Effects of plasma rich in growth factors (PRGF) on biomechanical properties of Achilles tendon repair.
OBJECTIVE
To assess the biomechanical effects of intra-tendinous injections of PRGF on the healing Achilles tendon after repair in a sheep model.


METHODS
Thirty sheep were randomly assigned into one of the six groups depending on the type of treatment received (PRGF or placebo) and survival time (2, 4 and 8 weeks). The Achilles tendon injury was repaired by suturing the tendinous edges employing a three-loop pulley pattern. A trans-articular external fixation system was then used for immobilization. The PRGF or placebo was administered on a weekly basis completing a maximum of three infiltrations. The force, section and tension values were compared between the operated and healthy Achilles tendons across all groups.


RESULTS
The PRGF-treated tendons had higher force at 8 weeks compared with the placebo group (p = 0.007). Between 2 and 4 weeks, a significant increase in force in both the PRGF-treated tendon (p = 0.0027) and placebo group (p = 0.0095) occurred. No significant differences were found for section ratio between PRGF-treated tendons and the placebo group for any of the time periods evaluated. At 2 weeks, PRGF-treated tendons had higher tension ratio compared with placebo group tendons (p = 0.0143). Both PRGF and placebo treatments significantly improved the force (p < 0.001 and p = 0.0095, respectively) and tension (p = 0.009 and p = 0.0039, respectively) ratios at 8 weeks compared with 2 weeks.


CONCLUSIONS
The application of PRGF increases Achilles tendon repair strength at 8 weeks compared with the use of placebo. The use of PRGF does not modify section and tension ratios compared with placebo at 8 weeks. The tension ratio progressively increases between 2 and 8 weeks compared with the placebo.
García-Cugat Foundation, Barcelona, Spain. cvgramenet@gmail.com.|Instituto Veterinario de Ortopedia y Traumatología (IVOT), Barcelona, Spain. cvgramenet@gmail.com.|Clínica Veterinaria Gramenet, Hospital Veterinari Montigalà , Av dels Banús 1, Santa Coloma de Gramenet, Barcelona, Spain. cvgramenet@gmail.com.
Diego
D
López-Nájera
García-Cugat Foundation, Barcelona, Spain.|Departamento de Medicina y Cirugía Animal, Universidad CEU Cardenal Herrera, Valencia, Spain.|CEU-UCH Chair of Medicine and Regenerative Medicine, García-Cugat Foundation, Valencia, Spain.
Mónica
M
Rubio-Zaragoza
García-Cugat Foundation, Barcelona, Spain.|Departamento de Medicina y Cirugía Animal, Universidad CEU Cardenal Herrera, Valencia, Spain.|CEU-UCH Chair of Medicine and Regenerative Medicine, García-Cugat Foundation, Valencia, Spain.
Joaquín J
JJ
Sopena-Juncosa
Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
Eduard
E
Alentorn-Geli
García-Cugat Foundation, Barcelona, Spain.|CEU-UCH Chair of Medicine and Regenerative Medicine, García-Cugat Foundation, Valencia, Spain.|Artroscopia GC, Hospital Quirón, Barcelona, Spain.
Ramón
R
Cugat-Bertomeu
García-Cugat Foundation, Barcelona, Spain.|Departamento de Medicina y Cirugía Animal, Universidad de Córdoba, Córdoba, Spain.
J Andrés
JA
Fernández-Sarmiento
García-Cugat Foundation, Barcelona, Spain.|Departamento de Medicina y Cirugía Animal, Universidad de Córdoba, Córdoba, Spain.
Juan M
JM
Domínguez-Pérez
García-Cugat Foundation, Barcelona, Spain.|CEU-UCH Chair of Medicine and Regenerative Medicine, García-Cugat Foundation, Valencia, Spain.|Artroscopia GC, Hospital Quirón, Barcelona, Spain.
Montserrat
M
García-Balletbó
Health Care Technology Group, Biomedical Research Networking Center Bioengineering, Biomaterials, Nanomedicine (CIBER-BBN), Valencia, Spain.|Biomechanics Institute of Valencia (IBV), Universidad Politecnica de Valencia, Valencia, Spain.
Víctor J
VJ
Primo-Capella
García-Cugat Foundation, Barcelona, Spain.|Departamento de Medicina y Cirugía Animal, Universidad CEU Cardenal Herrera, Valencia, Spain.|CEU-UCH Chair of Medicine and Regenerative Medicine, García-Cugat Foundation, Valencia, Spain.
José M
JM
Carrillo-Poveda
D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D000818:Animals; D001696:Biomechanical Phenomena; D005260:Female; D015552:Injections, Intralesional; D036341:Intercellular Signaling Peptides and Proteins / Q000627:therapeutic use*; D019637:Orthopedic Procedures / Q000379:methods*; D010949:Plasma; D011897:Random Allocation; D012756:Sheep; D013708:Tendon Injuries / Q000628:therapy*; D014945:Wound Healing
D036341:Intercellular Signaling Peptides and Proteins
Achilles tendon repair; Biomechanical properties; PRGF; PRP; Plasma-rich growth factors