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Platelet-rich plasma injection vs sham injection and tendon dysfunction in patients with chronic midportion achilles tendinopathy—Reply
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Kearney, Rebecca S. and Costa, Matthew L. (2021) Platelet-rich plasma injection vs sham injection and tendon dysfunction in patients with chronic midportion achilles tendinopathy—Reply. JAMA, 326 (19). pp. 1975-1976. doi:10.1001/jama.2021.16067
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Official URL: https://doi.org/10.1001/jama.2021.16067
Abstract
In Reply The entry criteria for our study1 were broad to reflect real-world practice rather than narrowing to smaller subgroups. To further replicate real-world practice, participants were recruited from general foot and ankle clinics rather than social media and sports medicine clinics. To be referred, patients had generally not improved with noninvasive management (eg, physiotherapy; n = 207), which may account for the long symptom duration, increased age, and increased body mass index of our participants, as noted by Dr Gremeaux and colleagues. Their letter also speculates that prior treatment (eg, injections and fluoroquinolones) could have altered tendon metabolism. However, only 34 of 240 participants had received prior injections; we do not have further information on fluoroquinolone use. We agree with Gremeaux and colleagues that characteristics such as severity, disease duration, and baseline functional status may affect outcome. Our primary analysis model was therefore adjusted for age, sex, laterality, and baseline Victorian Institute of Sport Assessment–Achilles score. Two prespecified subgroup analyses were performed, for laterality and duration of symptoms, because patients with bilateral tendinopathy and those with longer symptom duration may have worse outcomes. However, our secondary analyses confirmed the primary results. Tendinopathy subtypes (eg, calcification) were not reported in our study because of a lack of standardized descriptors to define such subtypes. After injection, study participants were not referred to physiotherapy for an eccentric loading program, as suggested by Gremeaux and colleagues. There is no consensus about concomitant interventions alongside PRP, and a previous randomized clinical trial about PRP published in JAMA2 was challenged for including physiotherapy because the eccentric loading program may mask the potential effect of PRP.
Item Type: | Journal Item | ||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||
SWORD Depositor: | Library Publications Router | ||||
Journal or Publication Title: | JAMA | ||||
Publisher: | American Medical Association (AMA) | ||||
ISSN: | 0098-7484 | ||||
Official Date: | 16 November 2021 | ||||
Dates: |
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Volume: | 326 | ||||
Number: | 19 | ||||
Page Range: | pp. 1975-1976 | ||||
DOI: | 10.1001/jama.2021.16067 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Reuse Statement (publisher, data, author rights): | ** From Crossref journal articles via Jisc Publications Router ** History: ppub 16-11-2021; issued 16-11-2021. | ||||
Access rights to Published version: | Restricted or Subscription Access |
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