The Effect of Autologous Platelet Rich Plasma in the Treatment of Achilles Tendon Ruptures: An Experimental Study on Rabbits

Abstract

Background: Achilles tendon ruptures are characterized by a long recovery period, high re-rupture rate and late return to work. To overcome these difficulties and augment tendon repair, many agents have been used. Aims: To determine the effect of autologous platelet rich plasma (PRP) in the treatment of Achilles tendon ruptures in rabbits. Study Design: Animal experimentation. Methods: The study included 14 New Zealand albino rabbits that were divided randomly into 2 groups, A and B, each containing seven rabbits. On day zero, all 28 Achilles tendons were tenotomized and repaired. In group A, the tendons were injected with PRP post-surgery, whereas those in group B were left untreated. On day 28, the right tendons in both groups were examined histopathologically via both light and electron microscopy, and the left tendons were subjected to biomechanical testing. Results: The histological and biomechanical findings in both light and electron microscopy in group A were better than those in group B, but the difference was not significant. According to Tang’s scale, the mean value in Group A was 3.57, while it was 3.0 in Group B. The mean value of Group A for the length of collagen bands was 48.09 nm while the mean value of Group B was 46.58 nm (p=0.406). In biomechanical tests, although stiffness values were higher in group A, the difference between groups was not significant. In addition, maximum load values did not differ between groups A and B. Conclusion: PRP had no effect on the healing process 28 days post-Achilles tendon rupture.

Keywords

• Achilles tendon, electron microscopy, platelet-rich plasma, tendon healing, tendon rupture

References

1. 1. Sanchez M, Anitua E, Azofra J, Andia I, Padilla S, Mujika I. Comparison of surgically repaired Achilles tendon tears using plateletrich fibrin matrices. Am J Sports Med 2007;35:245-51. [CrossRef]
2. 2. Konerding MA, Friederike A, Wellmann A, Li V, Li W. Impact of combinatory growth factor application on rabbit Achiles tendon injury with operative versus conservative treatment: A pilot study. Int J Mol Med 2010;25:217-24.
3. 3. Schepull T, Kvist J, Norrman H, Trinks M, Berlin G, Aspenberg P. Autologous platelets have no effect on the healing of human Achilles tendon ruptures. Am J Sports Med 2011;39:39-47. [CrossRef]
4. 4. Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M. Treatment of acute Achilles tendon rupture. A meta-analysis of randomized controllod trials. J Bone Joint Surgery Am 2005;87:2202-10. [CrossRef]
5. 5. Halıcı M, Karaoğlu S, Canöz O, Kabak Ş, Baktır A. Sodium hyaluronate regulating angiogenesis during Achilles tendon healing. Knee Surg Sports Traumatol Arthrosc 2004;12:562-7. [CrossRef]
6. 6. Petrou CG, Karachalios TS, Khaldi L, Katantanas AH, Lyritis GP. Calsitonin effect on Achilles tendon healing: An experimental study on rabbits. J Musculoskelet Neuronal Interact 2009;9:147-54.
7. 7. Leek BT, Tasto JP, Tibor LM, Healey RM, Freemont A, Linn MS, et al. Augmentation of tendon healing with butyric acid impregnated sutures: Biomechanical evaluation in a rabbit model. Am J Sports Med 2012;40:1762-71. [CrossRef]
8. 8. Çoban İ, Satoğlu S, Gültekin A, Tuna B, Tatari H, Fidan M. Effect of human amniotic fluid and membrane in the treatment of Achilles tendon ruptures in locally corticosteroid-induced Achilles tendinosis: An experimental study on rats. Foot Ankle Surg 2009;15:22-7. [CrossRef]

