Conservative treatment approach of Achilles tendon ruptures with orthobiologics: case series

The Achilles Tendon (AT) is one of the strongest tendons in the body; it is also the most frequently ruptured tendon with increasing incidence. Unlike other tendons, AT ruptures are highly correlated with physical activity. In fact, more than 75% of AT ruptures occur during sportive maneuvers. AT rupture is a prevalent and debilitating condition linked to overuse injuries in the ankle and foot. Managing this condition is often complex due to the inadequate vascularity of tendons, relying on synovial fluid diffusion for nutrient supply. The weakened strength resulting from AT rupture can heighten the risk of further complications. While surgical interventions are commonly employed as the primary treatment, challenges may persist in the postoperative period. In contrast, therapeutic interventions with orthobiologics and shockwave therapy have demonstrated notable success in regenerative procedures. In this case series, 3 patients received multiple sessions of bone marrow aspirate, injectable platelet-rich fibrin and extracorporeal shockwave therapy. In the initial sessions, they already exhibited satisfactory healing results as assessed through functional measures, MRI findings, and pain scores. The patients successfully resumed sports activities without complaints, and follow-up MRI scans indicated evident signs of AT restoration. This case series highlights the safe and effective use of autologous orthobiologic products and shockwave therapy as viable alternatives for enhancing the healing process in musculoskeletal tissue injuries.
Methods: Patients received the following treatments: a single Bone Marrow Aspirate (BMA) and then Injectable Platelet-Rich Fibrin (i-PRF) injections fortnightly for 12 weeks, in addition to a weekly session of Extracorporeal Shock Wave Therapy (ESWT). The patients were reassessed at all follow-ups with physical evaluation and ultrasound examination. In addition, we also recommended lifestyle adjustments emphasizing the importance of sleep, diet and metabolism for better tissue recovery. At the end of 12 weeks, we requested a new magnetic resonance imaging of the left ankle for a comparative study, which revealed a significant improvement in the radiological findings. The results of this case report suggest that the application of orthobiologics plus ESWT expedites healing and rehabilitation time and reduces costs and risks inherent to the surgical procedure, which is particularly important in elderly patients and/or with co –morbidities. This approach may therefore represent a viable alternative for the accelerated recovery of musculoskeletal tissue injuries with safety and efficacy.

 

Keywords: Case Series; Achilles Tendon; Bone Marrow Aspirate; Platelet-Rich Fibrin; Shockwave Therapy; Regenerative Medicine.