Comparison of efficacy of needling and a combination of needling and platelet rich plasma in relieving pain and improving function in patients of tennis elbow: a prospective, randomized, double blinded, placebo controlled clinical trial

Authors

  • Vikram Sharma Department of Orthopaedics, KD medical college and hospitals, Mathura, U.P, India
  • Vivek Chandak Department of Orthopaedics, KD medical college and hospitals, Mathura, U.P, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20210617

Keywords:

Tennis elbow, Lateral humeral epicondylitis, Tendinopathy, Growth factors, Platelet-rich plasma, Needling

Abstract

Background: Lateral epicondylitis is a common musculoskeletal disorder for which an effective treatment strategy remains unknown. Aim of the study was to examine whether a single injection of platelet-rich plasma (PRP) with needling is more effective than needling with placebo in reducing pain in adults with lateral epicondylitis. Study design used was randomized controlled trial.    

Methods: A total of 66 patients with chronic lateral epicondylitis were randomized (1:1) to receive either a blinded injection of PRP (group A) or saline (placebo) group B. The primary end point was a change in pain using the VAS and patient-rated tennis elbow evaluation (PRTEE) questionnaire. The secondary outcome being improvement in function (PRTEE scores).

Results: The VAS score and PRTEE score improved significantly in both the groups at all 3 follow-up examinations. Group A had significantly better results than the group B.

Conclusions: PRP injection are safe and effective management strategy for lateral epicondylitis

Author Biographies

Vikram Sharma, Department of Orthopaedics, KD medical college and hospitals, Mathura, U.P, India

Associate Professor in Department of Orthopaedics

Vivek Chandak, Department of Orthopaedics, KD medical college and hospitals, Mathura, U.P, India

Senior Resident

Department of Orthopaedics

References

Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of autologous platelet concentrate in lateral epicondylitis in a double- blind randomized controlled trial. Am J Sports Med. 2010;38(2):255-32.

Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemi-cal, and electron microscopy studies. J Bone Joint Surg Am. 1999;81(2):259-78.

Verhaar JA. Tennis elbow. Anatomical, epidemiological and therapeutic aspects. Int Orthop. 1994;18(5):263-7.

Chard MD, Hazleman BL. Tennis elbow-a reappraisal. Br J Rheumatol. 1989;28(3):186-90.

Nirschl RP, Pettrone FA. Tennis elbow: the surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 1979;61(6A):832-9.

Ljung BO, Alfredson H, Forsgren S. Neurokinin 1-receptors and sensory neuropeptides in tendon insertions at the medial and lateral epi- condyles of the humerus: studies on tennis elbow and medial epicondylalgia. J Orthop Res. 2004;22(2):321-7.

Zeisig E, Ohberg L, Alfredson H. Extensor origin vascularity related to pain in patients with tennis elbow. Knee Surg Sports Traumatol Arthrosc. 2006;14(7):659-63.

Major HP. Lawn-tennis elbow [letter]. Br Med J. 1883;2:557.

Coppinger JA, Cagney G, Toomey S. Characterization of the proteins released from activated platelets leads to localization of novel platelet proteins in human atherosclerotic lesions. Blood. 2004;103(6):2096-104.

Mishra A, Randelli P, Barr C, Talamonti T, Ragone V, Cabitza P. Platelet-rich plasma and the upper extremity. Hand Clin. 2012;28(4):481-91.

Mishra A, Woodall J Jr, Vieira A. Treatment of tendon and muscle using platelet-rich plasma. Clin Sports Med. 2009;28(1):113-25.

Kajikawa Y, Morihara T, Sakamoto H. Platelet rich plasma enhances the initial mobilization of circulation-derived cells for ten- don healing. J Cell Physiol. 2008;215(3):837-45.

Virchenko O, Aspenberg P. How can one platelet injection after tendon injury lead to a stronger tendon after 4 weeks? Interplay between early regeneration and mechanical stimulation. Acta Orthop. 2006;77(5):806-12.

Visser LC, Arnoczky SP, Caballero O, Kern A, Ratcliffe A, Gardner KL. Growth factor-rich plasma increases tendon cell proliferation and matrix synthesis on a synthetic scaffold: an in vitro study. Tissue Eng Part A. 2010;16(3):1021-9.

Wang X, Qiu Y, Triffitt J, Carr A, Xia Z, Sabokbar A. Proliferation and differentiation of human tenocytes in response to platelet rich plasma: an in vitro and in vivo study. J Orthop Res. 2012;30(6):982-90.

Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006;33(11):1774-8.

Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2011;39(6):1200-8.

Peerbooms JC, Sluimer J, Bruijn DL, Gosens T. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double- blind randomized controlled trial: platelet-rich plasma versus cortico- steroid injection with a 1-year follow-up. Am J Sports Med. 2010;38(2):255-62.

McShane JM, Shah VN, Nazarian LN. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow: is a corticosteroid necessary? J Ultrasound Med. 2008;27(8):1137-44.

