 12.3 ± 2.7 and 15.7 ± 5.9 weeks to achieve a single heel raise and 14.3 ± 2.7 and 17.7 ± 4.5 weeks to achieve 20 unilateral heel raises, respectively, with no significant differences between both groups. Moreover, no substantial disparities in clinical scores, period of jogging initiation and magnetic resonance imaging tendon assessments were noted.

Conclusions

PRP did not offer a distinct advantage over saline in terms of recovery from ATR in middle-aged males. This finding underscores the need to reassess the post-operative significance of PRP and highlights the importance of further research to determine its potential advantages and risks.

Level of Evidence

Level I.

One Step Double Augmentation with Human Dermis Allograft and Homologous PRP in Misdiagnosed and or Chronic Achilles Tendon Ruptures

OBJECTIVE

Misdiagnosed/chronic Achilles tendon injuries are rare and disabling for patients. The surgical treatment of these rare injuries aims to ensure the tendon heals mechanically and biologically. This is the prerequisite for a good clinical and functional outcome and reduces recurrences. The main aim of the study is to present a surgical technique that has proven to be original, reproducible, and capable of guaranteeing solid tendon repair and optimal tissue regeneration.

METHODS

We treated five patients, four males and one female, with the one-step double augmentation technique. All patients of this study complained of pain, but above all severe functional limitation that Achilles tendon injury had been causing for more than a month. In this study, we widely described the surgical technique, original and not found in the literature, which provides a biological graft (allograft of decellularized dermis) and homologous, thrombin-activated, platelet-rich plasma (H-PRP) in a single step. Surgical approach, always used by the first author, respected predefined steps: careful dissection and preparation of the peritendinous tissues from suture to the end of the procedure, tenorrhaphy, and augmentation with allopatch to obtain a mechanically effective repair to avoid recurrences, and finally "biological" augmentation with a unit of homologous, thrombin activated, PRP. We offered to all patients a regenerative rehabilitation program post-operatively.

RESULTS

All patients were evaluated clinically (functional clinical tests and questionnaires) and instrumentally (elastic-sonography and perfusion MRI). The obtained results have been evaluated at a minimum follow-up of 18 months and a maximum of 24 months. In all patients pain was resolved, and district function and kinetic chains improved with resumption of daily activities, work, and sports.

CONCLUSION

The present study confirmed the regenerative potential of decellularized dermis allograft and PRP (homologous and thrombin-activated). The same approach can also be exploited in cases of severe tendon destructuring and limited "intrinsic" regenerative potential at any age. The proposed one-step surgical technique of a double augmentation therefore appears useful, safe, reproducible, and applicable in all chronic tendon lesions with low regenerative potential.

Effects of Cyanoacrylate in Rabbits with Induced Achilles Tendon Rupture

BACKGROUND In this study, we aimed to investigate the effects of N-butyl-2-cyanoacrylate (cyanoacrylate) on the biomechanical and histopathological aspects of tendon healing in a rabbit model of Achilles tendon injury. MATERIAL AND METHODS In total, 36 rabbits were randomized to experimental (cyanoacrylate) and control groups (n=36 tendons in each group). A simple suture was used in the control group and a simple suture plus cyanoacrylate was used in the experimental group. Nine rabbits from each group were euthanized at week 4 and week 6 after surgery for histopathological and biomechanical testing. RESULTS Granulation tissue formation was significantly greater in the experimental group in week 4 and week 6 than in the control group. Foreign body giant cell formation was significantly higher in the experimental group in week 4 and week 6. The maximum rupture force was significantly higher in the experimental group in week 4 and week 6 than in the control group. Elasticity and stiffness were comparable between groups in week 4; however, stiffness, but not elasticity, was significantly higher in the experimental group in week 6. CONCLUSIONS In the short term, cyanoacrylate enhanced tendon endurance in both a histopathological and biomechanical manner. We conclude that the early initiation of rehabilitation in patients may be safe in cases of cyanoacrylate use for surgical repair of tendon injury.