Hi, good afternoon, today let's talk about Achilles tendon injuries or
tendon injuries in general around the foot and ankle as well as arthritic
conditions particularly ankle arthitis.
We've been very successful in
treating patients here with Achilles tendonitis, posterior tibial or anterior tibial tendinitis
or any kind of tendinitis around the foot and ankle
but my most exciting information is we have had very successful treatment with platelet-rich
plasma or shortened for PRP.
PRP for patients with complete Achilles tendon ruptures.
These were patients that were typically taken to surgery or taken to
surgery with a grafting or tendon transfers etcetera, but if we get them quick enough
our patients have all done very well with platelet-rich plasma and cast immobilization.
Now we have patients who return to full activity about the same time
compared to people that have undergone surgical intervention.
So let's talk about this PRP.
PRP basically is platelet-rich plasma.
We take about 10 cc's of the patient's blood, we centrifuge it in a special centrifuge
to concentrate and separate the platelets away from the red blood cells
and white blood cells and other inflammatory factors away from the
plasma that holds the platelets.
The platelets are healing cells like if you
cut yourself the platelets are gonna rush to clog up the bleed.
Platelets are also known as anti-inflammatory factor as well as the healing factors
in tendon injuries. So basically we're taking your blood, taking the healing substance from
your blood and using these platelets as soldiers and construction workers to
rebuild the tendons around the foot and ankle.
Again, we're most excited about this in complete Achilles tendon tears
if I get them early enough, we're able to go ahead and use this platelet gel.
My protocol is two sets of these injections about 2 to 3 weeks apart and casting
anywhere from six to eight weeks and I have an interesting video to follow that shows a patient
in less than a month out, this guy had a complete rupture of the Achilles tendon
when he was referred to me through the emergency room and he was
well prepared for surgery.
Luckily for him, we're able save him from the risk of surgery.
As we all know there are risks to surgery and
especially Achilles tendon surgery where there's not much fat in the back
so if it goes well, it's awesome.
Unfortunately, it doesn't always happen, we have patients
that are older diabetics and other immunocompromised states that have
Achilles tendon ruptures so we're able to go ahead and use this technology to our benefit
without the risk of surgery because if there is the dehiscence or
opening of the wound where the Achilles tendon surgery was done, there's going to
be a bad infection for sure and then the surgeon would have to go in and take out
all the sutures that are put in. They're typically non-absorbable sutures that
are used for Achilles tendon repairs
then you should braid it also
so these braided sutures will all have to be removed, the Achilles tendon has to be cleaned out
and a secondary surgery would need to be done, a big tendon transfer around the
ankle would need to be done to help to reinforce the Achilles tendon.
Now that has gone through two and possibly three surgeries in order to get this patient right again.
So we're able to avoid all this with platelet gel technology.
Now talking particularly about the Achilles tendon but this can work for most any
tendon around the foot and ankle.
So let's take you to the video of the patient at one month follow-up.
This is a male with Achilles tendon rupture on 3/11 now date of 4/3/2014.
The poor guy had a full Achilles tendon rupture with a divot at the Achilles tendon.
So we decided to treat this conservatively with platelet gel injection as you can see,
I mean when he first came to see us he he still had the black and blue from 3/11
but when he first came to see us he had no function,
no plantar flexion whatsoever and note the big divot right here where
the Achilles tendon was ruptured.
Now as you can see when I dorsiflex the Achilles tendon is intact,
I could feel the Achilles tendon right now all throughout this area,
there's no gaps noted.
Actually, the thickness of the Achilles tendon feels almost even completely normal right now.
So the Achilles tendon grew back from a rupture -- a full rupture
3/11 which now it's 4/3/14 less than a month.
Two platelet gel injections, two weeks apart, this is what we have right now.
So I'm gonna have this young lad go ahead and put his knee up.
We're gonna go ahead have --
push down on a gas pedal, back up, push down a gas pedal, back up, push down a gas pedal, back up.
Now you see that we have functioning Achilles tendon where we did not have
that less than a month ago. Let's move up and down. Up and down.
How was the procedure for you?
Pretty simple? "Pretty Simple."
I'll say a lot easier than going to surgery, no? "Yes."
Because surgery would entail... a surgical procedure would entail
making an incision from about here to here or even higher and
bringing down the Achilles tendon with a long incision and possible chance of
dehiscence which means the wound opens up or there's also that complication of
a of a blood clot when you're put into a cast and a lot of swelling, the chance of
getting a dehiscence or a wound here is very great back in the Achilles tendon area.
And when that happens then all the sutures need to be taken out and the Achilles tendon need be
washed out and the recovery will be prolonged. We decided to go for the platelet gel injections
because of the fact that number one, we didn't want the complications
but number two we did get him pretty early, he was referred to us by
the emergency room very quickly and before the Achilles tendon -- this is the
Achilles tendon area -- had a chance to contract up the leg.
Now the PRP is not going to work if the Achilles tendon retracted up the leg.
Luckily for him the emergency -- and he was smart enough go to the emergency room quickly,
the Achilles tendon did not have a chance to contract. So a platelet gel was injected
right into here, put him in a cast, he healed.
After the first injection we had about 50% growth and after the second one we have close to a
hundred percent of his Achilles tendon back already, but I'm still gonna put him
into a cast right now because protocol is I'm gonna have them in a cast for up
to six to eight weeks. We're gonna treat it like we did surgery and then
we're gonna get him to rehab.
That's about it .
Do you have any questions for me sir? "No."
So okay. Was the procedure exactly as I explained to you before?
"Yes it was."
Yes, okay well
let's take care of this.