9. 9. Malcarney HL, Bonar F, Murrell GA. Early inflammatory reaction after rotator cuff repair with a porcine small intestine submucosal implant: a report of 4 cases. Am J Sports Med 2005;33: 907-11. [CrossRef]
10. 10. Zheng MH, Chen J, Kirilak Y, Willers C, Xu J, Wood D. Porcine small intestine submucosa (SIS) is not an acellular collagenous matrix and contains porcine DNA: Possible implications in human implantation. J Biomed Mater Res B Applied Biomater 2005;73:61-7. [CrossRef]
11. 11. Nicholson GP, Breur GJ, Sickle DV, Yao JQ, Kim J, Blanchard CR. Evaluation of a cross-linked acellular porcine dermal patch for rotator cuff repair augmentation in an ovine model. J Shoulder Elbow Surg 2007;16:184-90. [CrossRef]
12. 12. Badhe SP, Lawrence TM, Smith FD, Lunn PG. An assessment of porcine dermal xenograft as an augmentation graft in the treatment of extensive rotator cuff tears. J Shoulder Elbow Surg 2008;17:35-9. [CrossRef]
13. 13. Sarrafian TL, Wang H, Hackett ES, Yao JQ, Shih MS, Ramsay HL, et al. Comparison of Achilles tendon repair techniques in a sheep model using a cross-linked acellular porcine dermal patch and platelet-rich fibrin matrix for augmentation. J Foot Ankle Surg 2010;49:128-34. [CrossRef]
14. 14. Lee DK. Achilles tendon repair with acellular tissue graft augmentation in neglected ruptures. J Foot Ankle Surg 2007;46:451- 5. [CrossRef]
15. 15. Bolt P, Clerk AN, Luu HH, Kang Q, Kummer JL, Deng ZL. BMP-14 gene therapy increases tendon tensile strength in a rat model of Achilles tendon injury. J Bone Joint Surg Am 2007;89:1315-20. [CrossRef]
16. 16. Forslund C, Aspenberg P. Improved healing of transected rabbit Achilles tendon after a single injection of cartilage-derived morphogenetic protein-2. Am J Sports Med 2003;31:555-9.
17. 17. Zhang F, Liu H, Stile F, Lei MP, Pang Y, Oswald TM, et al. Effect of vascular endothelial growth factor on rat Achilles tendon healing. Plast Reconstr Surg 2003;112:1613-9. [CrossRef]
18. 18. Taylor DW, Petrera M, Hendry M, Theodoropoulos JS. A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and ligament injuries. Clin J Sports Med 2011;21:344-52. [CrossRef]
19. 19. Jelinsky SA, Li L, Ellis D, Archambault J, Li J, St Andre M. Treatment with rhBMP12 or rhBMP13 increase the rate and the quality of rat Achilles tendon repair. J Othop Res 2011;29:1604- 12. [CrossRef]
20. 20. Paoloni J, de Vos RJ, Hamilton B, Murrell GAC, Orchard J. Platelet-rich plasma treatment for ligament and tendon injuries. Clin J Sports Med 2011;21:37-45. [CrossRef]
21. 21. Kajikawa Y, Morihara T, Sakamoto H, Matsuda K, Oshima Y, Yoshida A, et al. Platelet-rich plasma enhances the initial mobilization of circulation-derived cells for tendon healing. J Cell Physiol 2008;215:837-45. [CrossRef]
22. 22. Kim HJ, Kang SW, Lim HC, Han SB, Lee JS, Prasad L. The role of Transforming Growth Factor-β and bone morphogenetic protein with fibrin glue in healing of bone-tendon junction injury. Connect Tissue Res 2007;48:309-15. [CrossRef]
23. 23. Lyras DN, Kazakos K, Verettas D, Polychronidis A, Tryfonidis M, Botaitis S, et al. The influence of platelet-rich plasma on angiogenesis during the early phase of tendon healing. Foot Ankle Int 2009;30:1101-6. [CrossRef]
24. 24. Lyras DN, Kazakos K, Tryfonidis M, Agrogiannis G, Botaitis S, Kokka A, et al. Temporal and spatial expression of TGF - β1 in an Achilles tendon section model after application of plateletrich plasma. Foot Ankle Surg 2007;16:137-41. [CrossRef]
