Efficacy, safety and tolerability of autologous platelet rich plasma injection in the treatment of lateral epicondylitis
Keywords:PRP, Lateral epicondylitis, Steroid, Elbow, Platelet
Background: To evaluate the effects of platelet-rich plasma (PRP) infiltration in patients with lateral epicondylitis of the elbow.
Methods: A randomized, prospective study on 60 patients with lateral epicondylitis of the elbow was conducted at Ruby Hall Clinic, Pune. The patients were randomized and evaluated after receiving infiltration of three milliliters of PRP, or methyl prednisolone. The base-line evaluation was done using visual analog score (VAS) and modified Mayo performance index for elbow (MAYO). Re-evaluation was after 1 and 6 months of the procedure. Statistical analysis was done using independent t-test.
Results: After 6 months of treatment with PRP, patients with lateral epicondylitis had a statistically significant improvement in their VAS (p<0.05) in contrast to steroid. However, no statistical difference in modified Mayo performance index was found between the two groups at 1 and 6 months after intervention.
Conclusions: Treatment of patients with lateral epicondylitis with PRP reduces pain and is better tolerated than steroid therapy. Thus, the novel PRP therapy can be considered as a primary approach to treat patients of lateral epicondylitis conservatively.
Shiri R, Viikari-Juntura E, Varonen H, Heliovaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006;164(11):1065-74.
Varshney A, Maheshwari R, Juyal A, Agrawal A, Hayer P. Autologous Platelet-rich Plasma versus Corticosteroid in the Management of Elbow Epicondylitis: A Randomized Study. International journal of applied & basic medical research. 2017;7(2):125-8.
Brkljac M, Kumar S, Kalloo D, Hirehal K. The effect of platelet-rich plasma injection on lateral epicondylitis following failed conservative management. J Orthopaedics. 2015;12(Suppl 2):S166-70.
Geoffroy P, Yaffe MJ, Rohan I. Diagnosing and treating lateral epicondylitis. Canadian Family Physician. 1994;40:73-8.
Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. The Journal of bone and joint surgery American volume. 1979;61(6a):832-9.
Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. The American journal of sports medicine. 2010;38(2):255-62.
Smidt N, van der Windt DA, Assendelft WJ, Deville WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet (London, England). 2002;359(9307):657-62.
Haake M, Konig IR, Decker T, Riedel C, Buch M, Muller HH. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis : a randomized multicenter trial. J Bone Jt Surg. 2002;84-a(11):1982-91.
Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg. 2003;28(2):272-8.
Assendelft WJ, Hay EM, Adshead R, Bouter LM. Corticosteroid injections for lateral epicondylitis: a systematic overview. The British journal of general practice: the journal of the Royal College of General Practitioners. 1996;46(405):209-16.
Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. American J Sports Med. 2009;37(11):2259-72.
Okcu G, Erkan S, Senturk M, Ozalp RT, Yercan HS. Evaluation of injection techniques in the treatment of lateral epicondylitis: a prospective randomized clinical trial. Acta orthopaedica et traumatologica turcica. 2012;46(1):26-9.
Vaquero-Picado A, Barco R, Antuña SA. Lateral epicondylitis of the elbow. EFORT open reviews. 2016;1(11):391-7.
Monto R. Tennis Elbow Repair With or Without Suture Anchors: A Randomized Clinical Trial. Tech Shoulder Elbow Surg. 2014;15(3): 92-7.
Lo MY, Safran MR. Surgical treatment of lateral epicondylitis: a systematic review. Clin Orthopaed Rel Res. 2007;463:98-106.
Solheim E, Hegna J, Oyen J. Arthroscopic versus open tennis elbow release: 3- to 6-year results of a case-control series of 305 elbows. Arthroscopy: the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2013;29(5):854-9.
Geoffroy P, Yaffe MJ, Rohan I. Diagnosing and treating lateral epicondylitis. Canadian Family Physician Medecin de Famille Canadien. 1994;40:73-8.
Verhaar J, Walenkamp G, Kester A, van Mameren H, van der Linden T. Lateral extensor release for tennis elbow. A prospective long-term follow-up study. J Bone Jt Surg. 1993;75(7):1034-43.
Krogh TP, Bartels EM, Ellingsen T, Stengaard-Pedersen K, Buchbinder R, Fredberg U, et al. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med. 2013;41(6):1435-46.
Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet (London, England). 2010;376(9754):1751-67.
Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. The American journal of sports medicine. 2006;34(11):1774-8.