Two-year outcomes in adults with acute Achilles tendon ruptures are similar with PRP and placebo

Reference

Keene DJ, Alsousou J, Harrison P, et al, for the PATH-2 Trial group. Platelet-rich plasma injection for acute Achilles tendon rupture: two-year follow-up of the PATH-2 randomized, placebo-controlled, superiority trial. Bone Joint J 2022;104-B(11):1256-1265.

Synopsis

These authors randomized adults with clinically diagnosed acute complete mid-substance Achilles tendon ruptures to receive a single platelet-rich plasma injection (PRP; n = 114) or “placebo” (insertion of a dry needle; n = 116). The injections were performed using clinical landmarks. After the injections, all the patients’ ankles were immobilized for at least 3 weeks. After 6 weeks, the patients could resume full weight-bearing and were referred for supervised physical therapy. At the end of 24 weeks, (94% follow-up), there were no differences in pain, function, or re-tears. At the end of 2 years (77% follow-up), there was still no difference in pain, function, or re-tears between the treatment groups. Although the participants were supposed to have been masked to the intervention, the intervention group had 55 mL blood drawn compared with 5 mL in the placebo group; a potentially noticeable difference that could unmask the interventions. So, we have yet another study biased to favor the intervention that failed to find that the intervention — in this case, PRP — is any better than placebo.