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Sharma GK, Patil A, Kaur P, Rajesh S, Drakonaki E, Botchu R. Comparison of efficacy of ultrasound-guided platelet rich plasma injection versus dry needling in lateral epicondylitis-a randomised controlled trial. J Ultrasound 2024:10.1007/s40477-023-00846-9. [PMID: 38393452 DOI: 10.1007/s40477-023-00846-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/08/2023] [Indexed: 02/25/2024] Open
Abstract
PURPOSE To assess whether Ultrasound guided dry needling is adequate for both common extensor tendon tears and tendinosis or whether ultrasound guided platelet rich plasma (PRP) has a superior outcome when compared to dry needling when there are tears of the common extensor tendon. MATERIALS AND METHODS This is a single-centre, single-blinded, randomised controlled trial conducted between November 2018 and April 2020. 40 patients diagnosed with lateral epicondylitis based on clinical and sonographic features and having comparable baseline characteristics were randomly assigned to the two study groups (dry needling and PRP). Inclusion criteria were patients aged 20 years or more who were symptomatic for at least 3 months with sonographic evidence of lateral epicondylitis. Exclusion criteria were complete tear of common extensor tendon confirmed on ultrasound and presence of other associated diseases like osteoarthritis of shoulder and elbow. RESULTS There was significant improvement in the visual analogue scale pain score in PRP group compared to the dry needling group at 9 months. However, this difference was not evident at 3 and 6 months follow-up. Mean improvement in common extensor tendon thickness in PRP group (5.1 mm at 3 months and 4.3 mm at 6 months) was slightly better than dry needling (4.4 mm at 3 months and 4.0 mm at 6 months). There was no difference in tear (if present) healing between both groups at 3 months. However at 6 months follow up, PRP demonstrated significant (mean-2.5) healing in tear compared to dry needling (mean-3.1). CONCLUSION Two injections of Ultrasound guided PRP are more beneficial non operative treatment compared to ultrasound guided dry needling, in lateral epicondylitis.
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Affiliation(s)
- G K Sharma
- JIPSI (Jaipur Institute of Pain & Sports Injuries), Jaipur, India
- Department of Interventional Radiology and clinical Imaging, The liver unit, Cochin gastroenterology Group, Cochin, India
| | - A Patil
- Department of Radiology, Alameen Medical College, Vijayapur, India
- Department of Interventional Radiology and clinical Imaging, The liver unit, Cochin gastroenterology Group, Cochin, India
| | - P Kaur
- JIPSI (Jaipur Institute of Pain & Sports Injuries), Jaipur, India
- Department of Interventional Radiology and clinical Imaging, The liver unit, Cochin gastroenterology Group, Cochin, India
| | - S Rajesh
- Department of Pain Management, JIPSI (Jaipur Institute of Pain & Sports Injuries), Jaipur, India
- Department of Interventional Radiology and clinical Imaging, The liver unit, Cochin gastroenterology Group, Cochin, India
| | | | - Rajesh Botchu
- Department of Radiology, Alameen Medical College, Vijayapur, India.
- Department of Interventional Radiology and clinical Imaging, The liver unit, Cochin gastroenterology Group, Cochin, India.
