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Role of Human Amniotic Membrane and PRF Membrane in Achilles Tendon Repair: A Comparative Clinico – Radiological Study

Amit Lakhani, MS, DNB, MRCPS(Glassg), MNAS
INDIA

Role of Human Amniotic Membrane and PRF Membrane in Achilles Tendon Repair: A Comparative Clinico – Radiological Study

Amit Lakhani, MS, DNB, MRCPS(Glassg), MNAS, INDIA Dr Ena Sharma, MDS, INDIA

MMM COLLEGE AND HOSPITAL,SOLAN, SOLAN, Himachal Pradesh, INDIA

2021 Congress Abstract Presentation 4 minutes Not yet rated

Anatomic Location

Ankle / Foot / Calf

Anatomic Structure

Tendon

Diagnosis / Condition

Tears

Treatment / Technique

Biologics Repair / Reconstruction

Diagnosis Method

MRI

Sports Medicine

Sport Specific Injuries

Tendon

Achilles Tendon

This media is available to current ISAKOS Members, Global Link All-Access Subscribers and Webinar/Course Registrants only.

Summary: Achillies tendon repair with Human Amniotic membrane Vs Platelet rich fibrin

Introduction-
The Achilles tendon is the largest and most powerful tendon of human body. Despite being the thickest tendon in human body it is one of the common tendon to get rupture. Rerupture is one of the most frequent complications reported after TA tendon repair. Hypocellularity and hypovasularity are reasons for weaker construction after TA repair. Augmentation has been used in tendon repair to strengthen the repair site and reduce the risk of rerupture. Human Amniotic membrane(HAM) and PRF( platelate rich fibrin) can be used to augment tendon during repair. The human amniotic membrane is a bilayer translucent membrane fixed to the fetal surface of the placenta. This membrane is rich in cytokines. Helps in Promotion of Epithelialization, Inhibition of Fibrosis, Inhibition of Inflammation and Angiogenesis, Lack of Immunogenicity, Antimicrobial and Antiviral Properties Based on these properties and its unique structure makes it an ideal biomaterial and PRF membrane is autologous and It has a natural fibrin framework with growth factors within that may keep their activity for a relatively longer period and stimulate tissue regeneration effectively and Act as a potential scaffold and it seems to enhance cellular proliferation and differentiation, augmenting angiogenesis, acting as a matrix for tissue growth.
Material and methods-
we included 30 patients with Achillies tendon rupture and divided into two random groups 15 each. in one group HAM was used for augmentation and in other group PRF membrane was used.
With the patient prone, make a posteromedial incision approximately 10 cm long about 1 cm medial to the tendon and ending proximal to where the shoe counter strikes the heel. Approximate the ruptured ends of the tendon with a 2-0 nonabsorbable suture and wrap the membrane around the stitched site. Close the paratenon and skin. At 2 weeks, the cast is removed, the wound is inspected.

Results

The assessment included evidence of infection and pain graded by the visual analog scale recorded at preoperatively, postoperative 2 and 6weeks, 3 months and 6months,12 months and 18 months At each visit, the range of motion ( Thompson test , Rest angle and Calf Circumfrence ) Pinch test strength was compared with contralateral side
Healing evaluation with high-frequency ultrasound (HFUSG)
The parameters: (a) maximum thickness at the repair site; (b) proximal thickness of the normal tendon measured 8 mm proximal to the maximum thickness of the repair site.
Biologic response evaluation with inflammatory mediators serum levels of IL-6 and TGF-ß1 in patients
Though both membranes are equally effective in providing clinically significant outcomes with respect to VAS score, Pinch test, Biological evaluation of IL-6 and TGF-ß1 in all patients but HAM showed more stable results in consensus with higher total active range of motion, and better tendon glide on ultrasonography at follow-up (6-18 months). The levels of serum inflammatory biologic markers decreased in majority of HAM cases as compare to PRF. No infection/immune rejection phenomenon was seen in both groups.

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Role of Human Amniotic Membrane and PRF Membrane in Achilles Tendon Repair: A Comparative Clinico – Radiological Study

Role of Human Amniotic Membrane and PRF Membrane in Achilles Tendon Repair: A Comparative Clinico – Radiological Study

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Role of Human Amniotic Membrane and PRF Membrane in Achilles Tendon Repair: A Comparative Clinico – Radiological Study

Role of Human Amniotic Membrane and PRF Membrane in Achilles Tendon Repair: A Comparative Clinico – Radiological Study

Results

More ISAKOS 2021: Global Content