Platelet rich Plasma in Achilles Tendon Healing 2 (PATH-2) trial: protocol for a multicentre, participant and assessor-blinded, parallel-group randomised clinical trial comparing platelet-rich plasma (PRP) injection versus placebo injection for Achilles tendon rupture

Joseph Alsousou, David J Keene, Philippa A Hulley, Paul Harrison, Susan Wagland, Christopher Byrne, Michael Maia Schlüssel, Susan J Dutton, Sarah E Lamb, Keith Willett, Joseph Alsousou, David J Keene, Philippa A Hulley, Paul Harrison, Susan Wagland, Christopher Byrne, Michael Maia Schlüssel, Susan J Dutton, Sarah E Lamb, Keith Willett

Abstract

Background: Achilles tendon injuries give rise to substantial long-lasting morbidity and pose considerable challenges for clinicians and patients during the lengthy healing period. Current treatment strategies struggle to curb the burden of this injury on health systems and society due to lengthy rehabilitation, work absence and reinjury risk. Platelet-rich plasma (PRP) is an autologous preparation that has been shown to improve the mechanobiological properties of tendons in laboratory and animal studies. The use of PRP in musculoskeletal injuries is on the increase despite the lack of adequately powered clinical studies.

Methods and design: This is a multicentre randomised controlled trial to evaluate the efficacy and mechanism of PRP in patients with acute Achilles tendon rupture (ATR). All adults with acute ATR presenting within 12 days of the injury who are to be treated non-operatively are eligible. A total of 230 consenting patients will be randomly allocated via a remote web-based service to receive PRP injection or placebo injection to the site of the injury. All participants will be blinded to the intervention and will receive standardised rehabilitation to reduce efficacy interference.Participants will be followed up with blinded assessments of muscle-tendon function, quality of life, pain and overall patient's functional goals at 4, 7, 13, 24 weeks and 24 months post-treatment. The primary outcome is the heel-rise endurance test (HRET), which will be supervised by a blinded assessor at 24 weeks. A subgroup of 16 participants in one centre will have needle biopsy under ultrasound guidance at 6 weeks. Blood and PRP will be analysed for cell count, platelet activation and growth factor concentrations.

Ethics and dissemination: The protocol has been approved by the Oxfordshire Research Ethics Committee (Oxfordshire Research Ethics Committee A, reference no 14/SC/1333). The trial will be reported in accordance with the CONSORT statement and published in peer-reviewed scientific journals.

Trial registration number: ISRCTN: 54992179, assigned 12 January 2015. ClinicalTrials.gov: NCT02302664, received 18 November 2014. UK Clinical Research Network Study Portfolio Database: ID 17850.

Keywords: achilles tendon rupture; platele; platelet rich plasma; prp; tendon Injury; tendon injection.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Making autologous PRP in the PATH-2 study. (A) A whole blood sample is taken. (B) The Magellan Autologous Platelet Separator System is used to produce PRP. (C) The resulting PRP is collected in a syringe for injection into the Achilles tendon rupture gap. (D) The injection is delivered in the tendon rupture gap. PATH-2, Platelet Rich Plasma in Achilles Tendon Healing 2; PRP, platelet-rich plasma.
Figure 2
Figure 2
The patient pathway for the main study. The substudies are not shown in this diagram. NHS, National Health Service; PRP, platelet-rich plasma.

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