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Li S, Yang G, Zhang H, Li X, Lu Y. A systematic review on the efficacy of different types of platelet-rich plasma in the management of lateral epicondylitis. J Shoulder Elbow Surg 2022; 31:1533-1544. [PMID: 35337955 DOI: 10.1016/j.jse.2022.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP) is reported as an effective treatment for lateral epicondylitis (LE). Theoretically, different types of PRP have different therapeutic effects. However, there is controversy on the effects of different types of PRP in the treatment of LE. The purpose of this study was to systematically compare pain relief, functional improvement, and the success rate of treatment using 2 different types of PRP by reviewing and summarizing the data available in the current literature on LE after PRP injection. METHODS The PubMed, MEDLINE, Embase, Cochrane Library, and Web of Science databases were reviewed. A computerized literature search was performed for related studies published from database inception to August 2021 using the following terms: lateral epicondylitis, tennis elbow, tendinopathy, lateral elbow pain, PRP, and platelet-rich plasma. The PRP patients included in our study were divided into those receiving leukocyte-poor PRP (LP-PRP) and those receiving leukocyte-rich PRP (LR-PRP) according to the different preparation methods. Outcomes of interest included patient characteristics, types and preparations of PRP, clinical outcomes, success rates, and the safety of treatment at short- and long-term follow-up. RESULTS A total of 33 studies were evaluated in our analysis, including 2420 LE patients. LP-PRP was used in 19 of these studies, LR-PRP was used in 13, and both LP-PRP and LR-PRP were used in 1. Patients in both PRP groups showed significantly improved clinical outcomes after treatment compared with before treatment. The mean visual analog scale scores ranged from 6.1 to 8.0 before treatment, ranged from 1.5 to 4.0 at short-term follow-up, and ranged from 0.6 to 3.3 at long-term follow-up in the LR-PRP group. The mean visual analog scale scores ranged from 4.2 to 8.4 before treatment, 1.6 to 5.9 at short-term follow-up, and 0.7 to 2.7 at long-term follow-up in the LP-PRP group. The Disabilities of the Arm, Shoulder and Hand scores in the LR-PRP and LP-PRP groups ranged from 47.0 to 54.3 and 30.0 to 67.7, respectively, before treatment and ranged from 20.0 to 22.0 and 5.5 to 19.0, respectively, at long-term follow-up. The success rates in the LR-PRP and LP-PRP groups ranged from 70% to 100% and 36% to 100%, respectively. The complication rate was lower in the LP-PRP group (3.9%) than in the LR-PRP group (6.4%, P = .029), with the main complication being temporary pain after PRP treatment. CONCLUSION PRP treatment demonstrated significant improvements in terms of pain relief and functional improvement in LE patients regardless of the type of PRP. There were no significant differences in pain relief and functional improvement between LR-PRP and LP-PRP. The main complication was temporary pain after PRP injection, and the complication rate in the LP-PRP group was lower than that in the LR-PRP group.
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Affiliation(s)
- Shangzhe Li
- Department of Sports Medicine, Beijing Ji Shui Tan Hospital, School of Medicine, Peking University, Beijing, China
| | - Guang Yang
- Department of Sports Medicine, Beijing Ji Shui Tan Hospital, School of Medicine, Peking University, Beijing, China
| | - Hailong Zhang
- Department of Sports Medicine, Beijing Ji Shui Tan Hospital, School of Medicine, Peking University, Beijing, China
| | - Xu Li
- Department of Sports Medicine, Beijing Ji Shui Tan Hospital, School of Medicine, Peking University, Beijing, China
| | - Yi Lu
- Department of Sports Medicine, Beijing Ji Shui Tan Hospital, School of Medicine, Peking University, Beijing, China.
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Martins J, Neto IS, Gonçalves AF, Pereira A, Santiago M, Ferro I, Lopes T, Carvalho JL. Platelet-Rich Plasma Injection Associated With Microtenotomy in Lateral Epicondylitis – is a Tendon Tear Associated with the Therapeutic Response? Cureus 2022; 14:e22425. [PMID: 35371831 PMCID: PMC8941632 DOI: 10.7759/cureus.22425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Ultrasound-guided platelet-rich plasma (PRP) injections, as well as needle tenotomy, are becoming increasingly popular in the treatment of epicondylitis. Whether ultrasound (US) findings predict the clinical benefit of these techniques is unclear at the moment. This study aimed to investigate the relationship between the presence of tendon tear assessed by US and the therapeutic response of the PRP injection following needle microtenotomy in patients with epicondylitis. Methodology This is a retrospective observational study. Twenty-six patients with chronic (>three months) lateral epicondylitis recalcitrant to conservative treatment or corticosteroid injection. Patients underwent US-guided microtenotomy followed by PRP injection. Data regarding gender, age, US findings at baseline, and numeric pain rating scale (NPRS) scores before and after intervention were collected. Pain improvement rates were calculated at several follow-up time points, namely one, three, six, and 12 months post-intervention. Results are stated as mean ± standard deviation. Results At the time of intervention, the mean age was 47.6±6.5 years, and 57.7% of patients were men. Overall, the mean initial NPRS score was 7.5±1.2, and there were no statistically significant differences in mean initial NPRS scores between the groups with or without tendon tear on the US imaging. The mean improvement rate at one, three, and six months was similar between patients with and without tendon tear. However, a statistically significant difference was observed at 12 months (73.1±37.6% vs. 16.0±21.9, p=0.029). Conclusions Patients with tendon tear demonstrated a higher pain improvement rate at 12 months follow-up. This finding could predict the clinical response to this technique, thus allowing a better selection of the candidates.
