Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques

Abstract

Background:Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance.Purpose:To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction.Results:At a mean follow-up of 40 months, significant improvements in VAS-P (mean, –6.1; 95% CI, –6.8 to –5.5; P < .0001), QuickDASH (mean, –46; 95% CI, –52 to –40; P < .0001), and PRTEE (mean, –57; 95% CI, –64 to –50; P < .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; P < .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group (P = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course.Conclusion:A PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength, and function demonstrated at a mean follow-up of longer than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short term to midterm.

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

“…Lim et al reported that needling when combined with PRP injection gives favorable results versus physiotherapy in pain scores, modified Mayo Clinical Performance scores, and even in MRI imaging [ 36 ]. Similarly, beneficial results of PRP injections and concomitant needling were also reported by Gaspar et al Interestingly, this paper reports sustained good outcomes with PRP at a mean follow-up of over 3 years [ 37 ].…”

Predictors of Outcome Following Tenotomy in Patients with Recalcitrant Epicondylopathy

“…Both procedures were recently compared. 18 Although the results are similar, increased reduction in long-term pain was observed in the tenotomy group, and more patients required open surgery in the needle tenotomy group. In our study, we performed 15-25 needle passes with periosteum abrasion in the first intervention but only approximately 10 needle passes in the second intervention.…”

“…Going deeper, other authors described two different needle tenotomy modalities, including the so‐called peppering technique, which involves less tendon fenestrations (approximately five needle passes), and a more aggressive needle tenotomy involving multiple abrasions until tissue softening. Both procedures were recently compared . Although the results are similar, increased reduction in long‐term pain was observed in the tenotomy group, and more patients required open surgery in the needle tenotomy group.…”

Current Trends for Treating Lateral Epicondylitis

“…A study on the long-term efficacy of ATI treatment with a follow-up period of more than 4 years, reports symptomatic and functional improvement without adverse effects, complications, or infections in >70% participants. However, ATI treatment is still being explored with animal studies and preclinical trials, and requires further researches with a larger study population to determine the efficacy and safety ( Table 1 ) [ 22 , 26 , 28 - 34 ].…”