Treatment of Lateral Epicondylitis With Platelet-Rich Plasma, Glucocorticoid, or Saline A Randomized, Double-Blind, Placebo-Controlled Trial
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% ...
Citations
More filters
TL;DR: No significant differences were found at 12 weeks in patients treated with platelet-rich plasma (PRP) compared with an active control group, but at 24 weeks, clinically meaningful improvements were found in patients treating with leukocyte-enriched PRP compared with a control group.
Abstract: Background:Elbow tenderness and pain with resisted wrist extension are common manifestations of lateral epicondylar tendinopathy, also known as tennis elbow. Previous studies have suggested platelet-rich plasma (PRP) to be a safe and effective therapy for tennis elbow.Purpose:To evaluate the clinical value of tendon needling with PRP in patients with chronic tennis elbow compared with an active control group.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:A total of 230 patients with chronic lateral epicondylar tendinopathy were treated at 12 centers over 5 years. All patients had at least 3 months of symptoms and had failed conventional therapy. There were no differences in patients randomized to receive PRP (n = 116) or active controls (n = 114). The PRP was prepared from venous whole blood at the point of care and contained both concentrated platelets and leukocytes. After receiving a local anesthetic, all patients had their extensor tendons needled with or without PRP. Patients ...
319 citations
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: It is shown that key inflammatory mediators — such as cytokines, nitric oxide, prostaglandins and lipoxins — play crucial parts in modulating changes in the extracellular matrix within tendinopathy.
Abstract: Tendon disorders are common and confer a large socioeconomic burden. This Review discusses the role of inflammatory mechanisms in tendon homeostasis and resolution of tendon damage, which are crucial to consider in developing novel therapeutics for tendinopathies. Tendinopathy is a multifactorial spectrum of tendon disorders that affects different anatomical sites and is characterized by activity-related tendon pain. These disorders are common, account for a high proportion (∼30%) of referrals to musculoskeletal practitioners and confer a large socioeconomic burden of disease. Our incomplete understanding of the mechanisms underpinning tendon pathophysiology continues to hamper the development of targeted therapies, which have been successful in other areas of musculoskeletal medicine. Debate remains among clinicians about the role of an inflammatory process in tendinopathy owing to a lack of clinical correlation. The advent of modern molecular techniques has highlighted the presence of immune cells and inflammatory mechanisms throughout the spectrum of tendinopathy in both animal and human models of disease. Key inflammatory mediators — such as cytokines, nitric oxide, prostaglandins and lipoxins — play crucial parts in modulating changes in the extracellular matrix within tendinopathy. Understanding the links between inflammatory mechanisms, tendon homeostasis and resolution of tendon damage will be crucial in developing novel therapeutics for human tendon disease.
245 citations
TL;DR: There is good evidence to support the use of a single injection of LR-PRP under ultrasound guidance in tendinopathy, and both the preparation and intratendinous injection technique of PRP appear to be of great clinical significance.
Abstract: Background:Tendinopathy is very common in the general population. There are increasing numbers of clinical studies referring to platelet-rich plasma (PRP) and platelet-poor plasma (PPP) as treatments for tendinopathy.Purpose:To perform a meta-analysis of the outcomes of the PRP groups by preparation method and injection technique in tendinopathy. To determine the clinical effectiveness of the preparations and to evaluate the effect of controls used in the studies reviewed.Study Design:Systematic review and meta-analysis.Methods:The PubMed, EMBASE, CINAHL, and Medline databases were searched in March 2012, April 2014, and August 2015, and randomized controlled trials using autologous blood, PRP, PPP, or autologous conditioned plasma in tendinopathy with outcome measures of pain and follow-up time of 3 months were included in this review. Trials including surgery, tendon tears, and muscle or ligament injuries were excluded. Study quality was assessed using the Cochrane Collaboration risk-of-bias tool by 2 r...
244 citations
TL;DR: At 1-year follow-up, a PRP injection was found to be no more effective in improving quality of life, pain, disability, and shoulder range of motion than placebo in patients with chronic RCT who were treated with an exercise program.
Abstract: Background:Rotator cuff tendinopathy (RCT) is a significant source of disability and loss of work. Platelet-rich plasma (PRP) has been suggested to be beneficial in the treatment of RCT.Purpose:To investigate the effect of PRP injections on pain and shoulder functions in patients with chronic RCT.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 40 patients, 18 to 70 years of age, with (1) a history of shoulder pain for >3 months during overhead-throwing activities, (2) MRI findings of RCT or partial tendon ruptures, and (3) a minimum 50% reduction in shoulder pain with subacromial injections of an anesthetic were included in this placebo-controlled, double-blind randomized clinical trial. Patients were randomized into a PRP group (n = 20) or placebo group (n = 20). Patients received an ultrasound-guided injection into the subacromial space that contained either 5 mL of PRP prepared from autologous venous blood or 5 mL of saline solution. All patients underwent a 6-week sta...
