SAN FRANCISCO — Patients with severe chronic plantar fasciitis who received a platelet-rich plasma injection had a more durable response than patients who received a cortisone injection, according to a presenter here.
“Platelet-rich plasma is significantly more effective than cortisone both in the short-term and the long-term treatment of these difficult patients. I think to speculate, this is probably the result of modulation of the local angiogenesis collagen turnover,” Raymond R. Monto, MD, said at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.
In the prospective, block-randomized study, 36 patients with severe chronic plantar fasciitis who failed traditional nonoperative treatments underwent pretreatment MRIs and ultrasounds consistent with plantar fasciitis. Patients in the first group were treated with a single ultrasound-guided injection of 40 mg of methylprednisolone at the injury site. The second group received a single ultrasound-guided injection of 3 mL of unbuffered autologous platelet-rich plasma (PRP) at the injury site. All patients were immobilized fully weight bearing in a cam walker for 2 weeks and started on home exercises before returning to normal activities.
The methylprednisolone group, with an average age of 59 years, failed 5.4 months of standard nonoperative management and had an average pretreatment AOFAS score of 52. The patients who received PRP injections, with an average age of 51 years, failed 5.7 months of standard nonoperative management and had an average pretreatment AOFAS score of 37.
Three months following treatment, the methylprednisolone group had a post-treatment average AOFAS score of 81, which decreased to 74 and 58 at 6 months and 12 months, respectively. Patients treated with PRP had a post-treatment average AOFAS score of 95 at 3 months, which stayed at 94 points for the 6-month and 12-month follow-up.
“It raises the question of whether or not that this may be an assistive device when traditional treatment fails,” Monto said.
For more information:
· Monto RR. Platelet-rich rich plasma is more effective than cortisone for chronic severe plantar fasciitis. Paper #51. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
Disclosure: Monto is on the speakers bureau and is paid consultant for Exactech Inc. This was an unfunded study.