Arthroscopic Debridement Versus Platelet-Rich Plasma Injection: A Prospective, Randomized, Comparative Study of Chronic Lateral Epicondylitis With a Nearly 2-Year Follow-Up

Merolla, Giovanni; Dellabiancia, F.; Ricci, Annamaria; Mussoni, Maria Pia; Nucci, S; Zanoli, Gustavo; Paladini, Paolo; Porcellini, Giuseppe

doi:10.1016/j.arthro.2017.02.009

Cited by 49 publications

(34 citation statements)

References 45 publications

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“…Follow-up evaluations of the patients from both groups consistently showed that, although there were some beneficial clinical effects on pain complaints and elbow function after PRP injections at short-and medium-term follow-up, long-term clinical benefits were much more likely to occur among the arthroscopically managed patients. 13 Specifically, the arthroscopic approach provided more reliably and consistently diminished symptoms at long-term followup. In comparison, progressively worsening pain developed in the PRP group during activity at 1 and 2 years of follow-up in contradistinction to the arthroscopically managed patients.…”

Section: See Related Article On Page 1320mentioning

confidence: 95%

“…In a Level II evidence study by Merolla, Dellabiancia, Ricci, Mussoni, Nucci, Zanoli, Paladini, and Porcellini 13 entitled "Arthroscopic debridement versus platelet-rich plasma injection: A prospective, randomized, comparative study of chronic lateral epicondylitis with a nearly 2-year follow-up," the authors treated and subsequently evaluated the outcomes of 101 patients with a diagnosis of chronic lateral epicondylitis who were unresponsive to nonoperative measures. These patients underwent either PRP injections (n ¼ 51) or arthroscopic lateral epicondylitis debridement (n ¼ 50), and all were followed for approximately 2 years with outcomes determined based primarily on post-procedure pain scores, grip strength measurements, and an adaptation of the Patient-Related Tennis Elbow Evaluation.…”

Section: See Related Article On Page 1320mentioning

confidence: 99%

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Editorial Commentary: The Needle or the Knife? Platelet-Rich Plasma Versus Surgery for Lateral Epicondylitis

Field

2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The most efficacious treatment for patients with lateral epicondylitis who have not adequately improved despite being treated for extended periods with commonly used nonoperative measures is controversial. Are locally applied platelet-rich plasma (PRP) injections more effective than a surgical procedure, such as arthroscopic lateral epicondylitis debridement, in reducing symptoms for such patients? Level II evidence shows that long-term clinical benefits are much less likely to occur in patients receiving PRP injections. Moreover, in patients treated with PRP injection, progressively worsening pain is more likely to develop during activity at 1 and 2 years of follow-up in contradistinction to arthroscopically managed patients.

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Section: See Related Article On Page 1320mentioning

confidence: 95%

Section: See Related Article On Page 1320mentioning

confidence: 99%

Editorial Commentary: The Needle or the Knife? Platelet-Rich Plasma Versus Surgery for Lateral Epicondylitis

Field

2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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show abstract

“…The same findings for short and midterm follow-up were found when PRP was compared with arthroscopic TE release. However, improvement after arthroscopic surgical treatment resulted in sustained pain relief with better results for grip strength in more than 2 years follow-up compared to PRP [ 39 ]. In a meta-analysis of randomized controlled trials, Fitzpatrick et al evaluated the outcomes of the PRP groups by preparation method and injection technique in tendinopathy.…”

Section: Lateral Epicondylitismentioning

confidence: 99%

Platelet-Rich Plasma for Elbow Pathologies: a Descriptive Review of Current Literature

Kwapisz

Prabhakar

Compagnoni

et al. 2018

Curr Rev Musculoskelet Med

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Purpose of ReviewPlatelet-rich plasma is used in many orthopedic pathologies such as tendinopathies and ligament injuries. The clinical results reported in the scientific literature are, however, confusing. The aim of this manuscript is to provide a narrative literature review regarding the role of PRP in the most common elbow soft tissue pathologies.Recent FindingsThe response to PRP seems to be favorable when compared to steroid injection for pain management and for patient-reported outcomes in lateral epicondylitis. PRP injection does not seem to have the potential complications associated with a steroid injection such as skin atrophy, discoloration, and secondary tendon tears. Only a few manuscripts comparing the results of PRP treatment with either extracorporeal shockwave (ESW), dry needling, or even surgical treatments in lateral epicondylitis exist. The use of PRP in other elbow pathologies such as golfer’s elbow, ulnar collateral ligament injury, and distal biceps and triceps pathology is examined in few studies, with unclear recommendations.SummaryRegarding elbow pathologies, PRP injections in tennis elbow seems to be the best-studied intervention. A major limitation in these studies is the significant heterogeneity in the methods used for preparing PRP, for example employing leukocyte-rich, leukocyte-poor preparations, PRP with or without activation, which makes the results of the studies difficult to compare. Results of this review show that more studies on larger cohorts, with comparable formulations, and with longer follow-up are required to give optimal suggestions concerning the use of PRP in elbow pathologies.

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“… 56 In a prospective RCT, Merolla et al found that PRP and arthroscopic debridement had similar effectiveness in the short and medium term; however, surgery resulted in better pain and grip strength recovery at 2 years. 69 Because of the heterogeneity of PRP formulations among commercial systems, as well as the high degree of intersubject and intrasubject variability in the PRP composition produced, 70 much more work is needed to determine the optimal PRP formulation (eg, high or low leukocyte concentration) that is effective in providing long-term pain relief in chronic LE.…”

Section: Introductionmentioning

confidence: 99%

Chronic lateral epicondylitis: challenges and solutions

Lai¹,

Erickson²,

Mlynarek³

et al. 2018

OAJSM

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Lateral epicondylitis (LE) is a significant source of pain and dysfunction resulting from repetitive gripping or wrist extension, radial deviation, and/or forearm supination. Although most cases are self-limiting over several years, controversy exists regarding the best treatment strategy for chronic LE. Nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), shockwave therapy, and injections with corticosteroids or biologics are all conservative treatment options for LE. For refractory cases, surgical options include open, arthroscopic, and percutaneous techniques. In this review, the current evidence behind these treatment strategies is presented. The data demonstrate that NSAIDs, PT, bracing, and shockwave therapy provide limited benefit for treating LE. Biologics such as platelet-rich plasma and autologous whole-blood injections may be superior to steroid injections in the long-term management of LE. Although the initial results are promising, larger comparative studies on stem cell injections are needed. For refractory LE, open, arthroscopic, and percutaneous techniques are all highly effective, with no method seemingly superior over another. Arthroscopic and percutaneous approaches may result in faster recovery and earlier return to work.

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Arthroscopic Debridement Versus Platelet-Rich Plasma Injection: A Prospective, Randomized, Comparative Study of Chronic Lateral Epicondylitis With a Nearly 2-Year Follow-Up

Cited by 49 publications

References 45 publications

Editorial Commentary: The Needle or the Knife? Platelet-Rich Plasma Versus Surgery for Lateral Epicondylitis

Editorial Commentary: The Needle or the Knife? Platelet-Rich Plasma Versus Surgery for Lateral Epicondylitis

Platelet-Rich Plasma for Elbow Pathologies: a Descriptive Review of Current Literature

Chronic lateral epicondylitis: challenges and solutions

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