Assessment of clinical and functional outcomes after single dose injection of autologous platelet rich plasma in patients with chronic lateral epicondylitis: a prospective and brief follow up study
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20233259Keywords:
Platelet-rich plasma, Tennis elbow, Visual analog scale, Disabilities of shoulder arm and handAbstract
Background: Lateral epicondylitis is a chronic, painful, and debilitating elbow condition. The introduction of platelet-rich plasma as an adjunct to the conservative and operative treatment has revolutionized the research in this topic. PRP is considered to be the ideal autologous biological blood-derived product which helps in regenerating the degenerated tissue rather than just repairing it and helps in relieving pain and improving function.
Methods: This is a prospective study where 40 patients diagnosed with tennis elbow, failing other conservative treatment modalities were enrolled; and treated with single dose injection of autologous PRP; and were evaluated for clinical and functional outcomes using the visual analogue scale and disabilities of arm, shoulder, and hand scores on the follow-ups.
Results: Out of the 40 patients enrolled, there were 15 males and 25 females. The mean age of the population was 45.88±8.87 years. All the patients had improved statistically significant differences in mean VAS and DASH scores (p value<0.001) on each follow-up as compared to the baseline score with VAS score and DASH score improvement being more than 77% and 65% respectively at final follow up.
Conclusion: Our study concludes that a single local injection of autologous PRP appears to be the promising and safe modality of treatment in lateral epicondylitis, helping to improve the pain as well as the clinical and functional outcomes.
References
Nirschl RP, Pettrone FA. Tennis elbow: the surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 1979;61(6):832-9.
Jobe FW, Ciccotti MG. Lateral and medial epicondylitis of the elbow. J Am Acad Orthop Surg. 1994;2(1):1-8.
Hong QN, Durand MJ, Loisel P. Treatment of lateral epicondylitis: where is the evidence?. Joint Bone Spine. 2004;71(5):369-73.
Gruchow HW, Pelletier D. An epidemiologic study tennis elbow: incidence, recurrence, and effectiveness of prevention strategies. Am J Sports Med. 1979;7(4): 234-8.
Geoffroy P, Yaffe MJ, Rohan I. Diagnosing and treating lateral epicondylitis. Can Fam Physic. 1994; 40:73-8..
Smith RW, Papadopolous E, Mani R, Cawley MI. Abnormalmicrovascular responses in a lateral epicondylitis. Br J Rheumatol. 2010;23:43-9.
Wang JH, Iosifidis MI, Fu FH. Biomechanical basis for tendinopathy. Clin Orthop Relat Res. 2006;443:320-32.
Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med. 1992;11(4):851-70.
Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am. 1999;81: 259- 78.
Ljung BO, Forsgren S, Friden J, Substance P. Calcitonin gene‐related peptide expression at the extensor carpi radialisbrevis muscle origin: implications for the etiology of tennis elbow. J Orthop Res. 1999;17:554-9.
Assendelft WJ, Hay EM, Adshead R, Bouter LM. Corticosteroid injections for lateral epicondylitis: a systematic overview. Br J Gen Pract. 1996;46(405): 209-16.
Smidt N, Assendelft WJ, Arola H, et al. Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. Ann Med. 2003;35(1):51-62.
Smidt N, van der Windt DA, Assendelft WJ, Deville WL, Korthals-deBos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002;359(9307):657-62.
Wong SM, Hui AC, Tong PY, Poon DW, Yu E, Wong LK. Treatment of lateral epicondylitis with botulinum toxin: a randomized, double blind, placebo-controlled trial. Ann Intern Med. 2005;143(11):793-7.
Geaney LE, Arciero RA, DeBerardino TM, et al. The effects of platelet-rich plasma on tendon and ligament: basic science and clinical application. Op Techn Sports Med. 2011;19:160-4.
Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. JHand Surg. 2003;28:272-8.
Weibrich G, Kleis WK, Hafner G. Growth factor levels in platelet-rich plasma and correlations with donor age, sex, and platelet count. J Cranio Maxillofac Surg. 2002;30:97-102.
Landesberg R, Roy M, Glickman RS. Quantification of growth factor levels using a simplified method of platelet-rich plasma gel preparation. J Oral Maxillofac Surg. 2005;72:2237-42.
Bhanot S, Alex JC. Current applications of platelet gels in facial plastic surgery. Facial Plast Surg. 2002;18:27-34.
Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg. 2004;114:1502-8.
Everts PA, Knape JT, Weibrich G. Platelet-rich plasma and platelet gel: a review. J Extracorp Tech. 2006;38: 174.
Mishra A, Woodall J, Vieira A. Treatment of tendon and muscle using platelet-rich plasma. Clin Sports Med. 2009;28:113-25.
McAleer JP, Sharma S, Kaplan EM. Use of autologous platelet concentrate in a non healing lower extremity wound. Adv Skin Wound Care. 2006;19:354-63.
Everts PA, Overdevest EP, Jakimowicz JJ. The use of autologous platelet-leukocyte gels to enhance the healing process in surgery, a review. Surg Endosc. 2007;21(11):2063-8.
James SL, Ali K, Pocock C. Ultrasound guided dry needling and autologous blood injection for patellar tendinosis. Br J Sports Med. 2007;41:518-21.
de Vos RJ, Weir A, van Schie HT. Platelet-rich plasma function injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010;303:144-9.
Everts PA, Devilee RJ, Brown Mahoney C, et al. Exogenous application of platelet-leukocyte gel during open subacromial decompression contributes to improved patient outcome. A prospective randomized double-blind study. Eur Surg Res. 2008;40:203-10.
Randelli PS, Arrigoni P, Cabitza P. Autologous platelet rich plasma for arthroscopic rotator cuff repair. Disabil Rehabil. 2008;30:1584-9.
Kon E, Buda R, Filardo G. Platelet-rich plasma: intra- articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010;18:472-9.
Sa´nchez M, Anitua E, Azofra J. Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study. Clin Exp Rheumatol. 2008;26:910-3.
Ibrahim V, Dowling H. Platelet-rich plasma as a nonsurgical treatment option for osteonecrosis. PMR. 2012;4:1015-9.
Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasmainjection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008;1(3-4): 165-74.
MishraA, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006;34:1774-8.
Peerbooms JC, Sluimer J, Bruijn DJ. Positive effect of an autologous platelet concentrate in double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med. 2010;38:255-62.
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.
Niemiec P, Szyluk K, Jarosz A, Iwanicki T, Balcerzyk A. Effectiveness of platelet-rich plasma for lateral epicondylitis: a systematic review and meta-analysis based on achievement of minimal clinically important difference. Orthopaed J Sports Med. 2022;23:34-8.