Tennis Elbow, Study Protocol for Randomized Clinical Trial: Needling With and Without Platelet-Rich Plasma After Failure of Up-to-Date Rehabilitation

Abstract

Background: The conservative management of lateral epicondylitis is known to be a difficult-to-treat annoying condition. A treatment with platelet-rich plasma (PRP) is often performed, but its efficacy remains controversial.Methods: This study is a single-center, randomized double-blind controlled trial, preceded by a case series.This monocentric study including 232 patients will occur in two steps. During the first step, all patients will undergo an up-to-date rehabilitation, including epicondylar stretching and strengthening, periscapular tonification, epicondylar brace or taping, and focused extracorporeal shock waves therapy. Unsatisfied patients after the first step will be allocated for the 1:1 randomized trial of second step. Stratification is planned on age and lesion pattern. The masking will be quadruple (Participant, Care Provider, Investigator & Outcome Assessor). The patients will undergo ultrasound (US)-guided needling combined with either PRP (intervention group) or saline (Control group). Outcome data will be collected at -3, 0, 3, 6, and 12 months of the intervention.The primary endpoint is the pain improvement between months 0 and 3 on a 0-10 visual analog scale (VAS) during a maximal strength isometric contraction of the extensor carpialis brevis muscle. The secondary endpoints include the proportion of patients for which the tendon needling is not necessary after rehabilitation protocol, pain changes on VAS at rest and during maximal strength isometric contraction, changes of Single Assessment Numeric Evaluation (SANE) score, changes of Patient-Rated Tennis Elbow Evaluation (PRTEE) score, changes of maximal grip strength on Jamar test, and changes of the US of the epicondylar tendons (i.e. Volume of the lesion in mm3; Doppler reaction classified at the proportion of the tendon marked with the Doppler signal; Solution of continuity in mm3; Tendon thickness in mm; Concomitant superficial lesion & volume in mm3; Pain on a 0-10 VAS scale during sonopalpation).Discussion: The study results will provide insight into the effect of PRP as adjuvant therapy to tendon fenestration, and may contribute to identify the best preceding and concomitant rehabilitation protocol.Trial registration: ClinicalTrials.gov: NCT03987256, registered 20 August 2019