Re: Factors associated with positive outcomes of platelet-rich plasma therapy in Achilles tendinopathy
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LETTER TO THE EDITOR
Re: Factors associated with positive outcomes of platelet‑rich plasma therapy in Achilles tendinopathy Michele Abate1 · Luigi Di Carlo1 · Alberto Belluati2 · Vincenzo Salini3 Received: 22 March 2020 / Accepted: 23 April 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Dear Editor, We would like to thank Doctor Marc Russo and colleagues for their comment and suggestion to revise our study [1] from a new interesting point of view. We reanalyzed the data stratifying the patients by the number of factors associated with a clinically evident outcome (defined as a VISA-A score increase ≥ 20 points), namely male gender, age ≤ 40 years, BMI ≤ 25, and symptom duration ≤ 6 months at time of injection procedure. As shown in Table 1, out of 84 patients with mid-portion Achilles tendinopathy treated with platelet-rich plasma, none of the previously reported positive prognostic factors was found in 6 patients, 1 prognostic factor in 20, 2 in 23, 3 in 21, and 4 in 14 participants. None of the patients with no predictive factor showed a satisfactory outcome, whereas a gradual increase in the percentage of satisfactory outcomes was observed in relationship with the number of the predictive variables. The difference observed comparing the groups each other in progression (group A vs B, group B vs C, and so on) did not reach the level of statistical significance, this result being probably due to the small number of patients included in the analysis. On the contrary, the difference was clearly significant (p = 0.001) when the groups 2, 3, and 4 were compared with the groups 1 and 0. It may be inferred that the probability to get a positive clinical outcome is very high (~ 80%) when all the predictive
Table 1 Comparison between groups on the basis of positive outcomes Group
No. of predictive factors
No. of Outcomes* (29) cases (84)
A B C D E
0 1 2 3 4
6 20 23 21 14
0 1 (5%) 6 (26%) 11 (52.3%) 11 (78.5%)
p^
0.57 (B vs A) 0.06 (C vs B) 0.07 (D vs C) 0.11 (E vs D)
*Based on the number of clinically evident outcomes, the percentage of positive outcomes in each group are reported in brackets ^The comparisons between each group were performed in progression
factors are associated, whereas it is absent or very low when they are all lacking or only one is present. As suggested, we did not include the adherence to eccentric training among the variables considered as predictors of positive clinical results. Indeed, the rehabilitation procedure is performed after the injection and therefore cannot be used for the patients selection. However, the significant association with a clinically evident outcome (as shown in our paper) provides a scientific basis to its systematic implementation.
Compliance with ethical standard * Michele Abate [email protected] 1
Department of Medicine and Science of Aging, University G. D’Annunzio, Chieti-Pescara, Via dei Vestini 31, 66013 Chieti Scalo, CH, Italy
2
Division of Orthopedics and Traumatology, Santa Maria Delle Croci Hospital, Ravenna, Italy
3
Di
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