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Comparison of Surgically Repaired Achilles Tendon Tears Using Platelet-Rich Fibrin Matrices

Mikel Sánchez, MD^*, Eduardo Anitua, MD, DDS, Juan Azofra, MD^*, Isabel Andía, PhD, Sabino Padilla, MD, PhD and Iñigo Mujika, PhD^,

From the ^* Arthroscopic Surgery Unit, USP–La Esperanza Clinic, Vitoria-Gasteiz, Basque Country, Spain, the BTI Biotechnology Institute, Vitoria-Gasteiz, Basque Country, Spain, and the Department of Research and Development, Medical Services, Athletic Club Bilbao, Basque Country, Spain

Address correspondence to Iñigo Mujika, PhD, Athletic Club Bilbao, Sports Facilities, Garaioltza 147, Lezama, Bizkaia, Spain (e-mail: inigo.mujika{at}euskalnet.net).

Background: Platelet-rich fibrin matrices release a natural mixture of growth factors that play central roles in the complex processes of tendon healing.

Hypothesis: Application of autologous platelet-rich matrices during Achilles tendon surgery may promote healing and functional recovery.

Study Design: Case-control study and descriptive laboratory study; Level of evidence, 3.

Methods: Twelve athletes underwent open suture repair after complete Achilles tendon tear. Open suture repair in conjunction with a preparation rich in growth factors (PRGF) was performed in 6 athletes and retrospectively compared with a matched group that followed conventional surgical procedure. The outcomes were evaluated on the basis of range of motion, functional recovery, and complications. Achilles tendons were examined by ultrasound at 50 ± 11 months in retrospective controls and 32 ± 10 months in the PRGF group. In the laboratory portion of the study, PRGF treatment was characterized by the number of platelets and concentration of insulin (IGF-I), transformed (TGF-ß1), platelet-derived (PDGF-AB), vascular endothelial (VEGF), hepatocyte (HGF), and epidermal (EGF) growth factors in patients affected by musculoskeletal traumatic injuries.

Results: Athletes receiving PRGF recovered their range of motion earlier (7 ± 2 weeks vs 11 ± 3 weeks, P = .025), showed no wound complication, and took less time to take up gentle running (11 ± 1 weeks vs 18 ± 3 weeks, P = .042) and to resume training activities (14 ± 0.8 weeks vs 21 ± 3 weeks, P = .004). The cross-sectional area of the PRGF-treated tendons increased less (t = 3.44, P = .009). TGF-ß1 (74.99 ± 32.84 ng/mL), PDGF-AB (35.62 ± 14.57 ng/mL), VEGF (383.9 ± 374.9 pg/mL), EGF (481.5 ± 187.5 pg/mL), and HGF (593.87 ± 155.76 pg/mL) significantly correlated with the number of platelets (677 ± 217 platelets/µL, P < .05).

Conclusion: The operative management of tendons combined with the application of autologous PRGF may present new possibilities for enhanced healing and functional recovery. This needs to be evaluated in a randomized clinical trial.

Key Words: sports • platelets • growth factors • surgical repair • Achilles tendon

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