EC is a 80 y/o patient referred for platlelet rich plasma (PRP) injections of his inflamed left Achilles tendon. Patient was active with no significant past medical history. He denied any traumatic injury but had a 6 month history of severe left Achilles pain which was constant in duration, 6/10 in severity and progressive. Treatment to date included physical therapy, trial of non-steroidal anti-inflammatory mediations and massage. PRP therapy was considedered due to patient’s failure to improve.
PRP therapy is the injection of a patients own platelets into the damaged/irritated tissue. RPR therapy is aimed at accelerating the healing process.
Physical examination was significant for the following: reduced flexion/extension of lumbar spine secondary to pain, decreased sensation along the left big toe and outside aspect of foot, decreased strength of left big toe and significant muscle banding in both the back and leg.
After the initial evaluation, an x-ray of the lumbar spine was obtained which was significant for instability of the several vertebral bodies(anterolisthesis) along with marked reduction in the disc height at L5/S1.
EC’s Achilles tendon problem was not responding to conventional therapy since no have bothered to look beyond the tendon itself. He had irritation of the left L5 and S1 nerve root which required treatment in addition addressing the Achilles tendon inflammation.
Looking at the bigger picture is essential for maximal clinical outcomes. This is the essential paradigm required as we move from joint replacement to joint restoration. Ortho 2.0 presents four principal elements previously discussed.
Ed underwent PRP therapy in addition to injection of platelet derived growth factors at the L5/S1 and S1 levels. He had reduction of his debilitating Achilles pain and headed off to florida for the back nine. I will report back upon his return.