Double-blinded RCT in 60 men with chronic midportion Achilles tendinopathy. All did eccentric training, then received either one high-volume injection, four PRP injections, or sham saline. It asks whether adding HVI or PRP to eccentric loading improves pain, function, and tendon structure over training alone.
When a patient with chronic midportion Achilles tendinopathy has failed eccentric loading alone, this trial supports adding an injection rather than just continuing exercise.
The decision rule: if you need fast pain and function gains, HVI delivers the biggest short-term win at 6 and 12 weeks. By 24 weeks PRP catches up, so the choice is partly about timeline and injection burden (one HVI vs four PRP visits).
Note the catch with HVI: it contains steroid, and steroid tendinopathy outcomes are worse long-term than exercise. HVI satisfaction already dipped from 84% to 63% between 12 and 24 weeks, raising the worry that early gains erode and that a too-fast return to sport could risk rupture.
For boards, anchor the framework: eccentric loading is the foundation, neovascularization near Kager's fat pad drives pain, and VISA-A is the outcome tool. This is the first RCT showing PRP beats placebo in Achilles tendinopathy, credited to a 4-injection protocol.
Double-blinded RCT in 60 men with chronic midportion Achilles tendinopathy. All did eccentric training, then received either one high-volume injection, four PRP injections, or sham saline. It asks whether adding HVI or PRP to eccentric loading improves pain, function, and tendon structure over training alone.
When a patient with chronic midportion Achilles tendinopathy has failed eccentric loading alone, this trial supports adding an injection rather than just continuing exercise.
The decision rule: if you need fast pain and function gains, HVI delivers the biggest short-term win at 6 and 12 weeks. By 24 weeks PRP catches up, so the choice is partly about timeline and injection burden (one HVI vs four PRP visits).
Note the catch with HVI: it contains steroid, and steroid tendinopathy outcomes are worse long-term than exercise. HVI satisfaction already dipped from 84% to 63% between 12 and 24 weeks, raising the worry that early gains erode and that a too-fast return to sport could risk rupture.
For boards, anchor the framework: eccentric loading is the foundation, neovascularization near Kager's fat pad drives pain, and VISA-A is the outcome tool. This is the first RCT showing PRP beats placebo in Achilles tendinopathy, credited to a 4-injection protocol.