Management of Lateral Epicondylitis: A Prospective Comparative Study Comparing the Local Infiltrations of Leucocyte Enriched Platelet-Rich Plasma (L-aPRP), Glucocorticoid and Normal Saline

Efficacy of Platelet-Rich Plasma Injection in the Management of Lateral Epicondylitis: A Retrospective Assessment

OBJECTIVE

This study aimed to evaluate the efficacy of platelet-rich plasma (PRP) injections in managing lateral epicondylitis (LE), focusing on pain relief, functional improvement, side effects, and patient satisfaction.

METHODS

A retrospective analysis of 19 patients treated with PRP injections at a tertiary care center was conducted. Data included demographic characteristics, Visual Analog Scale (VAS) pain scores, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and patient satisfaction. Statistical analyses utilized paired t-tests and one-sample proportion tests. Statistical significance was set at p<0.05.

RESULTS

PRP injections significantly reduced VAS pain scores, with 21.05% (4/19) of patients achieving complete pain relief (VAS=0) and 47.37% (9/19) reducing scores to ≤3 (p=0.027). DASH scores improved substantially, with mean scores decreasing from 87.5% (19/19) (95% CI: 82.3-92.7%) pre-treatment to 18.5% (19/19) (95% CI: 12.7-24.3%) post-treatment (p<0.001). Prior corticosteroid use was associated with poorer outcomes (p=0.012). Patient satisfaction was high, with 89.5% (16/19) of patients reporting being "very satisfied" or "satisfied" (p=0.001).

CONCLUSION

PRP injections offer significant pain relief and functional improvement for patients with LE. This minimally invasive treatment is particularly valuable for high-demand populations, such as professional athletes, due to faster recovery times and reduced need for surgery. However, high patient satisfaction rates underscore its clinical utility. Prospective studies with larger cohorts are needed to further validate these findings and refine PRP protocols.

Industry affiliation influence on randomized controlled trials for platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review

Background

Explicit funding and industry affiliation are believed to potentially impact medical research. There have been an increasing number of studies that have evaluated this relationship. The purpose of this study is to determine whether industry affiliation influences the outcomes of randomized controlled trials that investigate the effectiveness of platelet-rich plasma (PRP) in the treatment of lateral epicondylitis.

Methods

A search of PubMed, SPORTDiscus, and SCOPUS was performed using the search terms "lateral epicondylitis" and "platelet-rich plasma" as well as "tennis elbow" and "platelet-rich plasma." Only studies from 2010 to present were considered. Final texts were then analyzed for industry affiliation and treatment efficacy. When determining whether a study was industry-affiliated, explicit financial supporters of the study, stated conflicts of interest, American Academy of Orthopaedic Surgeons disclosures, and the Centers for Medicare and Medicaid Services open payments database were assessed. Study outcomes were categorized as favorable, analogous, or unfavorable based on achieving a statistically significant (P < .05) comparison between PRP and control.

Results

A total of 26 studies were used. Of these, 20 were industry nonaffiliated and 6 were industry affiliated. There were 15 studies (2 affiliated and 13 nonaffiliated) that reported PRP as favorable compared to the comparison (corticosteroid, analogous whole blood, or normal saline). The endpoints were 6 and 12 months after the use of PRP or the comparison. Quantitative data analysis yielded results that were not statistically significant between industry-nonaffiliated and affiliated groups. The P values for 6-month visual analog scale, 12-month visual analog scale, 6-month disabilities of the arm, shoulder, and hand, 12-month disabilities of the arm, shoulder, and hand, 6-month patient-related tennis elbow evaluation, and 12-month patient-related tennis elbow evaluation were 0.577, 0.635, 0.554, 0.465, 0.273, and 0.157, respectively.

Conclusion

Despite our results indicating that industry affiliation does not have an impact on outcomes of randomized controlled trials examining the treatment of lateral epicondylitis with PRP, it is important for future studies to evaluate affiliations when making treatment recommendations.

