Platelet-Rich Plasma Treatment for Pain, Thickness, and Elasticity in Achilles Tendinopathy: A Randomized Pilot Study

ABSTRACT Introduction Achilles tendinopathy (AT) is a degenerative condition of the tendon. Platelet-rich plasma (PRP) has shown promise in treating tendinopathies. Shear wave elastography (SWE) can assess tendon elasticity in patients following treatment. This study investigated PRP treatment efficacy compared to control for pain and function, conventional sonographic measures, and tendon shear wave speed (SWS) in AT. Methods Twenty participants were randomized to PRP treatment ( n = 10) or the control group ( n = 10). Baseline and 24 wk pain and function were assessed using the Victorian Institute of Sport–Achilles (VISA-A) questionnaire and visual analog scale (VAS). Tendon thickness, echogenicity, and hyperemia were measured. Tendon SWS was obtained in passive neutral, dorsiflexed, and plantarflexed positions. Linear mixed-effects models were used to assess differences between treatment groups over time. Kruskal–Wallis tests were performed to assess between-group differences in tendon echogenicity and hyperemia. Results PRP had greater improvements in VISA-A (31.9 (5.7) vs 9.7 (7.0) points; P = 0.03) and VAS scores (−5.6 (0.8) vs −1.4 (1.0); P = 0.01). No differences were observed between groups in tendon thickness (PRP: 10.8 (0.54) mm; control: 9.9 (0.61) mm; P = 0.32), echogenicity (PRP: 0.11 (0.60); control: 0.14 (0.38); P = 1.00), or hyperemia (PRP: −0.56 (1.1); control: −0.14 (0.69); P = 0.44). No between-group differences in SWS were observed in neutral ( P = 0.96) or dorsiflexed ( P = 0.24) positions, but were observed in the plantarflexed position (PRP: 6.5 (0.38) m·s −1 ; control: 7.8 (0.43) m·s −1 ; P = 0.04). Conclusion PRP improved pain and function compared to a wait-and-see control group with no between-group differences in conventional sonographic measures or material properties assessed via elastography. Improvements in clinical measures appear unrelated to sonographic measures. PRP alone may not accelerate healing and may be best used in conjunction with other conservative treatments.