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Carlier Y, Bonichon F, Peuchant A. Recalcitrant lateral epicondylitis: Early results with a new technique combining ultrasonographic percutaneous tenotomy with platelet-rich plasma injection. Orthop Traumatol Surg Res 2021; 107:102604. [PMID: 33358122 DOI: 10.1016/j.otsr.2020.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/22/2020] [Accepted: 03/02/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE Surgical treatment of recalcitrant lateral epicondylitis [LE] remains difficult, with suboptimal results. This prospective study aimed to determine whether percutaneous epicondylar tenotomy combined with PRP injection under ultrasonography control would optimize the surgery results, with an early gain on pain and strength and a rapid return to professional activities at 3 months. The secondary objective was to determine whether clinical or biological risk factors (e.g., composition of the PRP) affected the outcomes. METHODS A total number of 261 Patients with recalcitrant LE underwent percutaneous epicondylar tenotomy under ultrasonography control, coupled with PRP injection. All patients were clinically assessed using VAS pain scale, the functional scores: QuickDASH [Disabilities of the Arm, Shoulder and Hand], Patient-Rated Tennis Elbow Evaluation [PRTEE] and MEPS [Mayo Elbow Performance Score]; Elbow Self-Assessment Score [ESAS]; grip strength; and return to work. RESULTS At 3-month follow-up, the VAS score decreased by 3.4 points (SD 2.2; p<0.0001), the QuickDASH decreased by 32.9 points (SD 18.9, range 56.1-23.1; p<0.0001), the PRTEE decreased by 14.8 points (SD 19.1, 49.8-26.4; p=0.017), and the MEPS increased by 19.4 points (SD 13.1, 67.4-86.9; p<0.0001); grip strength increased to 8.3kg (SD 10.7; p<0.0001) and increased by 26% (SD 0.60, 0.7-0.96; p<0.0001) as compared with the opposite side. The ESAS showed 78.3% improvement. CONCLUSION Treatment of recalcitrant LE by percutaneous tenotomy combined with PRP injection under ultrasonography control provides rapid recovery in terms of pain and strength, with a high level of satisfaction and a high rate of early return to work. STUDY DESIGN Case series.
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Affiliation(s)
- Yacine Carlier
- Department of orthopaedics, centre de l'arthrose de Mérignac (CAM), clinique du sport Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700 Mérignac, France.
| | - Françoise Bonichon
- Department of statistics, institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Alain Peuchant
- Department of biology, clinique du sport Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700 Mérignac, France
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Kirschner JS, Cheng J, Hurwitz N, Santiago K, Lin E, Beatty N, Kingsbury D, Wendel I, Milani C. Ultrasound-guided percutaneous needle tenotomy (PNT) alone versus PNT plus platelet-rich plasma injection for the treatment of chronic tendinosis: A randomized controlled trial. PM R 2021; 13:1340-1349. [PMID: 33644963 DOI: 10.1002/pmrj.12583] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tendinosis is a chronic degenerative condition. Current research suggests both percutaneous needle tenotomy (PNT) and leukocyte-rich platelet-rich plasma (LR-PRP) may be effective treatments for chronic tendinosis, but no studies have assessed the effectiveness of PNT alone versus PNT with intratendinous LR-PRP for multiple tendon types in a single study. OBJECTIVE To assess the efficacy of PNT versus PNT + LR-PRP to treat chronic tendinosis. STUDY DESIGN Double-blind, randomized, controlled comparative treatment study. SETTING Primary academic institution. PARTICIPANTS A convenience sample of 40 participants who had chronic tendinosis (rotator cuff, wrist extensor, wrist flexor, hip abductor, proximal hamstring, patellar, or Achilles) confirmed via ultrasound, failed conservative treatment, and did not have tendon tears, known coagulopathy, or systemic illnesses. INTERVENTIONS Participants were randomly assigned to PNT (n = 19) or PNT + LR-PRP (n = 21). Participants and outcomes assessors were blinded to treatment assignments. PNT was performed with 20-30 passes of a 22-gauge needle under ultrasound guidance, with 1% lidocaine given outside the tendon. LR-PRP was processed from whole blood (30-60 mL) and injected into the affected tendon using the same PNT technique. MAIN OUTCOME MEASURES Primary outcome was current numerical rating scale pain at 6 weeks. Secondary outcomes were average pain, function, general well-being, and sleep quality at 6, 52, and 104 weeks. RESULTS Baseline characteristics were similar between groups. Overall, there were no significant differences between groups over time for any of the outcomes (P > .05). Between-group analyses showed significantly lower current and average pain after PNT compared to PNT + LR-PRP at 6 weeks (estimated-mean [SE]: 3.1[0.4] vs. 4.6[0.6], P = .04; 3.4[0.4] vs. 4.9[0.5], P = .03) only. Adverse event rates were low (PNT-3.9%; PNT + LR-PRP-5.0%) and related primarily to postprocedural pain and inflammation. CONCLUSIONS Although pain scores were lower after PNT compared to PNT + LR-PRP at 6 weeks, there were no between-group differences in outcomes at 52 or 104 weeks.
