Clinical outcome of adding injection of freeze-dried platelet-derived factor concentrate to operative treatment accompanied by an early rehabilitation for Achilles tendon rupture in high-level athletes

Abstract

Background

Achilles tendon ruptures (ATRs) often occur in competitive athletes. Various studies have been conducted to improve the treatment outcomes for ATRs, but the results remain unsatisfactory for athletes.

Purpose

To review our experiences of adding injections of freeze-dried platelet-derived factor concentrate (FD-PFC) to surgical treatment with an early rehabilitation for ATRs in high-level athletes.

Methods

We retrospectively analyzed 8 high-level athletes (Tegner activity score ≥8) with ATR, who received postoperative injection of FD-PFC in addition to surgical treatment with an early rehabilitation protocol between May 2019 and November 2021. In all patients, surgery was performed using the modified side-locking loop suture technique, and an early rehabilitation protocol was implemented postoperatively. The prepared FD-PFC was injected into the Achilles tendon suture site under ultrasound guidance at 4 weeks postoperatively. Evaluation of the clinical outcomes included the following factor: the American Orthopedic Foot and Ankle Society ankle-hindfoot scale (AOFAS) score measured preoperatively and at one year postoperatively, time to ability to perform 20 continuous double- and single-leg heel raises (DHR/SHR), time to return to the original sport, and complications related to surgery or FD-PFC injection. In addition, magnetic resonance imaging (MRI) was performed for all patients at 12 and 24 weeks postoperatively to evaluate Achilles tendon maturation.

Results

The 8 patients consisted of 7 males and one female athletes with a mean age of 28.5 ± 5.2 years (range, 23–39 years) at the time of surgery. All patients were high-level athletes with a mean Tegner activity score of 9.0 ± 0.5 (range, 8–10). The mean AOFAS score improved significantly from 36.0 ± 9.4 preoperatively to 96.8 ± 3.6 at one year postoperatively (p < 0.001). The mean time to be able to perform 20 continuous DHR and 20 continuous SHR was 6.8 ± 0.8 weeks and 10.1 ± 1.6 weeks, respectively. All patients could return to their original sport at pre-injury levels with the mean time of 18.3 ± 2.7 weeks. Also, there were no complications related to surgery or injection. Furthermore, T2-weighted MRI showed the high signal intensity of the sutured tendon in 25 % (2 of 8 patients) at 12 weeks and 0 % (0 of 8 patients) at 24 weeks postoperatively.

Conclusions

The addition of FD-PFC injections to surgical treatment with an early rehabilitation protocol could provide satisfactory results for high-level athletes with ATRs, enabling them early return to their original sports at pre-injury level. This treatment option may be useful for athletes with ATRs.