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Lin M, Li W, Ni X, Sui Y, Li H, Chen X, Lu Y, Jiang M, Wang C. Growth factors in the treatment of Achilles tendon injury. Front Bioeng Biotechnol 2023; 11:1250533. [PMID: 37781529 PMCID: PMC10539943 DOI: 10.3389/fbioe.2023.1250533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
Achilles tendon (AT) injury is one of the most common tendon injuries, especially in athletes, the elderly, and working-age people. In AT injury, the biomechanical properties of the tendon are severely affected, leading to abnormal function. In recent years, many efforts have been underway to develop effective treatments for AT injuries to enable patients to return to sports faster. For instance, several new techniques for tissue-engineered biological augmentation for tendon healing, growth factors (GFs), gene therapy, and mesenchymal stem cells were introduced. Increasing evidence has suggested that GFs can reduce inflammation, promote extracellular matrix production, and accelerate AT repair. In this review, we highlighted some recent investigations regarding the role of GFs, such as transforming GF-β(TGF-β), bone morphogenetic proteins (BMP), fibroblast GF (FGF), vascular endothelial GF (VEGF), platelet-derived GF (PDGF), and insulin-like GF (IGF), in tendon healing. In addition, we summarized the clinical trials and animal experiments on the efficacy of GFs in AT repair. We also highlighted the advantages and disadvantages of the different isoforms of TGF-β and BMPs, including GFs combined with stem cells, scaffolds, or other GFs. The strategies discussed in this review are currently in the early stages of development. It is noteworthy that although these emerging technologies may potentially develop into substantial clinical treatment options for AT injury, definitive conclusions on the use of these techniques for routine management of tendon ailments could not be drawn due to the lack of data.
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Affiliation(s)
- Meina Lin
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Wei Li
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
- Medical School, Shandong Modern University, Jinan, China
| | - Xiang Ni
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Yu Sui
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Huan Li
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Xinren Chen
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Yongping Lu
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Miao Jiang
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Chenchao Wang
- Department of Plastic Surgery, The First Hospital of China Medical University, Shenyang, China
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Vaidya SR, Sharma SC, Al-Jabri T, Kayani B. Return to sport after surgical repair of the Achilles tendon. Br J Hosp Med (Lond) 2023; 84:1-14. [PMID: 37235667 DOI: 10.12968/hmed.2022.0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Achilles tendon rupture is among the most common sports injuries. In patients with high functional demands, surgical repair is preferred to facilitate early return to sporting function. This article reviews the literature and provides evidence-based guidance for return to sport after operative management of Achilles tendon rupture. A search was performed using PubMed, Embase and Cochrane Library for all studies reporting on return to sport after operative management of Achilles tendon rupture. The review included 24 studies reporting on 947 patients, and found that 65-100% of patients were able to return to sport between 3 and 13.4 months post-injury, with incidence of rupture recurrence 0-5.74%. These findings will help patients and healthcare professionals plan a recovery timeline, discuss athletic functionality post-recovery, and understand complications of repair and risk of tendon re-rupture.
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Affiliation(s)
| | | | - Talal Al-Jabri
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
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Daley P, Menu P, Louguet B, Crenn V, Dauty M, Fouasson-Chailloux A. Interest of platelet rich plasma in Achilles tendon rupture management: a systematic review. PHYSICIAN SPORTSMED 2022; 50:463-470. [PMID: 34392780 DOI: 10.1080/00913847.2021.1969216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Acute Achilles tendon rupture (ATR) is a disabling sport-related injury. Its management involves conservative treatment with early weight-bearing or surgical treatment. Platelet-rich plasma (PRP) has raised interest as an adjuvant for treatment, given its properties on tendon repair and its anti-inflammatory effect. We aimed to assess clinical impact of PRP use in surgical or non-surgical treatment of acute ATR: range of motion, muscle strength, function, return to sport and adverse events. METHOD A systematic literature research was performed using PubMed, ScienceDirect, and Google Scholar databases to collect studies reporting clinical outcomes after acute ATR treated with PRP. RESULTS Eight studies were eligible and included 543 acute ATR. Four were randomized comparative studies. A total of 128 patients were treated surgically and 415 were treated conservatively, 271 received PRP injection. Five studies described the type of PRP used, which was variable. Only one study including 12 patients found significant outcomes in favor of the PRP group, with a 4-week earlier recovery of a normal range of motion and a 7-week earlier return to running. No difference in clinical or morphological evaluations, strength measurement, and functional outcomes was found in other studies both at short and long-term. PRP did not seem to modify the frequency of adverse events. CONCLUSIONS Data are not clearly in favor of a significant effect of the PRP use for treatment of ATR. There might be a slight effect on evolution during the first months. Its interest should be assessed in future studies with strong methodology.
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Affiliation(s)
- Pauline Daley
- Chu Nantes, Service De Médecine Physique Et Réadapatation Locomotrice Et Respiratoire, Nantes, France.,Chu Nantes, Service De Médecine Du Sport, Nantes, France
| | - Pierre Menu
- Chu Nantes, Service De Médecine Physique Et Réadapatation Locomotrice Et Respiratoire, Nantes, France.,Chu Nantes, Service De Médecine Du Sport, Nantes, France.,Irms, Institut Régional De Médecine Du Sport, Nantes, France.,Inserm, Umr 1229, RMeS, Regenerative Medicine and Skeleton, Université De Nantes, Oniris, Nantes, France
| | - Bastien Louguet
- Chu Nantes, Service De Médecine Du Sport, Nantes, France.,Irms, Institut Régional De Médecine Du Sport, Nantes, France
| | - Vincent Crenn
- Chu Nantes, Clinique Chirurgicale Orthopédique Et Traumatologique, Nantes, France
| | - Marc Dauty
- Chu Nantes, Service De Médecine Physique Et Réadapatation Locomotrice Et Respiratoire, Nantes, France.,Chu Nantes, Service De Médecine Du Sport, Nantes, France.,Irms, Institut Régional De Médecine Du Sport, Nantes, France.,Inserm, Umr 1229, RMeS, Regenerative Medicine and Skeleton, Université De Nantes, Oniris, Nantes, France
| | - Alban Fouasson-Chailloux
- Chu Nantes, Service De Médecine Physique Et Réadapatation Locomotrice Et Respiratoire, Nantes, France.,Chu Nantes, Service De Médecine Du Sport, Nantes, France.,Irms, Institut Régional De Médecine Du Sport, Nantes, France.,Inserm, Umr 1229, RMeS, Regenerative Medicine and Skeleton, Université De Nantes, Oniris, Nantes, France
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