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Affiliation(s)
| | - Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Nicole Hurwitz
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Kristen Santiago
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Emerald Lin
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Nicholas Beatty
- Department of Rehabilitation Medicine, Mount Sinai Hospital, New York, New York, USA
- Regenerative SportsCare Institute, New York, New York, USA
| | - Dallas Kingsbury
- Department of Rehabilitation Medicine, NYU Langone Health, New York, New York, USA
| | - Ian Wendel
- Tri-County Orthopedics, Cedar Knolls, New Jersey, USA
| | - Carlo Milani
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
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Altahawi F, Li X, Demarest B, Forney MC. Percutaneous ultrasonic tenotomy with the TX-1 device versus surgical tenotomy for the treatment of common extensor tendinosis. Skeletal Radiol 2021; 50:115-124. [PMID: 32647907 DOI: 10.1007/s00256-020-03540-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare outcomes in patients treated for chronic common extensor tendinosis with percutaneous ultrasonic tenotomy (TX-1 device) versus surgical tenotomy. MATERIALS AND METHODS Outcomes from consecutive patients who underwent percutaneous tenotomy with the TX-1 device were compared with outcomes from consecutive patients who underwent surgical tenotomy. Patients were contacted to retrospectively assess their outcomes at 4 time points: before treatment, 2 weeks after treatment, 3 to 6 months after treatment, and 12 months after treatment. Outcomes were assessed using the quick disabilities of the arm, shoulder, and hand score (QuickDASH) and the Oxford elbow score (OES). Student's t tests were used to compare postprocedural versus preprocedural scores and percutaneous versus surgical tenotomy scores. RESULTS Response rates were 23 of 43 and 10 of 47 for surveyed percutaneous and surgical tenotomy patients, respectively. There were significant improvements from preprocedural scores in all primary outcome measures at 3-to-6-month and 12-month time points for both procedures. No significant changes from preprocedural scores were seen for either procedure at 2 weeks after treatment or between percutaneous and surgical tenotomy in preprocedural or postprocedural scores for any outcome measure. At 2 weeks, improved percutaneous tenotomy scores approached significance compared with percutaneous preprocedural QuickDASH (p = 0.060) and surgical 2-week OES function domain (p = 0.074) scores. CONCLUSION Ultrasonic percutaneous tenotomy with the TX-1 device and surgical tenotomy have similar outcomes for chronic common extensor tendinosis, with significant symptomatic improvement occurring after 3 to 6 months. Larger studies are needed to assess for differences at 2 weeks.
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Affiliation(s)
- Faysal Altahawi
- Section of Musculoskeletal Imaging, Cleveland Clinic, 9500 Euclid Ave, Mail Code A21, Cleveland, OH, 44195, USA
| | - Xin Li
- Pennsylvania Hospital, University of Pennsylvania, 800 Spruce Street, Philadelphia, PA, 19107, USA
| | - Brittani Demarest
- Section of Musculoskeletal Imaging, Cleveland Clinic, 9500 Euclid Ave, Mail Code A21, Cleveland, OH, 44195, USA
| | - Michael C Forney
- Section of Musculoskeletal Imaging, Cleveland Clinic, 9500 Euclid Ave, Mail Code A21, Cleveland, OH, 44195, USA.
