Efficacy and safety of platelet-rich plasma for acute achilles tendon injury: a meta-analysis / 中国输血杂志

【Objective】 To evaluate the clinical efficacy and safety of platelet-rich plasma(PRP) in acute achilles tendon injury by meta-analysis. 【Methods】 Literature on clinical randomized controlled trial of PRP in the treatment of acute achilles tendon injury from Wanfang database, CNKI, VIP database, The Chinese Biological Literature Database, The Chinese Clinical Trials Registry, PubMed, Embase, Cochrane and The US Clinical Trials Registry as of August 2023 were retrieved. The control group received conventional treatment for acute achilles tendon injury, while PRP treatment group received additional PRP treatment. The primary outcome measure was visual analogue pain scale, and the secondary outcome measures were the achilles tendon fracture score, maximum heel rise height, calf circumference and ankle range of motion. The quality of the literature was assessed using the Cochrane manual, and a meta-analysis of qualified literature was performed using RevMan 5.3 software. 【Results】 Seven articles were finally included, involving 421 patients with acute achilles tendon injury, including 212 patients in the PRP treatment group, and 209 patients in the conventional treatment group. The results of meta-analysis showed that there was no difference between the conventional treatment group and the PRP treatment group in terms of the visual analogue pain scale(SMD=-0.44, 95%CI: -0.94~0.06, P>0.05), calf circumference (MD=1.14, 95% CI: -1.56-3.84, P>0.05), ankle joint toe flexion range of motion (SMD=1.85, 95%CI: -1.38-5.09, P>0.05), ankle dorsiflexion range of motion(SMD=2.61, 95%CI: -0.95-6.17, P>0.05), achilles tendon fracture score (MD=-5.60, 95%CI: -15.36-4.16, P>0.05) and the maximum heel rise height (MD=-2.48, 95%CI: -5.30-0.33, P>0.05). And there was no difference in the incidence of adverse reactions between the two groups (X2=2. 455, P>0.05). 【Conclusion】 PRP injection for acute achilles tendon injury does not improve the biomechanical and clinical outcomes of patients, and the use of PRP does not increase the occurrence of adverse reactions.

Gait analysis combined with the expression of TGF-β1, TGF-β3 and CREB during Achilles tendon healing in rat / 中华创伤杂志(英文版)

PURPOSE@#To observe the changes of gait behavior and the expression of wound healing factors of transforming growth factor-β1 (TGF-β1), TGF-β3 and cAMP response element binding protein-1 (CREB-1) during the healing of Achilles tendon in a rat model, and to investigate whether gait analysis can be used to evaluate the tendon healing.@*METHODS@#Achilles tendon of 40 healthy male Sprague-Dawley rats were transected and sutured to establish the Achilles tendon injury (ATI) model. They were randomly divided into 4 groups based on the observational time point at 1, 2, 4 and 6 weeks after injury (n = 10 for each group). Before modeling, 9 rats were randomly selected for CatWalk gait analysis, which contained step cycle, single stance time and average speed. Data were recorded as the normal controls. After then, ATI models were established in the left hind limbs of the all 40 rats (ATI group), while the right hind limbs were only cut and sutured without injury of the Achilles tendon (sham operation group). At 1, 2, 4 and 6 weeks after injury, the gait behavior of the corresponding group of rats (n = 9) as observed and recorded by CatWalk platform. After then, the rats were sacrificed and Achilles tendon of both limbs was harvested. The tendon healing was observed by gross anatomy and histological examination, and the protein and mRNA expression of TGF-β1, TGF-β3, CREB-1 were observed by immunohistochemistry and qPCR. The results of tendon gross grading were analyzed by Wilcoxon rank sum test, and other data were analyzed by one-way analysis of variance among multiple groups.@*RESULTS@#Compared with normal controls, all gait indexes (step cycle, single stance time and average speed) were greatly affected following ATI, which however improved with time. The step cycle was significantly lower at 1, 2 and 4 weeks after ATI (compared with normal controls, all p  0.05). The single stance time of the ATI group was significantly shorter at 1 and 2 weeks after operation ((0.078 ± 0.010) s at 1 week, (0.078 ± 0.020) s at 2 weeks, all p < 0.001) and revealed no significant difference at 4 weeks (p = 0.120). The average speed of ATI group at 1, 2, 4, 6 weeks was significantly lower than that in the normal control group (all p < 0.001). Gross observation showed that the grade of local scar adhesion in ATI group increased significantly at 2, 4 and 6 weeks, compared with the sham operation group (all p < 0.001). Extensive adhesion was formed at 6 weeks after ATI. The results of HE staining showed that the number of fibroblast increased gradually and arranged more orderly in ATI group at 1, 2 and 4 weeks (all p < 0.001), and decreased at 6 weeks, but it was still significantly higher than that of the sham operation group (p < 0.001). Immunohistochemistry showed that the positive expression of TGF-β1, TGF-β3, CREB-1 in ATI group was higher than that in the sham operation group at 4 time points (all p < 0.05), which reached the peak at 2 weeks after operation and decreased at 4 weeks (p = 0.002, p < 0.001, p = 0.041, respectively). The results of qPCR suggested that the mRNA expression of TGF-β1, TGF-β3, CREB-1 in ATI group was higher than that in the sham operation group at all-time points (all p < 0.05), which reached the peak at 2 weeks after operation, decreased at 4 weeks, and significantly decreased at 6 weeks (all p < 0.001).@*CONCLUSION@#Gait behavior indexes are associated with Achilles tendon healing. The study gives an insight of TGF-β1, TGF-β3, CREB-1 changes in the coursing of Achilles tendon healing and these cytokines may be able to be used to regulate the Achilles tendon healing.