Hill JJ, Trapp RG, Colliver JA. Survey on the use of corticosteroid injections by orthopedists. Contemp Orthop. 1989;18:39-45.

Mac Dermid JC. Outcome evaluation in patients with elbow pathology: issues in instrument development and evaluation. J Hand Ther. 2001;14:105-14.

Zhang J, Keenan C, Wang JH. The effects of dexamethasone on human patellar tendon stem cells: implications for dexamethasone treatment of tendon injury. J Orthop Res. 2013;31(1):105-10.

Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jen- sen P, Ellingsen T. Treatment of lateral epicondylitis with platelet- rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial. Am J Sports Med. 2013;41(3):625-35.

Mi B, Liu G, Zhou W, Lv H, Liu Y, Wu Q et al. Platelet rich plasma versus steroid on lateral epicondylitis: meta-analysis of randomized clinical trials. Phys Sportsmed. 2017;45(2):97-104.

Gautam VK, Verma S, Batra S, Bhatnagar N, Arora S. Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. J Orthop Surg (Hong Kong). 2015;23(1):1-5.

Yadav R, Kothari SY, Borah D. Comparison of local injection of platelet rich plasma and corticosteroids in the treatment of lateral epicondylitis of humerus. J Clin Diagn Res. 2015;9(7):RC05-7.

Dhillon PBM, Aggarwal S, Marwaha N, Prakash M. Leukocyte- poor platelet-rich plasma versus bupivacaine for recalcitrant lateral epicondylar tendinopathy. J Orthop Surg (Hong Kong). 2015;23(1):6-10.

Creaney L. Platelet-rich plasma and the biological complexity of tissue regeneration. Br J Sports Med. 2011;45(8):611.

Raeissadat SA, Rayegani SM, Hassanabadi H, Rahimi R, Sedighipour L, Rostami K. Is platelet-rich plasma superior to whole blood in the management of chronic tennis elbow: one-year randomized clinical trial. BMC Sports Sci Med Rehabil. 2014;6(1).

Arirachakaran A, Sukthuayat A, Sisayanarane T, Laoratanavoraphong S, Kanchanatawan W, Kongtharvonskul J. Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta- analysis. J Orthop Traumatol. 2016;17(2):101-12.

Chou LC, Liou TH, Kuan YC, Huang YH, Chen HC. Autologous blood injection for treatment of lateral epicondylosis: a meta- analysis of randomized controlled trials. Phys Ther Sport. 2016;18:68-73.

Lo MY, Safran MR. Surgical treatment of lateral epicondylitis: a systematic review. Clin Orthop Relat Res. 2007;463:98-106.

Cohen MS, Romeo AA. Open and arthroscopic management of lateral epicondylitis in the athlete. Hand Clin. 2009;25:331-8.

Rha DW, Park GY, Kim YK, Kim MT, Lee SC. Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial. Clin Rehabil. 2012.

Lebiedziński R, Synder M, Buchcic P, Polguj M, Grzegorzewski A, Sibinski M. A randomized study of autologous conditioned plasma and steroid injections in the treatment of lateral epicondylitis. Int Orthop. 2015;39(11):2199-203.

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.

Palacio EP, Schiavetti RR, Kanematsu M, Ikeda TM, Mizobuchi RR, Galbiatti JA. Effects of platelet-rich plasma on lateral epicondylitis of the elbow: prospective randomized controlled trial. Rev Bras Ortop. 2016;51(1):90-5.

Mi B, Liu G, Zhou W, Lv H, Liu Y, Wu Q et al. Platelet rich plasma versus steroid on lateral epicondylitis: meta-analysis of randomized clinical trials. Phys Sports med. 2017;45(2):97-104.

Khaliq A, Khan I, Inam M, Saeed M, Khan H, Iqbal MJ. Effectiveness of platelets rich plasma versus corticosteroids in lat- eral epicondylitis. J Pak Med Assoc. 2015;65(11, 3):S100-4.

Mishra A, Harmon K, Woodall J Jr, Vieira A. Sports medicine applications of platelet rich plasma. Curr Pharm Biotechnol. 2012;13(7):1185-95.

Mishra A, Harmon K, Woodall J Jr, Vieira A. Sports medicine applications of platelet rich plasma. Curr Pharm Biotechnol. 2012;13(7):1185-95.

Lim W, Park SH, Kim B, Kang SW, Lee JW, Moon YL. Relationship of cytokine levels and clinical effect on platelet- rich plasma-treated lateral epicondylitis. J Orthop Res. 2018;36(3):913-20.

Gaspar MP, Motto MA, Lewis S, Jacoby SM, Culp RW, Lee Osterman A, et al. Platelet-rich plasma injection with percutaneous needling for recalcitrant lateral epicondylitis: comparison of tenotomy and fenestration techniques. Orthop J Sports Med. 2017;5(12):232596711774207.

Mishra AK, Skrepnik NV, Edwards SG, Jones GL, Sampson S, Vermillion DA, et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med. 2014;42(2):463-71.

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Published

2021-02-23

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Original Research Articles