Impact of autologous blood injections in treatment of mid-portion Achilles tendinopathy: double blind randomised controlled trial

Abstract

Objective To assess the effectiveness of two peritendinous autologous blood injections in addition to a standardised eccentric calf strengthening programme in improving pain and function in patients with mid-portion Achilles tendinopathy.Design Single centre, participant and single assessor blinded, parallel group, randomised, controlled trial.Setting Single sports medicine clinic in New Zealand.Participants 53 adults (mean age 49, 53% men) with symptoms of unilateral mid-portion Achilles tendinopathy for at least three months. Participants were excluded if they had a history of previous Achilles tendon rupture or surgery or had undergone previous adjuvant treatments such as injectable therapies, glyceryl trinitrate patches, or extracorporeal shockwave therapy.Interventions All participants underwent two unguided peritendinous injections one month apart with a standardised protocol. The treatment group had 3 mL of their own whole blood injected while the control group had no substance injected (needling only). Participants in both groups carried out a standardised and monitored 12 week eccentric calf training programme. Follow-up was at one, two, three and six months. Main outcome measuresThe primary outcome measure was the change in symptoms and function from baseline to six months with the Victorian Institute of Sport Assessment-Achilles (VISA-A) score. Secondary outcomes were the participant's perceived rehabilitation and their ability to return to sport.Results 26 participants were randomly assigned to the treatment group and 27 to the control group. In total, 50 (94%) completed the six month study, with 25 in each group. Clear and clinically worthwhile improvements in the VISA-A score were evident at six months in both the treatment (change in score 18.7, 95% confidence interval 12.3 to 25.1) and control (19.9, 13.6 to 26.2) groups. The overall effect of treatment was not significant (P=0.689) and the 95% confidence intervals at all points precluded clinically meaningful benefit or harm. There was no significant difference between groups in secondary outcomes or in the levels of compliance with the eccentric calf strengthening programme. No adverse events were reported. ConclusionThe administration of two unguided peritendinous autologous blood injections one month apart, in addition to a standardised eccentric training programme, provides no additional benefit in the treatment of mid-portion Achilles tendinopathy. Trial registration IntroductionAchilles tendinopathy causes chronic localised pain and stiffness. It affects over half of middle distance runners 1 and is responsible for up to 16% of affected people having to stop participating in their sport.2 It is also a problem among non-athletes, with 31% of cases occurring in sedentary individuals.3 The mid-portion is the most commonly affected part of the tendon. It is now recognised that the histopathological changes of tendinopathy are consistent with mucoid degeneration and poor tissue healing, rather than inflammation. [4][5][6] Several intri...

Autologous Blood and Platelet-Rich Plasma Injections in the Treatment of Achilles Tendinopathy: A Critically Appraised Topic

“…The designs of the appraised studies varied slightly, from eccentric strength training in conjunction with ultrasound-guided intratendinous PRPI 1,8 to peritendinous ABI and the standard of care. 2,4 All 4 studies found improvement in VISA-A scores regardless of treatment allocation.…”

“…1,2 It presents with localized pain, stiffness, and swelling in the midportion of the Achilles tendon. 3 The physical stress placed on the tendon results in microtrauma, which leads to subsequent inflammation and degeneration.…”

“…4 While it is not surprising that this condition affects the physically active, nearly one-third of Achilles tendinopathy cases occur in sedentary individuals. 2 Etiology for this condition stems from a change in loading patterns and/or overuse of the tendon, resulting in microscopic tearing and degenerative changes. 5 There are numerous causes contributing to the maladaptive response in these patients, such as mechanical, age-related, genetic, and vascular factors.…”

“…1,8 When comparing ABI with PRPI, ABIs are simpler and more cost-effective, as special processing or equipment is not needed. 2 ABIs can be done without ultrasound guidance and require a much smaller volume of blood to be taken from the patient. 2,4 Practitioners should use caution when suggesting or prescribing ABI or PRPI to patients with Achilles tendinopathy.…”

“…1 The growth factors, as well as other cytokines present in the blood, are proposed to be catalysts of tissue healing, as they aid in the production of type I collagen in tissue of the degenerating tendon. 2 In the PRPI performed in the included studies, 1,8 54 mL of blood was collected from the subject's cubital vein. Six milliliters of citrate was added to the blood sample to prevent early clotting.…”