Abstract
Background:
Lateral elbow pain is common with a population prevalence of 1%–3%. The study was a comparative trial to validate the efficacy of single injection of platelet-rich plasma (PRP) for tennis elbow as compared with single injections of triamcinolone and placebo (normal saline) over a short term period.
Materials and Methods:
Comparative trial with 3- and 6-month followup evaluated with visual analog scale (VAS) and facial pain scale (FPS). Our study included a total of eighty patients with unilateral or bilateral tennis elbows. The study population included patients between 20 and 40 years age group belonging to either sex with seventy unilateral and ten bilateral affections for more than 3-month duration. Patients suffering from elbow pain due to other problems or those who have received any form of injection were excluded from the study. One milliliter of 2% Xylocaine injection was given before injecting the proposed formulation under trial. VAS and FPS were used for scoring pain. Kruskal–Wallis test and Mann–Whitney U-tests were used for statistical analyses at 12 and 24 weeks.
Results:
Overall, 49 females and 31 males were included with thirty elbows in each group. Both the PRP and triamcinolone groups had better pain relief at 3 and 6 months as compared to normal saline group (P < 0.05), but at 6 months followup, the PRP group had statistically significant better pain relief than triamcinolone group. In the triamcinolone group, 13 patients had injection site hypopigmentation and 3 patients had subdermal atrophy.
Conclusions:
Over a short term period, PRP gives better pain relief than triamcinolone or normal saline in tennis elbow which needs to be validated over long term period by further studies.
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References
Allander E. Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes. Scand J Rheumatol 1974;3:145–53.
Chard MD, Hazleman BL. Tennis elbow – A reappraisal. Br J Rheumatol 1989;28:186–90.
Verhaar JA. Tennis elbow. Anatomical, epidemiological and therapeutic aspects. Int Orthop 1994;18:263–7.
Hamilton PG. The prevalence of humeral epicondylitis: A survey in general 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.
Major HP. Lawn tennis elbow. BMJ 1883;2:557.
Kraushaar B, Nirschl R. Tendinosis of the elbow (tennis elbow): Clinical features and findings of histological, immunohistochemical and electron microscopic studies. JBJS 1999;81A: 259.
Nirschl RP, Pettrone F. Tennis elbow: The surgical treatment of lateral epicondylitis. JBJS 1979;61A: 832.
Brummel J, Baker CL 3rd, Hopkins R, Baker CL Jr. Epicondylitis: Lateral. Sports Med Arthrosc 2014;22:e1–6.
Nirschl RP, Ashman ES. Elbow tendinopathy: Tennis elbow. Clin Sports Med 2003;22:813–36.
Walz DM, Newman JS, Konin GP, Ross G. Epicondylitis: Pathogenesis, imaging, and treatment. Radiographics 2010;30:167–84.
Saccomanni B. Corticosteroid injection for tennis elbow or lateral epicondylitis: A review of the literature. Curr Rev Musculoskelet Med 2010;3:38–40.
Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg Am 2003;28:272–8.
Chung B, Wiley JP. Effectiveness of extracorporeal shock wave therapy in the treatment of previously untreated lateral epicondylitis: A randomized controlled trial. Am J Sports Med 2004;32:1660–7.
Galvin R, Callaghan C, Chan WS, Dimitrov BD, Fahey T. Injection of botulinum toxin for treatment of chronic lateral epicondylitis: Systematic review and meta-analysis. Semin Arthritis Rheum 2011;40:585–7.
Tosun HB, Gumustas S, Agir I, Uludag A, Serbest S, Pepele D, et al. Comparison of the effects of sodium hyaluronate-chondroitin sulphate and corticosteroid in the treatment of lateral epicondylitis: A prospective randomized trial. J Orthop Sci 2015;20:837–43.
Lubkowska A, Dolegowska B, Banfi G. Growth factor content in PRP and their applicability in medicine. J Biol Regul Homeost Agents 2012;26 2 Suppl 1:3S–22S.
Ahmad Z, Brooks R, Kang SN, Weaver H, Nunney I, Tytherleigh-Strong G, et al. The effect of platelet-rich plasma on clinical outcomes in lateral epicondylitis. Arthroscopy 2013;29:1851–62.
Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen 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;41:625–35.
Brkljac M, Kumar S, Kalloo D, Hirehal K. The effect of platelet-rich plasma injection on lateral epicondylitis following failed conservative management. J Orthop 2015;12 Suppl 2:S166–70.
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;6:12.
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 followup. 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 followup. Am J Sports Med 2011;39:1200–8.
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;17:101–12.
Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med 2006;34:1774–8.
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;23:1–5.
Park SK, Choi YS, Kim HJ. Hypopigmentation and subcutaneous fat, muscle atrophy after local corticosteroid injection. Korean J Anesthesiol 2013;65 6 Suppl: S59–61.
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Seetharamaiah, V.B., Gantaguru, A. & Basavarajanna, S. A comparative study to evaluate the efficacy of platelet-rich plasma and triamcinolone to treat tennis elbow. IJOO 51, 304–311 (2017). https://doi.org/10.4103/ortho.IJOrtho_181_16
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DOI: https://doi.org/10.4103/ortho.IJOrtho_181_16