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Townsend C, Von Rickenbach KJ, Bailowitz Z, Gellhorn AC. Post-Procedure Protocols Following Platelet-Rich Plasma Injections for Tendinopathy: A Systematic Review. PM R 2020; 12:904-915. [PMID: 32103599 DOI: 10.1002/pmrj.12347] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Platelet-rich plasma (PRP) has been increasingly studied as a treatment for tendinopathy. Many factors may influence outcomes after PRP, including different protocols following administration. It was hypothesized that there would be heterogeneity in post-PRP protocols. LITERATURE SURVEY A systematized review of the literature on post-PRP protocols for tendinopathy was conducted using an electronic search of MEDLINE and Embase databases through September 2018. METHODOLOGY After duplicates were removed, English language articles involving adult patients who received PRP for tendinopathy were reviewed. Exclusion criteria included studies with fewer than 10 patients, PRP used to treat pathology other than tendinopathy, multiple protocols in one study, and surgical settings. Protocol specifics were extracted including nonsteroidal anti-inflammatory drugs (NSAID) restrictions before and after injection, postinjection restrictions on movement and weight bearing, use of orthoses, activity modifications, and postinjection rehabilitation protocols. Given limitations in the data, a meta-analysis was not performed. SYNTHESIS Eighty-four studies met inclusion criteria. Following PRP injection, weight-bearing restrictions were mentioned rarely (12% of protocols). Orthosis use was uncommon overall (18%) but more common in Achilles tendinopathy protocols (53%). The majority of protocols instituted a period of stretching (51%) and strengthening (54%). Stretching programs generally began 2-7 days following injection, and strengthening programs began within 2-3 weeks. Preinjection NSAID restriction was reported rarely (20%), whereas postinjection NSAID restriction was more common (56%), with a typical restriction of greater than 2 weeks (38%). Return to play or full activity was reported in 42% of protocols, most commonly at 4-6 weeks following injection. CONCLUSION Although the clinical effectiveness of PRP remains controversial, even less is known about the effect of post-PRP protocols, which may affect the outcomes attributed to PRP itself. No studies directly compare post-PRP protocols, and the protocols studied demonstrate substantial heterogeneity. Some consensus regarding post-PRP protocols exists, although the rationale for these recommendations is limited.
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Affiliation(s)
- Christine Townsend
- Department of Rehabilitation Medicine, New York-Presbyterian Rehabilitation Medicine, Weill Cornell Medical College & Columbia University Irving Medical Center, New York, NY, USA
| | - Kristian J Von Rickenbach
- Department of Rehabilitation Medicine, New York-Presbyterian Rehabilitation Medicine, Weill Cornell Medical College & Columbia University Irving Medical Center, New York, NY, USA
| | - Zachary Bailowitz
- Department of Rehabilitation Medicine, New York-Presbyterian Rehabilitation Medicine, Weill Cornell Medical College & Columbia University Irving Medical Center, New York, NY, USA
| | - Alfred C Gellhorn
- Department of Rehabilitation, Weill Cornell Medicine, New York, NY, USA
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Kim GM, Yoo SJ, Choi S, Park YG. Current Trends for Treating Lateral Epicondylitis. Clin Shoulder Elb 2019; 22:227-234. [PMID: 33330224 PMCID: PMC7714311 DOI: 10.5397/cise.2019.22.4.227] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/25/2022] Open
Abstract
Lateral epicondylitis, also known as 'tennis elbow', is a degenerative rather than inflammatory tendinopathy, causing chronic recalcitrant pain in elbow joints. Although most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, few refractory lateral epicondylitis are candidates for alternative non-operative and operative modalities. Other than standard conservative treatments including rest, analgesics, non-steroidal anti-inflammatory medications, orthosis and physical therapies, nonoperative treatments encompass interventional therapies include different types of injections, such as corticosteroid, lidocaine, autologous blood, platelet-rich plasma, and botulinum toxin, which are available for both short-term and long-term outcomes in pain resolution and functional improvement. In addition, newly emerging biologic enhancement products such as bone marrow aspirate concentrate and autologous tenocyte injectates are also under clinical use and investigations. Despite all non-operative therapeutic trials, persistent debilitating pain in patients with lateral epicondylitis for more than 6 months are candidates for surgical treatment, which include open, percutaneous, and arthroscopic approaches. This review addresses the current updates on emerging non-operative injection therapies as well as arthroscopic intervention in lateral epicondylitis.
