Platelet-Rich Plasma Versus Autologous Whole Blood for the Treatment of Chronic Lateral Elbow Epicondylitis: A Randomized Controlled Clinical Trial
TL;DR: PRP treatment seems to be an effective treatment for chronic lateral elbow epicondylitis and superior to autologous blood in the short term and the possibility of cost reduction of the method might justify the use of PRP over autOLOGous whole blood for chronic or refractory tennis elbow.
Abstract: Background: Chronic lateral elbow epicondylitis is a tendinosis with angiofibrolastic degeneration of the wrist extensors’ origin. Healing of this lesion is reported with the use of autologous blood as well as with platelet-rich plasma (PRP).Purpose: A comparative study of these 2 treatments was conducted in an effort to investigate the possible advantages of PRP.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: Twenty-eight patients were divided equally into 2 groups, after blocked randomization. Group A was treated with a single injection of 3 mL of autologous blood and group B with 3 mL of PRP under ultrasound guidance. A standardized program of eccentric muscle strengthening was followed by all patients in both groups. Evaluation using a pain visual analog scale (VAS) and Liverpool elbow score was performed at 6 weeks, 3 months, and 6 months.Results: The VAS score improvement was larger in group B at every follow-up interval but the difference was statistically significant only ...
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TL;DR: A simple method for organizing and comparing results in the literature is proposed and is based on 3 components: the absolute number of Platelets, the manner in which platelet Activation occurs, and the presence or absence of White cells.
Abstract: Platelet-rich plasma (PRP) has been the subject of hundreds of publications in recent years. Reports of its effects in tissue, both positive and negative, have generated great interest in the orthopaedic community. Protocols for PRP preparation vary widely between authors and are often not well documented in the literature, making results difficult to compare or replicate. A classification system is needed to more accurately compare protocols and results and effectively group studies together for meta-analysis. Although some classification systems have been proposed, no single system takes into account the multitude of variables that determine the efficacy of PRP. In this article we propose a simple method for organizing and comparing results in the literature. The PAW classification system is based on 3 components: (1) the absolute number of Platelets, (2) the manner in which platelet Activation occurs, and (3) the presence or absence of White cells. By analyzing these 3 variables, we are able to accurately compare publications.
428 citations
TL;DR: Neither injection of PRP nor glucocorticoid was superior to saline with regard to pain reduction in LE at the primary end point at 3 months, and neither had a short-term pain-reducing effect at 1 month in contrast to the other therapies.
Abstract: Background:Lateral epicondylitis (LE) is a common musculoskeletal disorder for which an effective treatment strategy remains unknown.Purpose:To examine whether a single injection of platelet-rich plasma (PRP) is more effective than placebo (saline) or glucocorticoid in reducing pain in adults with LE after 3 months.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 60 patients with chronic LE were randomized (1:1:1) to receive either a blinded injection of PRP, saline, or glucocorticoid. The primary end point was a change in pain using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire at 3 months. Secondary outcomes were ultrasonographic changes in tendon thickness and color Doppler activity.Results:Pain reduction at 3 months (primary end point) was observed in all 3 groups, with no statistically significant difference between the groups; mean differences were the following: glucocorticoid versus saline: −3.8 (95% CI, −9.9 to 2.4); PRP versus saline: −2.7 (95% ...
316 citations
Cites result from "Platelet-Rich Plasma Versus Autolog..."
...In conclusion, we were not able to reproduce the promising results of PRP treatment presented in recent studies.(8,43,56) The effect of PRP or glucocorticoid injection on pain and disability at a primary end point of 3 months (no attrition) was not statistically different from saline injection....
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TL;DR: Reporting of PRP preparation protocols in clinical studies is highly inconsistent, and the majority of studies did not provide sufficient information to allow the protocol to be reproduced, which does not enable comparison of the PRP products being delivered to patients.
Abstract: Background:Platelet-rich plasma (PRP) is a blood-derived preparation whose use has grown exponentially in orthopaedic practice. However, there remains an unclear understanding of the biological properties and effects of PRP on musculoskeletal healing. Heterogeneous processing methods, unstandardized
295 citations
TL;DR: Compared with leukocytes-poor Cascade PRP, leukocyte-rich GPS III PRP causes a significantly greater acute inflammatory response at 5 days after injection and there is no significant difference in the inflammatory response or cellularity regardless of the injection type at 14 days after intratendinous injection.
