I Did My Own Ultrasound Guided PRP Injection For Achilles Tendon Partial Tear, including PRP Dose Analysis

Hello, my name is Doctor Don Buford over at Texas Ortho Biologics. Got a great little case study here on using leukocyte rich PRP for a partial Achilles tendon tear. We're going to do this under Ultrasound guidance.

I put this up just for reference, just to remind everyone what's in PRP and why we're using this for orthopedic indications. We have a lot of different proteins, growth factors, cytokines, and even some plasma proteins that are all beneficial at certain stages of the healing process.

This is the specific PRP protocol for this case study. I drew 60 cc's of blood, and that was drawn into a 60 cc syringe. 6 cc's of ACDA was already in the syringe, so technically we only drew 54 cc's of blood. Added that to the 6 cc's of ACDA. That gives us a 60 cc syringe full.

The first PRP spin was for 2.5 minutes at an RCF of 2170.

We then take the uh plasma portion and put that into a second container, and the second spin is at 5 minutes at the same RCF of 2170. The end leukocyte rich PRP volume was 2 ccs. Remember, we started with 60.

Now, what about the platelet dose response curve for Achilles tendinopathy? We actually don't know. There's been some studies in animals, very, very few human outcome studies, and really, uh, nothing near um satisfactory for having even a beginning dose response curve.

This is the hematology analysis on the PRP that was done today. You can see we started on the left with a white blood cell count of 5.4. The granulocyte percentage was 60.4, and the platelet count was 207, all within normal range.

After making the PRP, which was uh 2 cc volume, the WBC count was 8.5, which is a 1.6 times increase in the leukocyte concentration. So it meets the criteria of being leukocyte rich, although it's not extremely leukocyte rich.

The granulocyte percentage dropped to 2.9%, and so that effectively means that 88% of the inflammatory granulocyte cells were removed in this process.

The RBC count dropped such that 96% of the RBCs were removed. So this is not an orthobiologic rich in in inflammatory RBCs either. And then finally, one of the metrics that we all follow, the platelet count. The platelet count increased to 2,069. That is a 10x platelet concentration increase.

And what that means for platelet dosing. Remember dosing is volume times concentration. So the volume is 2 cc's, the platelet count is 2,069. When you do that math, you come up with about 4.1 billion platelets in 2 ccs. So that's the platelet dose.

And so, this is what we did today. Platelet dose of 4 billion. We have no idea what the outcome is going to be because we just did it today, about an hour and a half ago, but at least we have one spot on the dose response curve that we can start to track.

This is the actual procedure. This is done on a conica Minolta machine. This is the calcaneus here. This hypeechoic line is the calcaneus. This is the Achilles coming off of the calcaneus.

The area of maximal Pain is right in this region here, right in the middle of the screen, and what you'll see here when we go into the short axis view is it's the left side.

Of this Achilles tendon that's partially torn. If you can see my pointer, it's right here.

And this happens to be the medial side of that Achilles tendon. So this is where the Pain is. When you look at the lateral side, you can see these fibers have a normal appearance.

When you look over here medially, you can start to see the tearing in the medial aspect. Here we've enlarged the view.

Again, laterally, tendon looks pretty good. Medially, when we go to the area of maximal Pain, you see this hypoechoic region. So, here's the needle coming in. This is a 25 gauge needle. This is a medial Approach. We're going to needle the tendon multiple times, and then we're going to inject our PRP intratendinous, and then also a little bit uh peritendinous.

You can see how well we can see the needle.

And again, this is just a 25 gauge needle. Nothing special about it. It's a short 25 gauge needle. We're needling the hypoechoic region of this tendon.

And then we'll go ahead and inject. Once we inject, you'll see some hypeechoic signal change that represents the PRP that we just injected. And so now we've injected.

And you can even see some fluid around the tendon here, that's PRP.

And so we'll see how this goes.

Thank you.