Achilles Tendon PRP Injection: Open Surgery or an Injection?
POSTED ON 1/16/2013 IN Foot and Ankle BY Christopher Centeno
Can an Achilles tendon PRP injection trump surgery? SD is a 55 year old woman who found herself in the worst possible place with an Achilles tendon tear. Unlike most torn Achilles tendons that snap and retract back like broken rubber bands, hers became shredded but didn't snap. This meant that it had many good sized tears throughout the substance of the tendon. She tried to go into a boot and on crutches a few times, but every follow-up MRI showed no healing. Physical therapy was no help and two surgeons told her they wouldn't touch this situation with a 10 foot pole, while one wanted to spend hours trying to sew back all of these tears. This surgery would have left her on crutches for months again and unable to fully use this ankle for between 6 months and a year. Her pre-treatment ultrasound images are above from May of this year when she was first seen in clinic (top row). I have pointed out the dark spots in the roundish tendon (seen on cross section) which represent tears. They are literally everywhere, which is certainly why the two surgeons told her they couldn't help. I agreed to treat it with a type of special PRP that can't really be found outside of a Regenexx network provider, 20 times more concentrated in healing platelets than are usually found in the blood (the 20X Regenexx-SCP procedure). This is because automated bedside PRP machines used by >99% of all physicians can only get to 3-14X concentration with the vast majority not concentrating over 7X. For the procedure itself, I took a 30 gauge needle (the same type they use to inject Botox into wrinkles) and used exacting ultrasound guidance to meticulously fill each tear. We did this twice, once in July and then again in October of this year. She wasn't instructed to use any crutches and was told to work out as tolerated (don't do much if it hurts from the injection, low impact exercise if it isn't sore). The result? While her results are not necessarily experienced by all patients, she reports that she's nearly pain-free and slowing increasing her work-outs under the direction of her PT. What's very interesting are the follow-up ultrasound images I took yesterday in clinic (above on the bottom row). Note that the nasty dark tears are almost all gone and we now have something that looks like a normal Achilles tendon. The upshot? Open surgery on this patient would have been almost impossible, given that the tendon would have to be filleted open and then sewn back together in many areas, weakening the tendon and dramatically increasing the chance of rupture. Instead, all she needed were high skill injections of super concentrated platelets with a Botox needle!
NOTE: Regenexx-SCP is a medical procedure and like all medical procedures has a success and failure rate. Not all Regenexx-SCP Achilles Tendon patients can expect the same result.
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