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Scientific News in Foot Pain (Part 6):
Clinical and Magnetic Resonance Imaging Outcomes Following Platelet Rich Plasma Injection for Chronic Midsubstance Achilles Tendinopathy
Platelet rich plasma is a preparation that can be made in a clinic or operating room. Blood is taken from a vein and placed in a centrifuge, a device that rotates at high-speed causing the different parts of the blood to separate. The red blood cells themselves settle to the bottom. The water, salts, and protein in the serum rise to the top. In between these two layers is a white layer which contains platelets and white blood cells. This unproven treatment has received much attention by the lay press, because many prominent athletes have used it for their musculoskeletal injuries.
There is little in the way of significant proof to show its effectiveness. In addition, few private insurances have accepted it and therefore the costs of this treatment are often borne by the patient. It can be quite expensive.
Dr. Owens (Owens RF Jr et al. Clinical and magnetic resonance imaging outcomes following platelet rich plasma injection for chronic midsubstance Achilles tendinopathy. Foot Ankle Int. 2011 Nov;32(11):1032-9.) has reviewed his series of patients treated for Achilles tendinitis with PRP injections over a two-year period. On MRI scan, only one of six patients showed improvement after the injection. Test scores showed mild to modest improvements. Tendinitis does tend to improve without treatment. This study was not controlled, so it is difficult to determine whether these small improvements occurred because of the injection or would’ve happened naturally.
I have stated previously that PRP and other biological treatments show great promise in the treatment of musculoskeletal conditions, but the effectiveness and reasons for doing these injections have not been established. The great many promising treatments come and go in medicine. It is always advisable to wait on these treatments until their risks, benefits, and potential complications have been worked out through controlled scientific studies.
–Brett Fink, MD. Co-author of The Whole Foot Book: A Comprehensive Guide to Taking Care of your Feet
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