Comparison on effects of platelet-rich plasma versus autologous conditioned serum on Achilles tendon healing in a rat model

Background: The paratenon is important for Achilles tendon healing. There is much interest in the use of exogenous growth factors (GFs) as potential agents for accelerating the healing of damaged Achilles tendons. Purpose/Hypothesis: The present study used a rat model to study the responses of the injured Achilles tendon to GFs in the presence or absence of the paratenon. The hypothesis was that responses of the injured tendon to GFs would be lower in the absence of a paratenon. Study Design: Controlled laboratory study. Methods: A 4-mm defect was created in the right Achilles tendon of 60 skeletally mature rats, which were treated with a validated combination of GFs (bFGF, BMP-12, and TGF-β1). Animals were randomly assigned to the intact paratenon (IP) group or resected paratenon (RP) group. Healing was studied anatomically, mechanically, and histologically after 1, 2, and 4 weeks. Results: IP tendons showed improved healing compared with RP tendons. IP tendons were significantly stronger (32.2 N and 48.9 N, respectively) than RP tendons (20.1 N and 31.1 N, respectively) after 1 and 2 weeks. IP tendons did not elongate as much as RP tendons and had greater cross-sectional areas (18.0 mm2, 14.4 mm2, and 16.4 mm2, respectively) after 1, 2, and 4 weeks compared with RP tendons (10.5 mm2, 8.4 mm2, and 11.9 mm2, respectively). On histology, earlier collagen deposition and parallel orientation of fibrils were found for IP tendons. Conclusion: The paratenon is essential for efficient Achilles tendon healing. Healing with GFs in this Achilles tendon defect model was superior in the presence of the paratenon. Clinical Relevance: Biological approaches to tendon engineering using GFs are in vogue and have been shown to improve healing of the rat Achilles tendon, most likely by inducing progenitor cells located within the paratenon. Clinically, resection or incision of the paratenon has been proposed for wound closure. Our data demonstrate the fundamental importance of the paratenon, which therefore should be preserved during Achilles tendon repair, especially if augmented with products such as platelet-rich plasma or autologous conditioned serum that are rich in GFs.

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Phenytoin accelerates tendon healing in a rat model of Achilles tendon rupture

Bratislava Medical Journal ◽

10.4149/bll_2016_107 ◽

2016 ◽

Vol 117 (09) ◽

pp. 543-546

Author(s):

B. Hajipour ◽

A. M. Navali ◽

S. Ali Mohammad ◽

G. Mousavi ◽

M. Gahvechi Akbari ◽

...

Keyword(s):

Achilles Tendon ◽

Rat Model ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Healing

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Quantitative Assessment of Tendon Healing by Using MR T2 Mapping in a Rabbit Achilles Tendon Transection Model Treated with Platelet-rich Plasma

Radiology ◽

10.1148/radiol.2015141544 ◽

2015 ◽

Vol 276 (3) ◽

pp. 748-755 ◽

Cited By ~ 17

Author(s):

Taisuke Fukawa ◽

Satoshi Yamaguchi ◽

Atsuya Watanabe ◽

Takahisa Sasho ◽

Ryuichiro Akagi ◽

...

Keyword(s):

Achilles Tendon ◽

Quantitative Assessment ◽

Platelet Rich Plasma ◽

T2 Mapping ◽

Tendon Healing

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Effect of BMP-12, TGF-β1 and autologous conditioned serum on growth factor expression in Achilles tendon healing

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-011-1772-x ◽

2011 ◽

Vol 20 (10) ◽

pp. 1907-1914 ◽

Cited By ~ 37

Author(s):

Patricia E. Heisterbach ◽

Atanas Todorov ◽

Rudolf Flückiger ◽

Christopher H. Evans ◽

Martin Majewski

Keyword(s):

Growth Factor ◽

Achilles Tendon ◽

Tendon Healing ◽

Autologous Conditioned Serum ◽

Factor Expression ◽

Growth Factor Expression ◽

Tgf Β1

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The Effect of Platelet-Rich Plasma on Achilles Tendon Healing in a Rabbit Model

Acta Orthopaedica et Traumatologica Turcica ◽

10.3944/aott.2016.16.0045 ◽

2016 ◽

Cited By ~ 1

Author(s):

Masaki Takamura

Keyword(s):

Achilles Tendon ◽

Platelet Rich Plasma ◽

Rabbit Model ◽

Tendon Healing

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Effects of immobilization on achilles tendon healing in a rat model

Journal of Orthopaedic Research® ◽

10.1002/jor.1100120415 ◽

1994 ◽

Vol 12 (4) ◽

pp. 582-591 ◽

Cited By ~ 58

Author(s):

George A. C. Murrell ◽

Edward G. Lilly ◽

Richard D. Goldner ◽

Anthony V. Seaber ◽

Thomas M. Best

Keyword(s):

Achilles Tendon ◽

Rat Model ◽

Tendon Healing

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Real-time sonoelastography evaluation of the Achilles tendon following ultrasound-guided platelet-rich plasma injection and eccentric exercise for the treatment of refractory Achilles tendinopathy

Ultrasound ◽

10.1177/1742271x18818608 ◽

2018 ◽

Vol 27 (3) ◽

pp. 138-147

Author(s):

Chin Chin Ooi ◽

Michal Schneider ◽

Peter Malliaras ◽

Meng Ai Png ◽

Martine Chadwick ◽

...

Keyword(s):

Achilles Tendon ◽

Eccentric Exercise ◽

Platelet Rich Plasma ◽

Tendon Healing ◽

Inverse Correlation ◽

Strain Ratio ◽

Achilles Tendinopathy ◽

Post Treatment ◽

Tendon Stiffness ◽

Plasma Injection

The objective of this study was to investigate the feasibility of using sonoelastography to depict Achilles tendon stiffness after platelet-rich plasma injection and eccentric exercise for chronic Achilles tendinopathy, and to correlate sonoelastography findings with clinical outcome up to 12 months after treatment. Forty-five Achilles tendons from 45 patients (33 males, 12 females; mean age 51 years) were examined using sonoelastography and ultrasound at baseline, 4–6 weeks, 6 months and 12 months post-treatment. The strain ratio (between Achilles tendon and Kager's fat) during sonoelastography was obtained. The proportion of tendons with hypoechogenicity and neovascularity were documented. Clinical outcomes were assessed by the Victorian Institute of Sport Assessment-Achilles questionnaire and correlated with sonographic findings. The Victorian Institute of Sport Assessment-Achilles improved significantly from 38.4 (±14.1) at baseline, 77.2 (±12.5) at 6 months ( p < 0.001) to 81.2 (±10.8) at 12 months ( p < 0.001). The strain ratio values were 2.16 (±1.02) at baseline, 2.03 (±0.67) at 4–6 weeks, 1.81 (±0.62) at 6 months and 1.19 (±0.34) at 12 months with a significant reduction observed at 6 months (p = 0.006) and 12 months ( p < 0.001). At 12-month evaluation, none of the tendons regained a normal echotexture. Strain ratio demonstrated a moderately good inverse correlation with Victorian Institute of Sport Assessment-Achilles (r = −0.610, p<0.001) while B-mode and Doppler ultrasound did not show a significant correlation (r = −0.041, p = 0.817, and r = −0.116, p = 0.514). Achilles tendon stiffness shows moderately good correlation with clinical symptom at 12-month post-treatment. Sonoelastography using strain ratio could be a promising ancillary tool for monitoring Achilles tendon healing after treatment.

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