Updates in Management of Achilles Tendon Rupture: Simple Literature Review

Background: Achilles tendon rupture (AT) is considered a subversive injury for the young athletes since its fullrecovery takes12 months. In addition to this, there is escalation in the risk of re-injury of the same tendon.Objective: In this review, we aim to assess and evaluate Achilles tendon rupture mechanism of injury, and itsdiagnosis and management published in the current literature. Method: A comprehensive search was done usingbiomedical databases including Medline, and PubMed, for studies concerned with evaluation of Achilles TendonRupture published in English language. Keywords used in our search through the databases were “AchillesTendon Rupture Mechanism and Pathophysiology”, “Achilles Tendon Rupture Management”, and “AchillesTendon Rupture Diagnosis”. Conclusion: The incidence of Achilles tendon rapture among athletes is commonand increasing. Determining the best management option is still controversy among orthopedic surgeons. Opensurgery is associated with the lowest rates of re- rupture incidence, but increase risk of other complications.Percutaneous repair was found to have a low complications rate in comparison to open surgery, but it isassociated with increased risk of sural nerve injury. The recent studies have clearly demonstrated the effectivenessof functional rehabilitation techniques, with biotherapy as potential future for development.

Explore the Clinical Effect of Skeletal Muscle Ultrasound in the Diagnosis of Achilles Tendon Injury / 现代医院

Objective Explore the clinical value of ultrasonography in the diagnosis of skeletal muscle injury in the Achilles tendon .Methods Select visit from March 2016 to March 2017 period in orthopedic hospital 56 patients with Achil-les tendon injury , using a random number table group , the experimental group using diagnostic ultrasound skeletal muscles of the control group using diagnostic methods MIR , and ultimately by surgery as a diagnostic criteria between the two groups of patients with the diagnosis .Results Diagnostic accuracy rate of the experimental group were 96.42%.Skeletal muscle ul-trasound display achilles tendon rupture 12 patients , 6 patients with chronic Achilles tendon hyperplasia , swelling of the A-chilles tendon 6 patients, the diagnostic accuracy of the control group were 92.86%.Skeletal muscle ultrasound display A-chilles tendon rupture in 10 patients, 8 patients with chronic Achilles tendon hyperplasia , swelling of the Achilles tendon 3 patients.The results between the two groups of patients was statistically significant , that is P<0.05.Conclusion Ultra-sound in the diagnosis of skeletal muscle tendon injury in a significant clinical effect , but also has an affordable price , easy to operate and less damage to human advantage .It should be introduced .