Therapeutic Efficacy of Combined Extracorporeal Shock Wave Therapy and Platelet-Rich Plasma Therapy in a Rat Model of Acute Achilles Tendinopathy.

BACKGROUND

Extracorporeal shock wave therapy (ESWT) and platelet-rich plasma (PRP) therapy are effective treatments for tendinopathy; however, in some cases, these monotherapies are ineffective, leading to a delayed return to competition for athletes or the need for surgical intervention in middle-aged and older patients, creating challenges in clinical practice.

PURPOSE/HYPOTHESIS: Few clinical reports have examined the synergistic therapeutic effects of combined ESWT and PRP therapy in fields other than tendinopathy, such as pseudarthrosis. The authors hypothesized that the combined use of ESWT and PRP would exert a synergistic therapeutic effect on tendon disorders. Consequently, when compared with monotherapy, the effects would be observed earlier, promoting pain relief and tendon healing. This study aimed to evaluate the therapeutic efficacy of combined ESWT and PRP therapy in a rat model of acute Achilles tendinopathy.

STUDY

DESIGN

Controlled laboratory study.

METHODS

Fifty male Sprague-Dawley rats (10 weeks old) were randomly assigned to control, sham, ESWT, PRP, and combined treatment (E+P) groups. Collagenase-induced Achilles tendinopathy was established only in the left hindlimb of all mice, except those in the control group, on day -7. The ESWT, PRP, and E+P groups were administered ESWT on day 0 or injected with PRP on day 1 (stored at -30°C before injection). The load ratios between the injured and healthy hindlimbs were measured on days 0, 7, 14, 21, and 28. Pathologic evaluation and Achilles tendon scoring were performed on day 28.

RESULTS

On day 0, the load ratios of the injured limbs were significantly decreased in all groups, except the control group. On day 7, the ESWT and PRP groups demonstrated significant improvements in the ratios as compared with the sham group. The E+P group showed significantly superior improvement when compared with both groups. Pathologic analysis revealed remarkable tendon healing in the E+P group, which significantly outperformed ESWT and PRP monotherapy.

CONCLUSION

ESWT combined with PRP administration produces a synergistic effect, resulting in earlier pain relief and better tendon repair than monotherapy alone.

CLINICAL RELEVANCE: The combined use of ESWT and PRP may offer an enhanced therapeutic strategy for tendinopathies in clinical settings.