Regenerative Injection Therapies for Achilles Tendinopathy
Achilles tendonitis is one of the most common overuse injuries seen by orthopaedists. While there are several different known causes of Achilles tendonitis, overuse and degeneration are two of the most common reasons. In the truest sense, Achilles tendinopathy more accurately describes the condition. Tendinitis means inflammation within a tendon whereas, tendinosis refers to micro tears commonly as the result of overuse. Collectively tendinopathy incorporates both of these findings.
Those who suffer from Achilles tendinopathy typically complain of pain either along the midportion of the tendon or at the insertion site at the heel. Stiffness in the morning and increasing pain with activity is common. Thickening of the tendon can result from injury or from degenerative changes seen with age. For some, swelling and redness may also be present.
Historically, the normal treatment course for Achilles tendinopathy has focused on activity modification including rest, ice, non-steroidal ant inflammatory medication (NSAID), and stretching exercises. In rare cases, corticosteroid injections have been given for Achilles tendonitis, but there is concern for risk of tendon rupture associated with this.
Unfortunately for some, Achilles tendinopathy can become a chronic condition in which adhesions can may form between the tendon and tendon sheath. This is a much harder condition to treat. There are several different surgical approaches to address this problem however, recovery can be prolonged and return to certain activities may be limited on a long term basis.
Beyond the standard treatments mentioned above, regenerative injection therapies including Prolotherapy and PRP also may also have a place in the management of Achilles tendinopathy. On the Prolotherapy side, a randomized clinical trial that was conducted in Australia (Yelland et al 2011) showed that Prolotherapy when combined with specific exercises was very effective early at reducing stiffness and allowing for increased activity. Several studies have evaluated the use of PRP for Achilles tendinopathy. A European study that is due to publish this month in Foot and Ankle Surgery, reported on 83 Achilles tendons that were followed for an average of 50 months after a single PRP injection. Statistically significant score improvements were seen on the Victoria Institute of Sports Assessment – Achilles (VISA-A) questionnaire. 91.6% of the patients were satisfied with the treatment at final follow-up. No tendon ruptures were seen.
A similar study by Filardo et al (2014) showed a positive outcomes for 27 cases of chronic Achilles tendinopathy treated with leucocyte positive PRP with an average of 54 months of follow-up.
The published data on the use of regenerative injections for Achilles tendinopathy is very limited at the present time. This is an area that is presently being investigated. The results do appear to be promising so far.