PRP during Achilles tendon surgery

Pain Treatment following Achilles Tendon Surgery

Ross Hauser, MD

Treatment following Achilles Tendon Surgery

There have been numerous studies testing the validity of use of Platelet Rich Plasma during open surgery. These studies have lead some to question whether or not PRP can help with post-surgical rehabilitation if applied at the time of surgery.

One of the big problems with studies on PRP or stem cell enhancements at the time of surgery is the problem of dilution.2 In my article on Arthroscopic knee surgery for osteoarthritis I came upon a study that found that during surgery, surgical dyes, irrigation fluids, and other liquids forced into the repair area significantly diluted healing agents during surgery and more importantly post-surgery.

So theoretically, we are asking a weakened PRP treatment to heal surgical damage

However, doctors writing in the medical journal Foot and Ankle Specialists said:

Treatment protocols with PRP have been performed in 2 ways- administered adjunctively during tendon surgery and as a stand-alone injection (please see my article What is Platelet Rich Plasma Therapy?)

The senior researcher had utilized PRP by both methods to treat Achilles tendinopathy over a 7 year period. Twenty six patients were followed, half having undergone Achilles tendon surgery in combination with PRP administration and the other half PRP injections alone.

Both the stand-alone injection group and surgical/injection groups had statistically significant degrees of improvement in pre-MRI and post-MRI imaging studies. There was no statistically significant difference between the 2 treatment groups.3

PRP did help in surgery and helped equally without surgery. This is why seeking a consultation with a doctor experienced in the varied PRP, stem cells, and a comprehensive Prolotherapy approaches can offer the patient more options pre and post surgery for enhanced and accelerated achilles repair.

One note on immobilization 

In stark contradiction to the Rice, Ice, Compress, Elevate theory in managing post surgical treatment, doctors in August of 2016 published their research that functional weight-bearing mobilization enhanced the early healing response of achilles tendon recovery. In addition, early ankle range of motion was improved without the risk of Achilles tendon elongation (laxity and instability) and without altering long-term functional outcome.4

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1. De Carli A, Lanzetti RM, Ciompi A, et al. Can platelet-rich plasma have a role in Achilles tendon surgical repair? Knee Surg Sports Traumatol Arthrosc. 2016 Jul;24(7):2231-7. doi: 10.1007/s00167-015-3580-1. Epub 2015 Mar 22. [Pubmed]

2. Stopka SS, Wilson GL, Pearsall AW. Dilution Effect of Intra-articular Injection Administered After Knee Arthroscopy. Dilution Effect of Intra-articular Injection Administered After Knee Arthroscopy. J Surg Orthop Adv. 2015 Winter;24(4):209-12. [Pubmed]

3. Oloff L, Elmi E, Nelson J, Crain J. Retrospective Analysis of the Effectiveness of Platelet-Rich Plasma in the Treatment of Achilles Tendinopathy: Pretreatment and Posttreatment Correlation of Magnetic Resonance Imaging and Clinical Assessment. Foot Ankle Spec. 2015 Dec;8(6):490-7. [Pubmed]

4. Valkering KP, Aufwerber S, Ranuccio F, Lunini E, Edman G, Ackermann PW. Functional weight-bearing mobilization after Achilles tendon rupture enhances early healing response: a single-blinded randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2016 Aug 18. [Pubmed]

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