Platelet‐rich plasma injections as a treatment for Achilles tendinopathy and plantar fasciitis in athletes

Abstract

Platelet‐rich plasma (PRP) injections represent a growing interest in the use of biologic therapies for treatment of musculoskeletal injuries. One possible application of PRP is in the management of overuse injuries commonly experienced by athletes. The aim of this review is to evaluate and summarize existing evidence regarding the efficacy of PRP in the treatment of Achilles tendinopathy and plantar fasciitis in athletes. Although many lower quality single‐armed studies have demonstrated clinical improvement in athletes treated for Achilles tendinopathy with PRP, higher quality randomized controlled trials (RCTs) have shown no clear benefit in athletes. Existing data suggest PRP significantly improves clinical outcomes for plantar fasciitis in the general population, but very few studies and no RCTs are available that specifically analyze outcomes in athletic populations. More research is needed to evaluate how platelet concentration, leukocyte and erythrocyte presence, and sport type may interact to affect clinical outcomes in athletes.

Platelet-rich Plasma Injection for the Treatment of Partial Achilles Tendon Rupture: A Case Report

“…Previously, PRP concentrations of at least 1.5 x 10 6 platelets/μL were suggested to be sufficient for healing in musculoskeletal injuries. 20 Yet, in a recent systematic review of five randomized controlled trials that employed PRP for treating acute Achilles tendon ruptures, the effectiveness varied within a range of 4-6x baseline platelet concentration, though not all studies completed injectate analysis to confirm platelet concentration. 21 Some studies have found LP-PRP to be more effective and safer than LR-PRP when applied to intra-articular lesions, [22][23][24] though the generalizability of this application remains controversial for intra-and peri-tendinous application.…”

“…21 Studies with lowerlevel evidence, including case series and retrospective analyses amongst athletes, have demonstrated benefits of PRP for chronic Achilles tendinopathy. 20 PLT concentration factor (PLT-CF) in these studies ranged from 2.2-8.0, where PLT-CF is equal to the PLT concentration in PRP formulation divided by Serum PLT concentration. 20 Our patient presented with a unique scenario involving an acute Achilles tendon rupture after undergoing two previous orthobiologic injections.…”

“…20 PLT concentration factor (PLT-CF) in these studies ranged from 2.2-8.0, where PLT-CF is equal to the PLT concentration in PRP formulation divided by Serum PLT concentration. 20 Our patient presented with a unique scenario involving an acute Achilles tendon rupture after undergoing two previous orthobiologic injections. Sonographic and MRI assessments at the time of presentation confirmed the presence of a tendinous deficit (Figures 1 and 2).…”

The varying clinical effectiveness of single, three and five intraarticular injections of platelet-rich plasma in knee osteoarthritis

“…PRP therapy utilizes the biologically active regeneration cascade to stimulate natural healing responses and promote tissue healing. Orthopaedics and sport medicine doctors use PRP injections frequently for bone, ligament, and tendon injuries [10], as well as cartilage injuries and osteoarthritis [11][12][13][14][15]. Although PRP is a widely used minimally invasive treatment method in orthopedic and sports medicine fields to promote tissue healing and regeneration, there are still some unanswered questions remain, particularly regarding the optimal number of injections required for achieving the best clinical outcomes in treating KOA.…”

Elevated IL-1β and Comparable IL-1 Receptor Antagonist Levels Are Characteristic Features of L-PRP in Female College Athletes Compared to Male Professional Soccer Players

“…Notably, the majority of published clinical studies are observational in nature and lack well-designed randomized control trials (RCTs) [9]. The challenges in standardizing or classifying PRP quality, patient physical condition, injection protocols, and rehabilitation protocols further complicate the interpretation of clinical data [3,10,11]. In contrast, a report has suggested that PRP treatment may be effective in facilitating the resumption of sports-related activities in young recreational athletes in a relatively shorter period of time [5].…”