Study comparing the efficacy of platelet rich plasma versus steroid versus placebo in lateral epicondylitis
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20170532Keywords:
Tennis elbow, Platelet rich plasma, Steroid, Lateral epicondylitisAbstract
Background: Lateral epicondylitis is seen more commonly in non-athletes than athletes. Non-operative methods are the mainstay of treatment being effective in more than 95% of cases. Platelet rich plasma (PRP) has shown promising results in many studies as compared to steroid injection & other modes of conservative management. Hence, this study was done to evaluate PRP efficacy in our clinical setup and in the people of age group most commonly being affected.
Methods: This randomized study was conducted at Narayana Medical College Hospital, Nellore, for a period of two years from December 2014 to June 2016 on 150 consenting patients diagnosed as suffering from lateral epicondylitis. Using lottery method for randomization the patients were divided into three groups, based on which the treatment was received. Group –N with 50 patients received 3 ml of normal saline as placebo. Group –P with 50 patients received 3 ml of extracted PRP injection. Group –S with 50 patients received depot preparation of 40 mg of methyl prednisiolone injected into the affected area. The data collected and recorded in the appropriate proforma. Post therapy assessment was done using with Oxford elbow score.
Results: The overall mean ages of the patients in the three groups (Group P, Group S and Group N) are 38.62±7.53, 37.82±7.79 and 36.3±6.93 respectively. Female preponderance was observed in all the groups. Most common presenting complaint was elbow pain seen in 100% of cases. Most common side involved was the dominant side, right side involvement was seen in 136 cases and left side in 14 cases. The Oxford elbow score pre-treatment in all the groups was not statistically significant and the Oxford elbow score at the end of 12 weeks and 24 weeks treatment showed that PRP and steroid was better than normal saline in control of pain.
Conclusion: Lateral epicondylitis or tennis elbow is a painful debilitating condition of elbow, which creates disturbance in functional activities. A single injection of PRP at the site of the elbow pain resulted in relief of pain in patients with longer duration as compared to local steroids to other conservative treatments.
Metrics
References
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):5-7.
Croisier JL, Foidart-Dessalle M, Tinant F, Crielaard JM, Forthomme B. An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy. Br J Sports Med. 2007;41:269-75.
Buchbinder R, Green SE, Youd JM, AssendelftWJ, Barnsley L, Smidt N. Shock wave therapy for lateral elbow pain. Cochrane Database Syst Rev. 2005;4:CD003524.
Borrione P, Gianfrancesco AD, Pereira MT, Pigozzi F. Platelet-rich plasma in muscle healing. Am J Phys Med Rehabil. 2010;89(10):854–61.
Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006;34(11):1774–8.
Mishra A, Collado H, Fredericson M. Platelet-rich plasma compared with corticosteroid injection for chronic lateral elbow tendinosis. PMR. 2009;1(4):366–70.
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;18(6):12.
Dawson J, Doll H, Boller I, Fitzpatrick R. The development and validation of a patient-reported questionnaire to assess outcomes of elbow surgery. J Bone Joint Surg Br. 2008;90:466-73.
Hamilton P. The prevalence of humeral epicondylitis: a survey ingeneral practice. J R Coll Gen Pract. 1986;36:464-5.
Kivi P. The etiology and conservative treatment of humeral epicondylitis. Scand J Rehabil Med. 1983;15:37-41.
Ono Y, Nakamura R, Shimaoka M, Hiruta S, Hattori Y, Ichihara G, et al. Epicondylitis among cooks in nursery schools. Occup Environ Med. 1998;55:172-9.
Ritz BR. Humeral epicondylitis among gas and waterworks employees. Scand J Work Environ Health. 1995;21:478-86.
Struijs PA, Smidt N, Arola H, Dijk VC, Buchbinder R, Assendelft WJ. Orthotic devices for the treatment of tennis elbow. Cochrane Database Syst Rev. 2002;1:CD00182.
Everts PA, Knape JT, Weibrich G, Schönberger JP, Hoffmann J, Overdevest EP, et al. Platelet-rich plasma and platelet gel: a review. J Extra Corpor Technol. 2006;38:174-87.
Anitua E, Andía I, Sanchez M, Azofra J, del Mar Zalduendo M, de la Fuente M, et al. Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res. 2005;23:281-6.
Murray MM, Spindler KP, Abreu E, Muller JA, Nedder A, Kelly M. Collagen-platelet rich plasma hydrogel enhances primary repair of the porcine anterior cruciate ligament. J Orthop Res. 2007;25:81-91.
Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone & Joint Surg. 1979;61(6):832-9.
VCIII D, Milanese S, Worth D, Grimmer-Somers K. The Anatomy of the Forearm Extensor Muscles and the Fascia in the Lateral Aspect of the Elbow Joint Complex. Anatom Physiol. 2013;3(117):2161.
Chard MD, Hazleman BL. Tennis elbow—a reappraisal. Rheumatology. 1989;28(3):186-90.
Binder AI, Hazleman BL. Lateral humeral epicondylitis—a study of natural history and the effect of conservative therapy. Rheumatol. 1983;22(2):73-6.
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. American J Sports Med. 2011;39(6):1200-8.
Omar AS, Ibrahim ME, Ahmed AS, Said M. Local injection of autologous platelet rich plasma and corticosteroid in treatment of lateral epicondylitis and plantar fasciitis: Randomized clinical trial. The Egyptian Rheumatol. 2012;34:43–9.
Hechtman KS, Tjin-A-Tsoi EW, Zvijac JE, Uribe JW, Latta LL. Biomechanics of a less invasive procedure for reconstruction of the ulnar collateral ligament of the elbow. American J Sports Med. 1998;26(5):620-4.
Andia I, Latorre PM, Gomez MC, Burgos-Alonso N, Abate M, Maffulli N. Platelet-rich plasma in the conservative treatment of painful tendinopathy: a systematic review and meta-analysis of controlled studies. Br Med Bull. 2014;110(1):99-115.