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Affiliation(s)
- Gyeong Min Kim
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Seung Jin Yoo
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Sungwook Choi
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Yong-Geun Park
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
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Abate M, Di Carlo L, Salini V. Platelet rich plasma compared to dry needling in the treatment of non-insertional Achilles tendinopathy. PHYSICIAN SPORTSMED 2019; 47:232-237. [PMID: 30427252 DOI: 10.1080/00913847.2018.1548886] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The efficacy of platelet rich plasma in the treatment of Achilles tendinopathy is controversial. Despite positive results observed in open studies, randomized controlled trials failed to show difference against saline or rehabilitation. Aims of this retrospective observational study were to compare the efficacy of platelet-rich plasma and dry needling and to assess possible differences age and sex-related. METHODS Groups of 46 and 38 patients with non-insertional Achilles tendinopathy were treated with platelet-rich plasma and dry needling (once a week for 3 weeks), respectively. At baseline, 3 and 6 months, pain and function scores and the percentage of satisfactory outcomes were evaluated. Sub-group analyses were performed according to age and sex. RESULTS At 3 and 6 months no differences in terms of pain and function between groups were observed, but the percentage of subjects reporting satisfactory results, at 6 months, was higher in platelet rich plasma group. Better results were observed in younger subjects, with a greater reduction of pain, improvement of function, and accordingly of the percentage of positive outcomes. A trend toward better results was also observed in males. CONCLUSION Beneficial effects of platelet rich plasma and dry needling in non-insertional Achilles tendinopathy have been observed only in some subjects, but not in others; platelet rich plasma shows a slight superiority against dry needling, mainly in younger persons; finally, a gender difference in the therapeutic response can be hypothesized.
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Affiliation(s)
- Michele Abate
- a Department of Medicine and Science of Aging , University G. d'Annunzio , Chieti Scalo , Italy
| | - Luigi Di Carlo
- a Department of Medicine and Science of Aging , University G. d'Annunzio , Chieti Scalo , Italy
| | - Vincenzo Salini
- a Department of Medicine and Science of Aging , University G. d'Annunzio , Chieti Scalo , Italy
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Martin JI, Atilano L, Merino J, Gonzalez I, Iglesias G, Areizaga L, Bully P, Grandes G, Andia I. Platelet-rich plasma versus lidocaine as tenotomy adjuvants in people with elbow epicondylopathy: a randomized controlled trial. J Orthop Surg Res 2019; 14:109. [PMID: 31014382 PMCID: PMC6480601 DOI: 10.1186/s13018-019-1153-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/12/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To determine the efficacy of platelet-rich plasma (PRP) compared to lidocaine as a tenotomy adjuvant for people with elbow tendinopathy. METHODS Our study was a parallel-group, double-blind, randomized trial involving 71 patients with recalcitrant elbow tendinopathy who received two sessions of ultrasound-guided tenotomy with either PRP or lidocaine in a tertiary public hospital. The primary end point was the percentage of patients with an improvement exceeding 25% reduction in disability (Spanish version of the Disabilities of the Arm, Shoulder and Hand questionnaires-DASH-E) at 6 and 12 months; the secondary outcome was the percentage of patients exceeding 25% reduction in pain (VAS-P). RESULTS There was no evidence of significant differences in the proportion of patients who experienced clinically relevant improvements. After 6 months, 18 patients (78.59%) in the lidocaine group and 19 patients (73.08%) in the PRP group showed improved function above 25% (unadjusted odds ratio, 0.90; 95% confidence interval [CI], 0.90 (0.17 to 4.60)); 21 patients (72.21%) in the lidocaine group versus 22 patients (84.62%) in the PRP group achieved more than 25% pain reduction (unadjusted odds ratio, 0.48; 95% CI, 0.10 to 2.37). After 12 months, 17 patients (70.83%) in the lidocaine group versus 19 patients (76%) in the PRP group had improved function (unadjusted odds ratio, 0.71; 95% CI, 0.13 to 3.84), and 19 patients (76%) in the lidocaine group versus 20 patients (90.91%) in the PRP group had improved pain above 25% (unadjusted odds ratio, 0.35; 95% CI, 0.06 to 2.51). Hypercholesterolemia and baseline vascularization influenced outcomes. There were no differences between groups in the adjusted odds ratios. CONCLUSION PRP results in similar improvements to those obtained with lidocaine. Selecting patients according to their pretreatment status can improve treatment efficacy. TRIAL REGISTRATION NCT01945528 , EudraCT 2013-000478-32. Registered 18 August 2013, enrolment of the first participant 10 March 2014.