Corticosteroid injections for the treatment of lateral epicondylitis are superior to platelet-rich plasma at 1 month but platelet-rich plasma is more effective at 6 months: an updated systematic review and meta-analysis of level 1 and 2 studies

BACKGROUND

The purpose of this study was to perform a systematic review and meta-analysis of studies comparing local injections of either platelet-rich plasma (PRP) or corticosteroid for the treatment of lateral elbow epicondylitis.

METHODS

A systematic review of MEDLINE, Embase, Scopus, and Google Scholar was performed, and all level 1 and 2 randomized studies from 2000 to 2022 were included. Clinical symptoms, patient perceived outcomes, and pain were assessed by the DASH (disabilities of the arm, shoulder and hand questionnaire) and pain by the visual analog scale (VAS). Publication bias and risk of bias were assessed using the Cochrane Collaboration's tools. The modified Coleman Methodology Score (CMS) and the GRADE system were used to assess the quality of the body of evidence. Heterogeneity was assessed using χ2 and I2 statistics.

RESULTS

Thirteen studies were included in the analysis. Five studies had a high risk of bias, and the risk of bias across studies was assessed as unclear. There was no publication bias identified. Two of the four GRADE domains (inconsistency of results, imprecision of results) were downgraded to low quality, and the final GRADE assessment was downgraded to a low quality of evidence. The mean CMS score was 62.8, indicating fair quality. The pooled estimate for VAS at 1 month favored corticosteroids (P = .75) but favored PRP at three (P = .003) and six months (P = .0001). The pooled estimate for the DASH score favored corticosteroids at 1 month (P = .028) but favored PRP at three (P = .01) and six months (P = .107) CONCLUSION: The results of this meta-analysis suggest that PRP has no advantage over steroid injections within the first month of treatment, but that it is superior to steroids at both 3 and 6 months. These results also suggest that corticosteroids have a short-term beneficial effect during the early treatment period, although the quality of the available evidence is not very robust in support of this finding. However, these findings must all be viewed with caution as the high risk of bias and moderate to low quality of the included studies may not justify a recommendation of one treatment over another.

Comparison between acupotomy and corticosteroid injection for patients diagnosed with different classifications of tennis elbow: a randomized control trial

BACKGROUND

Tennis elbow has long been one of the most controversial subjects in orthopaedics. Many scholars thought the use of open or arthroscopic surgery was reserved for patients with refractory symptoms. Therapy with percutaneous acupotomy performed under local anaesthesia also removes degenerated tissue, releases strain, and therefore provides an alternative treatment option to surgical excision.

METHODS

The aim of this single-blinded randomized control trial was to examine the long-term clinical effectiveness of a nonsurgical percutaneous release technique (acupotomy) and the current recommended treatment (steroid injection) in people diagnosed with a refractory tennis elbow. Ninety patients with refractory symptoms were included. The intervention period was 6 weeks. According to the classification, 38 patients had extra-articular tennis elbow, 36 patients had intraarticular tennis elbow, and 16 patients had mixed type tennis elbow. Forty-five patients were randomly assigned to treatment with percutaneous release by acupotomy according to their classified condition, and 45 patients were randomly assigned to treatment with steroid injection alone. The visual analogue scale (VAS), a tenderness assessment, a grip assessment, and the Nirschl staging system were used for outcome evaluation at pretreatment and the posttreatment timepoints from 12 to 48 weeks.

RESULTS

During the first weeks, there were no differences observed between the groups. By 6, 24 and 48 weeks, significant differences were observed between the two groups. The acupotomy group scored significantly better in visual analogue scale score (VAS) of pain, tenderness during palpation, pain-free grip strength (PFGS) and Nirschl staging than the corticosteroid group.

CONCLUSIONS

For patients with lateral epicondylitis, acupotomy is just as effective as corticosteroid injections in the short term (< 6 weeks). In the long term, acupotomy has greater efficacy and is associated with a lower rate of recurrence than corticosteroid injections in the management of lateral epicondylitis.

TRIAL REGISTRATION

The National Health Commission announced the "ethical review measures for biomedical research involving people" in 2019, which was not mandatory in previous studies.