Comparison of Local Injection of Platelet Rich Plasma and Corticosteroids in the Treatment of Lateral Epicondylitis of Humerus

Yadav, Raman P; Kothari, S Y; Borah, Diganta

doi:10.7860/jcdr/2015/14087.6213

Cited by 56 publications

(56 citation statements)

References 17 publications

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“…LE, also known as tennis elbow, remains one of the most perplexing disorders of the musculoskeletal system. It is thought to result from overuse or repetitive microtrauma resulting in a primary tendonosis of the ECRB muscle with or without involvement of the extensor digitorum communis (EDC) and extensor carpi radialis longus (ECRL) . During the last decade, various conservative and noninvasive treatments have been used without consistent and satisfactory results, and a transition to the use of PRP injection for treatment of LE was observed.…”

Section: Discussionmentioning

confidence: 99%

Relationship of cytokine levels and clinical effect on platelet‐rich plasma‐treated lateral epicondylitis

Lim

Park²,

Kim

et al. 2017

Journal Orthopaedic Research

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Lateral epicondylitis (LE) is difficult to manage and can result in significant patient morbidity. Currently, the clinical use of platelet-rich plasma (PRP) for painful tendons has received attention, but its efficacy remains controversial. This study aimed to investigate the clinical effects of PRP and its biological components. A total of 156 patients with LE were randomly divided into group 1, treated with a single injection of 2-ml autologous PRP, and group 2, treated with a control received only physical therapy without injection. Both groups used a tennis elbow strap and performed stretching and strengthening exercises during 24 weeks' follow-up. Pain and functional improvements were assessed using the visual analog scale (VAS), Modified Mayo Clinic Performance Index for the elbow, and magnetic resonance imaging (MRI). White blood cell count, platelet count, and levels of platelet-derived growth factor-AB (PDGF-AB), PDGF-BB, transforming growth factor-β (TGF-β), vascular endothelial growth factor, epithelial growth factor, and interleukin-1 β in PRP were measured and investigated for statistical correlation with the clinical score. At 24 weeks, all pain and functional variables, including VAS score, Mayo Clinic performance scores, and MRI grade, improved significantly in group 1 (p < 0.05). PDGF-AB, PDGF-BB, and TGF-β levels were more significantly increased in PRP than in whole blood. TGF-β level significantly correlated with Mayo Clinic performance score and MRI grade improvement. Thus, TGF-β level in PRP is considered to play a pivotal role in tendon healing. These results may contribute to identifying the best protocol for PRP application in tendinopathies. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:913-920, 2018.

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Section: Discussionmentioning

confidence: 99%

Relationship of cytokine levels and clinical effect on platelet‐rich plasma‐treated lateral epicondylitis

Lim

Park²,

Kim

et al. 2017

Journal Orthopaedic Research

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“…This was similar in the studies done by Yadav et al in which the mean age group was 36.6 and 36.7 in the two groups respectively. 1 In this study, the males affected by tennis elbow were 33 and females were 77 and the most common presenting complaint seen in 100% of cases was elbow pain. Similar female preponderance was also reported in earlier studies.…”

Section: Discussionmentioning

confidence: 99%

Study comparing the efficacy of platelet rich plasma versus steroid versus placebo in lateral epicondylitis

et al. 2017

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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.

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“…[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] The most common reasons for exclusion were review paper (53), non-tendinopathy (14), injection of active control (7; eg, whole blood, PRP) and non-randomised study (7). Several manuscripts were excluded from this review because they were superseded by papers from the same study with longer follow-up including de Vos et al 29 30 and Peerbooms et al 31 A flow diagram of study identification and selection is shown in figure 1.…”

Section: Study Selectionmentioning

confidence: 99%

Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: systematic review and meta-analysis of randomised injection-controlled trials

Miller

Parrish²,

Roides³

et al. 2017

BMJ Open Sport Exerc Med

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AimTo determine the efficacy of platelet-rich plasma (PRP) injections for symptomatic tendinopathy.DesignSystematic review of randomised, injection-controlled trials with meta-analysis.Data sourcesSystematic searches of MEDLINE and EMBASE, supplemented by manual searches.Eligibility criteria for selecting studiesRandomised controlled trials with 3 months minimum follow-up that evaluated pain reduction with PRP versus control (saline, local anaesthetic, corticosteroid) injections in patients with symptomatic tendinopathy.ResultsA total of 16 randomised controlled trials (18 groups) of PRP versus control were included. Median sample size was 35 patients, a study size that would require an effect size ≥1.0 to achieve statistical significance. PRP was more efficacious than control in reducing tendinopathy pain, with an effect size of 0.47 (95% CI 0.22 to 0.72, p<0.001), signifying a moderate treatment effect. Heterogeneity among studies was moderate (I2=67%, p<0.001). In subgroup analysis and meta-regression, studies with a higher proportion of female patients were associated with greater treatment benefits with PRP.ConclusionsInjection of PRP is more efficacious than control injections in patients with symptomatic tendinopathy.

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Comparison of Local Injection of Platelet Rich Plasma and Corticosteroids in the Treatment of Lateral Epicondylitis of Humerus

Cited by 56 publications

References 17 publications

Relationship of cytokine levels and clinical effect on platelet‐rich plasma‐treated lateral epicondylitis

Relationship of cytokine levels and clinical effect on platelet‐rich plasma‐treated lateral epicondylitis

Study comparing the efficacy of platelet rich plasma versus steroid versus placebo in lateral epicondylitis

Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: systematic review and meta-analysis of randomised injection-controlled trials

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