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Affiliation(s)
- Jose Ignacio Martin
- Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Leire Atilano
- Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Josu Merino
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.,Department of Orthopaedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Igor Gonzalez
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.,Department of Orthopaedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Gotzon Iglesias
- Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Luis Areizaga
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.,Department of Orthopaedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Paola Bully
- Primary Care Research Unit of Bizkaia (Basque Healthcare Service), BioCruces Health Research Institute, Bilbao, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia (Basque Healthcare Service), BioCruces Health Research Institute, Bilbao, Spain
| | - Isabel Andia
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.
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11
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Martin JI, Atilano L, Merino J, Gonzalez I, Iglesias G, Areizaga L, Bully P, Grandes G, Andia I. Predictors of Outcome Following Tenotomy in Patients with Recalcitrant Epicondylopathy. PM R 2019; 11:979-988. [PMID: 30609276 DOI: 10.1002/pmrj.12064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 12/02/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Elbow tendinopathies are associated with tenderness, pain, and functional disability with ensuing socioeconomic costs. There is lack of consensus regarding the best treatment for patients recalcitrant to first-line conservative treatments. Percutaneous needle tenotomy is considered a regenerative approach that injures the tendon to elicit a healing response. OBJECTIVE To investigate whether demographic characteristics, clinical factors, baseline sonographic entities, or their interactions are related to the likelihood of responding positively to needle tenotomy over a 1-year follow-up period. DESIGN Prospective case series. SETTING Tertiary institutional hospital. PARTICIPANTS Patients with elbow tendinopathy for whom conservative treatments had failed and who had persistent symptoms lasting for at least 3 months. METHODS Patients underwent needle tenotomy with or without PRP followed by a lighter needle tenotomy within a 2-week interval as part of treatment. MAIN OUTCOME MEASUREMENTS Disabilities of the Arm, Shoulder and Hand (DASH) and Visual Analogue Scale for pain (VAS-P) scores were assessed before intervention (baseline) and at 6 weeks and 3, 6, and 12 months after intervention. A generalized linear mixed effects model was created to examine whether injectate type, clinical, demographic, or pretreatment sonographic entities or their interactions influenced clinical outcomes. RESULTS The authors analyzed 74 elbows (71 patients). At baseline, analyzed patients (mean age: 49.48 years; 51.35% women) scored 43.30 and 5.83 on the DASH and VAS-P, respectively. Pretreatment tendon vascularization was a predictor of pain (P = .011) and DASH score changes (P = .019). The linear mixed effect model revealed that male gender and hypercholesterolemia were associated with enhanced functional recovery, (P = .020 and P < .001, respectively). Moreover, the interactions between pretreatment vascular status (P = .039), echotexture (P = .037) and enthesophytes (P = .028) influenced the temporal pattern of functional recovery after needle tenotomy. CONCLUSIONS Baseline patient characteristics, such as gender and hypercholesterolemia, along with ultrasound features may be predictive of outcomes following needle tenotomy for elbow tendinopathy. LEVEL OF EVIDENCE IV (NCT01945528).
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Affiliation(s)
- Jose I Martin
- Department of Radiology, Interventional Sonography Cruces, University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, Biscay, Spain
| | - Leire Atilano
- Department of Radiology, Interventional Sonography Cruces, University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, Biscay, Spain
| | - Josu Merino
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, Biscay, Spain.,Department of Orthopedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Igor Gonzalez
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, Biscay, Spain.,Department of Orthopedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Gotzon Iglesias
- Department of Radiology, Interventional Sonography Cruces, University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, Biscay, Spain
| | - Luis Areizaga
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, Biscay, Spain.,Department of Orthopedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Paola Bully
- Primary Care Research Unit of Bizkaia, BioCruces Health Research Institute, Bilbao, Spain
| | - Gontzal Grandes
- Primary Care Research Unit of Bizkaia, BioCruces Health Research Institute, Bilbao, Spain.,Enkarterrri-Ezkerraldea-Cruces Health Region, Basque Health Service (Osakidetza), Bilbao, Spain
| | - Isabel Andia
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, Biscay, Spain
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12
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Kwapisz A, Prabhakar S, Compagnoni R, Sibilska A, Randelli P. Platelet-Rich Plasma for Elbow Pathologies: a Descriptive Review of Current Literature. Curr Rev Musculoskelet Med 2018; 11:598-606. [PMID: 30255288 PMCID: PMC6220004 DOI: 10.1007/s12178-018-9520-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Platelet-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 FINDINGS The 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. Regarding 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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Affiliation(s)
- Adam Kwapisz
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland.
