Resolution of Bilateral Achilles Tendinosis Following High-Concentration Platelet-Rich Plasma Therapy: A Case Report
Hassan Mubark
ABSTRACT
Background: Achilles tendinosis is a chronic degenerative tendon disorder that may be resistant to conservative treatment. Platelet-rich plasma (PRP), a concentrated source of platelet-derived growth factors and signalling proteins, has emerged as a biological treatment option for chronic tendon pathology.
Case Presentation: A 56-year-old woman with a background of Crohn’s disease treated with Pentasa presented with a 5-month history of symptomatic bilateral Achilles tendinopathy following an injury, involving the left mid-portion and right distal Achilles tendon. Symptoms persisted despite extensive conservative management, including analgesia, anti-inflammatory medication, physiotherapy, footwear and orthotic measures, and extracorporeal shock wave therapy.
Baseline musculoskeletal ultrasound demonstrated significant tendinopathic changes, with marked thickening of the left mid-portion and right distal Achilles tendons, each measuring approximately 11.2 mm. Given the persistence of symptoms despite conservative treatment, the patient underwent ultrasound guided PRP therapy, with PRP precisely administered into the pathological tendon substance and surrounding paratenon. PRP was prepared using the Arthrex ACP® Double-Syringe System, with centrifugation at 1,500 RPM for 5 minutes, producing a platelet concentrate of up to approximately three times the patient’s baseline platelet concentration.
Outcome: Clinical improvement became evident approximately two months after treatment and progressed thereafter. At nine-month follow-up, the patient reported complete resolution of bilateral Achilles symptoms, restoration of function, and no recurrence. Follow-up ultrasound demonstrated marked structural improvement, with reduction in tendon thickening and resolution of the previously abnormal morphology. Most notably, the right distal Achilles tendon decreased from approximately 11.2 mm before treatment to 7 mm after treatment, consistent with normalization of tendon thickness.
Conclusion: This case demonstrates an excellent clinical and ultrasonographic outcome following precisely targeted ultrasound-guided intratendinous and paratenon PRP therapy for bilateral Achilles tendinosis refractory to extensive conservative management. The findings support the potential role of targeted PRP therapy as a biological treatment option for persistent Achilles tendinopathy. Future prospective studies involving larger patient cohorts, standardized PRP preparation and injection protocols, objective clinical and ultrasound outcome measures, and longer-term follow-up are recommended to confirm treatment efficacy, durability of response, and optimal patient selection.
