A prospective comparative study to compare orthobiological PRP platelet rich plasma intra lesional injectional therapy compare to steroid injection in treatment of Achilles tendonitis and intractable plantar fasciitis a clinical follow up study for 2 Years

Background: Achilles Tendonitis and intractable Chronic Plantar Fasciitis are a common orthopedic condition that can prove difficulty in treatment successfully. Tendon injury often become chronic because of poor blood supply to these areas. The high rates of relapses of plantar fasciitis, with a wide complications rate of rupture tendon especially in Achilles Tendonitis, they were treated by local steroid injection. That lead to evaluate another Method in treatment of soft tissue inflammatory Tendonitis by the use of Orthobiologics method PRP Platelets Rich Plasma therapy offers a promising solution to accelerate healing of tendon injuries in treatment of these intractable tendonitis. Aim of study: We studied the effectiveness of the Orthobiologics PRP Platelets Rich plasma, intralesional injection in chronic inflammatory soft tissue Tendonitis Plantar Fasciitis, Achilles Tendonitis, in Compare to intralesional steroid injection treatment of chronic inflammatory soft tissue tendonitis to evaluate the success and relapse rate of inflammation process for 2 years follow up. Methods: Patients with inflammatory soft tissue Tendonitis, plantar fasciitis& Achilles Tendonitis not responded to a minimum of 1-year standard conservative management were offered PRP therapy. In this prospective comparative study of 100 patients with inflammatory soft tissue Tendonitis, Achilles Tendonitis and plantar fasciitis, in private clinic sector sharing with blood bank in Sulaimani teaching Hospital center of Sulaimaniyah city, from May 2010 till June 2012. were randomized according to inclusion exclusion criteria into two groups. Group A, 50 patients all of them with chronic inflammatory Tendonitis with failure of other modalities of conservative treatments, they receive PRP Platelets Rich Plasma injections of 3 to 5 ml PRP from blood of the same patient were collected & separated in plasma cell separation department of blood bank in Sulaimaniyah teaching Hospital center. Group B, 50 patients were treated by Steroid injection, for the same inflammatory soft tissue tendonitis, Achilles Tendonitis & plantar fasciitis. The follow up times were 12, and 24 months. Results: We used two important scoring systems for assessment & evaluation of the results of this procedure, during follow up assessment of these patients, there were no systemic or local complications were noted at any time. The pain was reported by patients according to VAS Score were (78.%) in 12 months & (80%) in 24 months, they have No pain, Mild or moderate pain in group A, were treated by PRP therapy. However, the VAS score for Cortisone are 25% at 12 months, 23% at 24 months for No pain level, mild and moderate pain scoring level, with 75%, 77% of severe pain and excruciating pain for same time of follow up, according to criteria of the Roles and Maudsley score for PRP at 12 months, 24 months results were rated 85%, 94% as excellent & good scoring, for group A, were PRP therapy used. However, the results for same time in group B, were used Cortisone therapy are 32%, 20% as excellent & good scoring rate. That meaning low rate of improvement with Cortisone usage in compared to high rate of improvement according to criteria of the Roles and Maudsley score, at the last follow-up (p<0.01). & Relapses of inflammations for second or third times. Conclusions: We concluded that intralesional injection of PRP resulted in safe, significant reduction of inflammatory process, sustained improvement of pain, with high rate of functional outcome in compare to steroid intralesional injection for treatment of inflammatory soft tissue tendonitis (Achilles Tendonitis and intractable Plantar Fasciitis) a Clinical Follow up Study for 2 Years was more effective and durable than cortisone injection for the treatment of chronic recalcitrant cases of plantar fasciitis.