title: Platelet-rich plasma injections for the treatment of refractory Achilles tendinopathy: results at 4 years.
abstract: BACKGROUND
  Chronic Achilles tendinopathy is responsible for a severe reduction in physical performance and persistent pain. There is currently a number of therapeutic options and the local administration of growth factors is an emerging treatment strategy. In particular, platelet-rich plasma (PRP) is a widely used way to provide a local regenerative stimulus for tendon healing. The aim of this study was to document the mid-term results obtained after treating recalcitrant Achilles tendinopathy with injections of high concentrate, leucocyte-rich PRP.
  
  
  METHODS
  Twenty-seven patients (mean age: 44.6 years; 22 men and 5 women) affected by chronic mid-portion Achilles tendinopathy (7 bilateral, for a total of 34 tendons), refractory to previous treatments, were enrolled. Patients were treated with three ultrasound-guided intra-tendinous injections of PRP at 2-week intervals. Patients were prospectively evaluated at baseline, and then at 2, 6, and up to a mean of 54.1 months of follow-up (minimum 30 months), using the following tools: Blanzina, VISA-A, EQ-VAS for general health, and Tegner scores.
  
  
  RESULTS
  The VISA-A score showed a significant improvement: the baseline score of 49.9±18.1 increased to 62.9±19.8 at 2 months (p=0.002), with a further improvement at 6 months (84.3±17.1, p<0.0005), and stable results at 4.5 years (90.0±13.9). The EQ-VAS score also showed a similar positive trend. An evaluation of the activity level confirmed these findings, showing a significant improvement in the Tegner score over time (p=0.017 for the final evaluation). The longer duration of symptoms before treatment was associated with a slower return to sport (p=0.041).
  
  
  CONCLUSIONS
  PRP injections produced good overall results for the treatment of chronic recalcitrant Achilles tendinopathy with a stable outcome up to a medium-term follow-up. Longer symptom duration was related with a more difficult return to sporting activity.
authors: II Orthopaedic and Traumatology Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors: Giuseppe
authors: G
authors: Filardo
authors: Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors: Elizaveta
authors: E
authors: Kon
authors: II Orthopaedic and Traumatology Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors: Berardo
authors: B
authors: Di Matteo
authors: II Orthopaedic and Traumatology Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors: Alessandro
authors: A
authors: Di Martino
authors: II Orthopaedic and Traumatology Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors: Giulia
authors: G
authors: Tesei
authors: Radiology and Diagnostic Imaging Department, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors: Patrizia
authors: P
authors: Pelotti
authors: Immunohaematology and Transfusion Medicine Service, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors: Annarita
authors: A
authors: Cenacchi
authors: II Orthopaedic and Traumatology Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors: Maurilio
authors: M
authors: Marcacci
mesh_terms: D000125:Achilles Tendon; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053657:Platelet-Rich Plasma; D011446:Prospective Studies; D052256:Tendinopathy / Q000188:drug therapy*; D013997:Time Factors