| | - Sharad Prabhakar
- Department of Orthopedics Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Riccardo Compagnoni
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, UniversitàdegliStudi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- 1 Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Aleksandra Sibilska
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland
| | - Pietro Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, UniversitàdegliStudi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- 1 Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
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13
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Andia I, Maffulli N. A contemporary view of platelet-rich plasma therapies: moving toward refined clinical protocols and precise indications. Regen Med 2018; 13:717-728. [PMID: 30246605 DOI: 10.2217/rme-2018-0042] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The positive extensive clinical experience with platelet-rich plasma (PRP) in different medical areas has prompted researchers to explore clinical opportunities for optimized PRP therapies. PRP is safe but we have to make it more effective. The growing diversity of formulations and presentations enrich the field of PRP research and offer hope to refine clinical indications. Moving toward targeting the right disease phenotypes with the right PRP formulation or combination product (PRP + cell products) can offer opportunities to change treatment options in osteoarthritis and nonhealing wounds. Both are active areas of research that could offer opportunities, although cost efficacy is still an open question. Our position is to believe that these serious disease areas are likely to benefit from PRP therapies.
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Affiliation(s)
- Isabel Andia
- Regenerative Medicine Laboratory, BioCruces Health Research Institute, Cruces University Hospital, 48903 Barakaldo, Spain
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine & Dentristry, Salerno, Italy.,Queen Mary University of London, Barts & the London School of Medicine & Dentistry, London, UK
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14
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Aydın A, Atiç R. Comparison of extracorporeal shock-wave therapy and wrist-extensor splint application in the treatment of lateral epicondylitis: a prospective randomized controlled study. J Pain Res 2018; 11:1459-1467. [PMID: 30122976 PMCID: PMC6080668 DOI: 10.2147/jpr.s166679] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Extracorporeal shock-wave therapy (ESWT) and wrist-extensor splints (WESs) are two commonly used methods in the treatment of lateral epicondylitis. In this study, the efficacy of these two methods was compared. Methods The study was planned as a prospective randomized controlled study. A total of 67 patients were enrolled. The patients were divided into two groups: group 1 received ESWT (32 patients) and group 2 received WES (35 patients). Patients in group 1 underwent four sessions of ESWT once every week. In each session, an ESWT device at 10–12 Hz, 2,000 pulses, and 1.6–1.8 bar pressure was used. Patients in group 2 used a wrist splint, holding the wrist at 30°–45° extension for 4 weeks. Patients were assessed for handgrip strength, pain at rest, pain while working, and quality of life. Data were collected before and after treatment (at weeks 4, 12, and 24). A visual analog scale was used to evaluate pain at rest and while working, a hand dynamometer for handgrip strength, subscales of the SF36 Health Survey to evaluate quality of life, and the Turkish version of the patient-rated tennis-elbow evaluation was used to evaluate functioning of the affected arm during various daily life activities. Results In both ESWT and WES groups, although there were considerably significant improvements (P<0.001) in the parameters evaluated (pain at rest and while working, handgrip strength, Patient-Rated Tennis Elbow Evaluation, Nirschl score, and SF36 subscales) were observed at 4, 12, and 24 weeks compared to pretreatment values, there was no statistically significant difference between the two groups in terms of our evaluation parameters at the three time points (P>0.05). Conclusion Both ESWT and WES applications were found to yield significantly superior results when compared to pretreatment values. In comparison of the two groups, on the other hand, there was no statistically significant difference.
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Affiliation(s)
- Abdulkadir Aydın
- Prosthetics and Orthotics Department, Dicle University Medical School, Diyarbakir, Turkey,
| | - Ramazan Atiç
- Orthopedics and Traumatology Department, Dicle University Medical School, Diyarbakır, Turkey
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