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Blood Transfus. 2014 Oct;12(4):533-40. doi: 10.2450/2014.0289-13. Epub 2014 Jun 19.

Platelet-rich plasma injections for the treatment of refractory Achilles tendinopathy: results at 4 years.

Author information

II Orthopaedic and Traumatology Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
Radiology and Diagnostic Imaging Department, Rizzoli Orthopaedic Institute, Bologna, Italy.
Immunohaematology and Transfusion Medicine Service, Rizzoli Orthopaedic Institute, Bologna, Italy.



Chronic Achilles tendinopathy is responsible for a severe reduction in physical performance and persistent pain. There is currently a number of therapeutic options and the local administration of growth factors is an emerging treatment strategy. In particular, platelet-rich plasma (PRP) is a widely used way to provide a local regenerative stimulus for tendon healing. The aim of this study was to document the mid-term results obtained after treating recalcitrant Achilles tendinopathy with injections of high concentrate, leucocyte-rich PRP.


Twenty-seven patients (mean age: 44.6 years; 22 men and 5 women) affected by chronic mid-portion Achilles tendinopathy (7 bilateral, for a total of 34 tendons), refractory to previous treatments, were enrolled. Patients were treated with three ultrasound-guided intra-tendinous injections of PRP at 2-week intervals. Patients were prospectively evaluated at baseline, and then at 2, 6, and up to a mean of 54.1 months of follow-up (minimum 30 months), using the following tools: Blanzina, VISA-A, EQ-VAS for general health, and Tegner scores.


The VISA-A score showed a significant improvement: the baseline score of 49.9±18.1 increased to 62.9±19.8 at 2 months (p=0.002), with a further improvement at 6 months (84.3±17.1, p<0.0005), and stable results at 4.5 years (90.0±13.9). The EQ-VAS score also showed a similar positive trend. An evaluation of the activity level confirmed these findings, showing a significant improvement in the Tegner score over time (p=0.017 for the final evaluation). The longer duration of symptoms before treatment was associated with a slower return to sport (p=0.041).


PRP injections produced good overall results for the treatment of chronic recalcitrant Achilles tendinopathy with a stable outcome up to a medium-term follow-up. Longer symptom duration was related with a more difficult return to sporting activity.

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