Evidence for Achilles Tendinopathy

Achilles Tendinopathy

A recent study published by Boesen et al in the American Journal of Sports Medicine, carried out a randomised double-blinded study comparing a high volume injection (HVI) with platelet rich plasma (PRP) (1). This study concluded that HVI and PRP injections were more effective at reducing pain and improving activity level than eccentric training alone. They also noted the injection therapies were more effective at reducing the tendon thickness and intratendinous vascularity.

Filardo et al presented their 4-year results in patient who underwent PRP injections for Chronic Achilles Tendinopathy (2). These patients had failed all previous treatment modalities and following a course of three injections, had significant improvement in pain and functional scores out to 4 years after the injections.

A study in the Journal of Ultrasound looked at the results of ultrasound guided injection for patellar and Achilles tendinopathy (3). The patients were followed up with pain and sports outcome questionnaires as well as an ultrasound at 6 months. Ferrero et al concluded that all scores significantly improved with the ultrasound guided injections. They also noted a significant improvement in the appearance of the tendon matrix, potentially helping to prevent degenerative lesions.

Deans et al published their series of patients who underwent treatment for chronic Achilles tendinopathy with injection of PRP under ultrasound guidance (4). There was a significant improvement in reducing pain and improving activities of daily living, sports activities and quality of life.

  1. Boesen AP, Hansen R, Boesen MI, Malliaras P, Langberg H. Effect of High-Volume Injection, Platelet-Rich Plasma, and Sham Treatment in Chronic Midportion Achilles Tendinopathy: A Randomized Double-Blinded Prospective Study. Am J Sports Med. 2017 Jul;45(9):2034–43.
  2. Filardo G, Kon E, Di Matteo B, Di Martino A, Tesei G, Pelotti P, et al. Platelet-rich plasma injections for the treatment of refractory Achilles tendinopathy: results at 4 years. Blood Transfus. 2014 Oct;12(4):533–40.
  3. Ferrero G, Fabbro E, Orlandi D, Martini C, Lacelli F, Serafini G, et al. Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy. Journal of Ultrasound. 2012 Dec;15(4):260–6.
  4. Deans VM, Miller A, Ramos J. A prospective series of patients with chronic Achilles tendinopathy treated with autologous-conditioned plasma injections combined with exercise and therapeutic ultrasonography. J Foot Ankle Surg. 2012 Nov;51(6):706–10.