Abstract: Background: Numerous studies have shown platelet-rich plasma (PRP) preparations differ with respect to the inclusion of certain blood components, which may affect the host’s cellular response.Hypothesis: This study evaluated the inflammatory effect of Biomet GPS III leukocyte-rich PRP (LR-PRP) versus MTF Cascade leukocyte-poor PRP (LP-PRP) after intratendinous injection in an animal model. The authors anticipated that LR-PRP would incite a greater acute inflammatory response than LP-PRP.Study Design: Controlled laboratory study.Methods: A total of 17 skeletally mature New Zealand White rabbits were tested. In all cases, healthy patellar tendons were treated. In the control animals, one patellar tendon was injected with 2 mL autologous whole blood, and the other was injected with 2 mL sterile saline. Seven total tendons were injected with whole blood, and 7 tendons were injected with saline. In the experimental animals, one patellar tendon was injected with 2 mL LR-PRP, and the other was injected with 2 mL...
249 citations
References
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University of Vermont1, Delft University of Technology2, Northwestern University3, Vrije Universiteit Brussel4, University of British Columbia5, Leiden University Medical Center6, University of Oregon7, University of Maryland, Baltimore8, State University of New York Upstate Medical University9, University of Massachusetts Lowell10
TL;DR: A definition of a joint coordinate system (JCS) for the shoulder, elbow, wrist, and hand is proposed and a standard for the local axis system in each articulating segment or bone is generated.
3,866 citations
TL;DR: Not all currently marketed PRP devices are qual; some do not concentrate viably active platelets n sufficient numbers to produce a healing enhance- herefore, the term PRP is preferred to autologous latelet gel, plasma-rich growth factors (PRGFs), or a ere autOLOGous platelet concentrate.
1,626 citations
TL;DR: The definition of PRP, its safety, its proper development, and its most efficacious means of application are discussed.
Abstract: P l atelet-rich plasma (PRP) has been a breakthrough in the stimulation and acceleration of bone and soft tissue healing. It represents a relatively new biotechnology that is part of the growing interest in tissue engineering and cellular therapy today. Because of its newness, there is a potential for misunderstanding, misuse, and application of what the practitioner may incorrectly think is PRP. The purpose of this paper is to discuss the definition of PRP, its safety, its proper development, and its most efficacious means of application.
1,357 citations
TL;DR: A variety of potentially therapeutic growth factors were detected and released from the platelets in significant levels in platelet-rich plasma preparations and may be capable of expediting wound healing in a variety of as yet undetermined specific wound applications.
Abstract: Growth factors released from activated platelets initiate and modulate wound healing in both soft and hard tissues. A recent strategy to promote the wound-healing cascade is to prepare an autologous platelet concentrate suspended in plasma, also known as platelet-rich plasma, that contains growth factors and administer it to wound sites. The purpose of this study was to quantitate platelet number and growth factors released from a prepared platelet concentrate. Whole blood was drawn from 10 healthy patients undergoing cosmetic surgery and concentrated into platelet-rich plasma. Platelet counts on whole blood and platelet-rich plasma were determined using a Cell-Dyn 3200. Platelet-derived growth factor-BB, transforming growth factor-[beta]1, vascular endothelial growth factor, endothelial growth factor, and insulin-like growth factor-1 were measured in the platelet-rich plasma using the enzyme-linked immunosorbent assay method. In addition, platelet activation during the concentration procedure was analyzed by measuring P selectin values in blood serum. An 8-fold increase in platelet concentration was found in the platelet-rich plasma compared with that of whole blood (baseline whole blood, 197 ± 42 × 10 3
1,054 citations
"Platelet-Rich Plasma Versus Autolog..." refers background in this paper
...The use of PRP for healing purposes was first popularized in maxillofacial and plastic surgery in the 1990s.(10) Its use in orthopaedics started later and it is increasing....
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TL;DR: This study reviews and evaluates the human studies that have been published in the orthopaedic surgery and sports medicine literature and the regulation of PRP by antidoping agencies is discussed.
Abstract: Platelet-rich plasma (PRP) has been utilized in surgery for 2 decades; there has been a recent interest in the use of PRP for the treatment of sports-related injuries. PRP contains growth factors and bioactive proteins that influence the healing of tendon, ligament, muscle, and bone. This article examines the basic science of PRP, and it describes the current clinical applications in sports medicine. This study reviews and evaluates the human studies that have been published in the orthopaedic surgery and sports medicine literature. The use of PRP in amateur and professional sports is reviewed, and the regulation of PRP by antidoping agencies is discussed.
1,040 citations