title: Nonoperative biological treatment approach for partial Achilles tendon lesion.
abstract: Tendon injuries, especially those of the Achilles tendon, are major concerns in sports medicine. The clinical presentation can be acute or chronic and the pathologic findings can range from peritendonitis to full-thickness tendon rupture. Nonsurgical treatment is not always successful; in particular, significant partial ruptures seem to respond poorly to conservative measures and do not improve with time. Surgery is most often considered the favored treatment option for this kind of lesion to obtain pain relief and full functionality with long-standing effects.This article describes a case of a partial tear of the Achilles tendon in a 34-year-old competitive athlete where surgical treatment was avoided in favor of a new biological approach. We applied autologous platelet growth factors through multiple platelet-rich plasma injections; approximately 6.5 billion platelets were injected into the lesion 3 times, 7 days apart. The treatment with platelet-rich plasma and a progressive rehabilitation program allowed the patient to play for 20 minutes in a basketball game 64 days after the trauma and in a full game 75 days after the trauma. To date, 18 months later, he has participated regularly in all the season's games and received no further treatment for his tendon.The fast tissue repair, confirmed by magnetic resonance and ultrasound imaging, allowed a swift return to full functionality and competitive sports activity, suggesting a possible role of platelet growth factors in promoting rapid tendon healing with high-quality tissue. This biological approach may represent a less-invasive therapeutic option even in cases where severe tendon lesions are candidates for surgical treatment.
authors.affiliation: Department of Orthopedic and Sports Trauma, Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy. g.filardo@biomec.ior.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Filardo
authors.forename: Mirco Lo
authors.initials: ML
authors.lastname: Presti
authors.forename: Elizaveta
authors.initials: E
authors.lastname: Kon
authors.forename: Maurilio
authors.initials: M
authors.lastname: Marcacci
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D017713:Platelet Transfusion / Q000379:methods*; D013708:Tendon Injuries / Q000601:surgery / Q000628:therapy*; D016212:Transforming Growth Factor beta / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D016212:Transforming Growth Factor beta