25. 25. Aspenberg P, Virchenko O. Platelet concentrate injection improves Achilles tendon repair in rats. Acta Orthop Scand 2004;75:93-9. [CrossRef]
26. 26. Virchenko O, Aspenberg P. How can one platelet injection after tendon injury lead to a stronger tendon after 4 weeks? Acta Orthop 2006;77:806-12. [CrossRef]
27. 27. Kaux JF, Drion PV, Colige A, Pascon F, Libertiaux V, Hoffmann A. Effects of platelet-rich plasma (PRP) on the healing of Achilles tendons of rats. Wound Repair Regen 2012;20:748-56. [CrossRef]
28. 28. Xu K, Al-Ani MK, Sun Y, Xu W, Pan L, Song Y, et al. Plateletrich plasma activates tendon derived stem cells to promote regeneration of Achilles tendon rupture in rats. J Tissue Eng Regen Med 2015 (article in press). [CrossRef]
29. 29. De Vos RJ, Weir A, Tol JL, Verhaar JAN, Weinans H, van Schie HTM. No effects of PRP on ultrasonographic tendon structure and neovascularization in chronic midportion Achilles tendinopathy. Br J Sports Med 2011;45:387-92. [CrossRef]
30. 30. De Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA 2010;303:144-9. [CrossRef]
31. 31. Kaniki N, Willits K, Mohtadi NG, Fung V, Bryant D. A retrospective comparative study with historical control to determine the effectiveness of platelet rich plasma as art of nonoperative treatment of acute achilles tendon rupture. Arthroscopy 2014;30:1139-45. [CrossRef]
32. 32. De Carli A, Lanzetti RM, Ciompi A, Lupariello D, Vadala A, Argento G. Can platelet-rich plasma have a a role in Achilles tendon surgical repair? Knee Surg Sports Traumatol Arthrosc 2015 (online article).
33. 33. Yokota K, Ishida O, Sunagawa T, Suzuki O, Nakamae A, Ochi M. Platelet-rich plasma accelerated surgical angio-genesis in vascular-implanted necrotic bone: An experimental study in rabbits. Acta Orthop 2008;79:106-10. [CrossRef]
34. 34. Efeoglu, C, Akcay YD, Erturk S. A modified method for preparing platelet-rich plasma: An experimental study. J Oral Maxillofac Surg 2004;62:1403-7. [CrossRef]
35. 35. Tang J, Ishii S, Usui M, Aoki M. Dorsal and circumferential sheath reconstructions for flexor sheath defect with concomitant bony injury. J Hand Surg 1994;19:61-9. [CrossRef]
36. 36. Kurtz CA, Loebig TG, Anderson DD, DeMeo PJ, Campbell PG. Insulin-like growth factor I accelarates functional recovery from Achilles tendon injury in a rat model. Am J Sports Med 1999;27:363-9.
37. 37. Anitua E, Andia I, Sanchez M, Azofra J, del Mar Zalduendo M, de la Fuente M, et al. Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res 2005;23:281-6. [CrossRef]
38. 38. Lui PPY, Cheuk YC, Hung LK, Fu SC, Chan KM. Increased apoptosis at the late stage of tendon healing. Wound Repair Regen 2007;15:702-7. [CrossRef]
39. 39. Mae T, Shino K, Maeda A, Toritsuka Y, Horibe S, Ochi T. Effect of gamma irradiation on remodeling process of tendon allograft. Clin Orthop Relat Res 2003;414:305-14. [CrossRef] 40. Steiner M. Biomechanics of tendon healing. J Biomech 1982;15:951-8. [CrossRef]
40. 41. Sasaki K, Yamamoto N, Kiyosawa T, Sekido M. The role of collagen arrangement change during tendon healing demonstrated by scanning electron microscopy. J Electron Microsc (Tokyo) 2012;61:327-34. [CrossRef]
41. 42. Hazard SW, Myers RL, Ehrlich HP. Demonstrating collagen tendon fibril segments involvement in intrinsic tendon repair. Exp Mol Pathol 2011;91:660-3.