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AimSlow recovery and disability after Achilles tendon rupture are major challenges. Platelet Rich Plasma (PRP) is an autologous supraphysiological concentration of platelets from whole blood that has demonstrated positive cellular and physiological effects on healing in the laboratory and is widely used in musculoskeletal treatments. However, evidence from adequately powered, robust clinical trials is lacking. We aimed to determine the clinical efficacy of PRP for treatment of acute Achilles tendon rupture.Methods230 adults starting Achilles rupture non-surgical management within 12 days of injury were randomised to PRP injection or dry needle insertion to the rupture gap, under local anaesthetic. Participants were blinded to study treatment and received standardised rehabilitation. Blinded outcome assessments were at 4, 7, 13, and 24 weeks. The primary outcome was muscle-tendon function assessed by work performed during the heel-rise endurance test (HRET), measured with the Limb Symmetry Index (LSI) (0–100%; 100% denotes full recovery) at 24 weeks. Secondary outcomes were the Achilles Tendon Rupture Score (ATRS), quality of life (SF-12), pain and goal attainment. The trial was prospectively registered.ResultsOf 230 participants, 114 were allocated to PRP injection (103 received PRP), 116 were allocated to and received placebo. At 24 weeks, 201/230 (87%) completed the HRET and 214/230 (93%) completed patient reported outcomes. Participant characteristics between the groups were similar. There was no difference between groups at 24 weeks in LSI (mean difference = -4.373; 95% CI −11.217 to 2.471; p=0.195). There were no differences in the secondary outcomes and adverse event rates.ConclusionThis trial design and standardised PRP preparation secure the first robust clinical trial evidence for PRP in managing Achilles tendon rupture, and suggest that PRP offers no patient benefit. The use of PRP in soft tissue injuries must be questionable unless supported by equally robust evidence indicating positive outcomes.

Introduction Ankle supports are routinely issued to patients following ankle injury and surgery [Lin et al. 2010]. Patients may be advised to use Tubigrip (elasticated tubular bandage), a stirrup brace or a type of removable walker boot (Figure 1). The primary differences in support design are the extent and direction of mechanical limitation to ankle joint motion. One of the main aims of the initial phase of rehabilitation after injury or surgery is to optimise the recovery of a normalised walking gait pattern. Aim To determine the effects of ankle supports on gait symmetry in healthy adults. Methods Participants were 18 healthy adult volunteers. This study was a randomised three-treatment, three-period, cross-over design. The order of ankle supports tested was balanced using Latin squares. Outcomes: 1) step length and single limb support time symmetry indices (SI). SI are an expression of the relationship between the injured and uninjured limb [Hodt-Billington et al. 2011]. The SI have a minimum of 0 (perfect symmetry) and 0.1 is equivalent to 10% asymmetry, 0.5 is 50% asymmetry and so on. 2) step width (cm). These temporo-spatial gait parameters were measured on the GAITRite® electronic walkway system (CIR Symptoms, Havertown, PA, USA). The concurrent validity of GAITRite® has been established against the VICON® system [Webster et al. 2005]. Participants walked across the electronic walkway six times in each support (twice at slow, preferred and fast walking speeds). Gait outcomes were normalised for walking velocity by use of multilevel modelling. Results Participants were on average 42 (SD 13) years old and 88% were female. The walker boot resulted in gait abnormalities compared with Tubigrip. There was greater asymmetry in step length in the walker boot when compared to Tubigrip by a 10% margin (95% CI 9 to 12%, p Discussion Walker boots induce step length and single limb support time asymmetry and widen step width compared with Tubigrip in non-pathological gait. There are no important differences in gait in an ankle stirrup brace compared with Tubigrip. Further research is required to directly compare the effects of these ankle supports in clinical populations to further inform clinical decision making. References Alfredson, H. et al., Am J Sport Med. 1998;26(3):360–366 Jarvinen, T. A. et al., Foot Ankle Clin. 2005;10(2):255–266 Malliaras, P. et al., Sports Medicine (Auckland, N. Z.), 43(4):267–286