Tendon Repair
The aim of the Tendon theme research programme is to achieve translation from basic to clinical research. There have been several basic science studies that have looked into the regeneration of ruptured tendon using biological agents such as platelets. This sub-theme aims to utilise these findings for the benefit of patients with ruptured tendon.
New, fast and efficient treatments of incapacitating and painful ruptures and tears of tendons, including Achilles and rotator cuff, are an urgent and growing clinical and societal need. Platelets play a major role in haemostasis and in the healthy response to injury, and have been proposed as therapeutic agents for enhancing repair of tendon injuries, with small and large animal models demonstrating their potential. Synergetic effects with mechanical stimuli, known to be active in promoting tendon healing, are likely to play a significant role.
Tendon injuries are common and can be incapacitating for months. Achilles tendon is the most injured tendon in the human body (20% of all tendon ruptures). The incidence of Achilles tendon rupture is increasing and currently averages 8.5 -12 / 100,000 inhabitants per year. For Achilles tendon ruptures alone, the estimated UK societal costs (acute healthcare and lost days at work) are £75M per year. Further, current treatments are associated with a significant risk of Achilles re-rupture of up to 15%. New cost-effective treatments that reduce both the risk of re-rupture and time to functional healing are urgently needed to address this challenge.
Platelets Rich Plasma (PRP) is easily obtainable, low cost and low risk and its possible beneficial outcome holds promise for a new regenerative treatment that reduces both the risk of re-rupture and time to functional healing. This research has great potential both at short and longer time scales for the development of regenerative therapies for tendon injuries in other sites and for other musculoskeletal diseases.
The research project proposed here has major potential in both the short and longer term for the development of regenerative therapies for musculoskeletal disease. Data from the project will provide input into protocols for treatment administration and rehabilitation of Achilles rupture. Our novel multidisciplinary approach will help consolidate the evidence for PRP not just in tendons but also other soft and hard tissues. The project will involve investigating PRP effect at cellular, tissue and clinical level, to produce level one evidence of PRP application. The study will include in-depth analysis of the platelet function after activation and in tissues. The randomised control trial will offer a high level of evidence in regard to the clinical efficacy of PRP in regeneration of tendon.
The successful completion of the pilot clinical study, which is using elastography for a functional outcome measure, together with evidence from the laboratory studies, will form the basis for a 2011 application to the Health Technology Assessment programme to provide for a multi-centre study to establish this treatment nationally.
Outline of the trial impact;
• Demonstrate clinical efficacy of PRP in Achilles ruptures in clinical trials
• Provide novel ultrasound functional imaging tool for tendon surgery outcome measurement
• Promote Oxford as the UK centre of excellence for tendon injury research and treatment
The BRC has allowed us to expand our translational research by freeing up the time of investigators, so that they can concentrate on research. It has allowed us to take our trials to bedside and has permitted us to look at treatment types not previously studied closely in Oxford.
The Tendon Theme has three components:
• PATH (Platelet Rich Plsama in Accelerated Tendo-Achilles Healing)
• FUSE (Functional UltraSound Elastography)
• Genetic Influences in Achilles Tendon Rupture