240 citations
Additional excerpts
...5 (0-75) Placebo 90 (60-100) 65 (10-90) 35 (10-100) 35 (3-100) 40 (1-100) 10 (0-100) Flexion, deg PRP 180 (90-180) 180 (110-180) 180 (140-180) 180 (160-180) 180 (160-180) 180 (170-180) Placebo 180 (80-180) 180 (90-180) 180 (100-180) 180 (100-180) 180 (120-180) 180 (140-180) Abduction, deg PRP 180 (70-180) 180 (70-180) 180 (90-180) 180 (160-180) 180 (160-180) 180 (170-180) Placebo 180 (70-180) 180 (80-180) 180 (90-180) 180 (90-180) 180 (100-180) 180 (110-180) IR, deg PRP 60 (0-90) 90 (30-90) 90 (60-90) 90 (50-90) 90 (50-90) 90 (70-90) Placebo 70 (0-90) 90 (10-180) 90 (30-180) 90 (30-180) 90 (40-180) 90 (60-90) ER, deg PRP 90 (40-90) 90 (50-90) 90 (80-90) 90 (80-90) 90 (80-90) 90 (90-90) Placebo 90 (0-180) 90 (20-180) 90 (40-180) 90 (40-180) 90 (50-180) 90 (50-90)...
[...]
...0) VAS PRP 80 (60-100) 50 (10-100) 40 (5-80) 30 (0-100) 25 (0-90) 7....
[...]
References
More filters
TL;DR: In many randomised trials researchers measure a continuous variable at baseline and again as an outcome assessed at follow up to see whether a treatment can reduce pre-existing levels of pain, anxiety, hypertension, and the like.
Abstract: In many randomised trials researchers measure a continuous variable at baseline and again as an outcome assessed at follow up. Baseline measurements are common in trials of chronic conditions where researchers want to see whether a treatment can reduce pre-existing levels of pain, anxiety, hypertension, and the like.
Statistical comparisons in such trials can be made in several ways. Comparison of follow up (post-treatment) scores will give a result such as “at the end of the trial, mean pain scores were 15 mm (95% confidence interval 10 to 20 mm) lower in the treatment group.” Alternatively a change score can be calculated by subtracting the follow up score from the baseline score, leading to a statement such as “pain reductions were 20 mm (16 to 24 mm) greater on treatment than control.” If the average baseline scores are the same in each group the estimated treatment effect will be the same using these two simple approaches. If the treatment is effective the statistical significance of the treatment effect by the two methods will depend on the correlation between baseline and follow up scores. If the correlation is low using the change score will …
1,721 citations
Journal Article•
University of Leeds1, University of Copenhagen2, Marche Polytechnic University3, Charité4, University of Paris5, Sapienza University of Rome6, University of Newcastle7, Leeds General Infirmary8, University of Erlangen-Nuremberg9, University of New South Wales10, University of Vienna11, Innsbruck Medical University12, Medical University of Vienna13
TL;DR: The first report from the OMERACT ultrasound special interest group is presented, which has compared US against the criteria of the O MERACT filter, and for the first time are consensus US definitions for common pathological lesions seen in patients with inflammatory arthritis.
Abstract: Ultrasound (US) has great potential as an outcome in rheumatoid arthritis trials for detecting bone erosions, synovitis, tendon disease, and enthesopathy. It has a number of distinct advantages over magnetic resonance imaging, including good patient tolerability and ability to scan multiple joints in a short period of time. However, there are scarce data regarding its validity, reproducibility, and responsiveness to change, making interpretation and comparison of studies difficult. In particular, there are limited data describing standardized scanning methodology and standardized definitions of US pathologies. This article presents the first report from the OMERACT ultrasound special interest group, which has compared US against the criteria of the OMERACT filter. Also proposed for the first time are consensus US definitions for common pathological lesions seen in patients with inflammatory arthritis.
1,215 citations
"Treatment of Lateral Epicondylitis ..." refers background in this paper
...The US findings in tendinopathy in general are characterized by increased tendon size, Doppler activity, irregularity of the fibrillar appearance, focal hypoechoic areas, and calcifications.(1,27,33,61) Several studies have described these US features in patients with LE....
[...]
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
"Treatment of Lateral Epicondylitis ..." refers methods in this paper
...5 mL of PRP, with a platelet concentration increased on average by 8-fold compared with whole blood.(13) To achieve a physiological pH, the PRP was buffered with 8....
[...]
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
TL;DR: This review covers some of the recent investigations into the roles of five growth factors whose activities have been best characterised during tendon healing: insulin-like growth factor-I (IGF-I), transforming growth factor β (TGFβ), vascular endothelial growthFactor (VEGF), platelet-derived growth factor (PDGF), and basic fibroblast growth factor ($FGF).
Abstract: sustained and eventually terminated by a large number and variety of molecules. Growth factors represent one of the most important of the molecular families involved in healing, and a considerable number of studies have been undertaken in an effort to elucidate their many functions. This review covers some of the recent investigations into the roles of five growth factors whose activities have been best characterised during tendon healing: insulin-like growth factor-I (IGF-I), transforming growth factor β (TGFβ), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), and basic fibroblast growth factor (bFGF). All five are markedly up-regulated following tendon injury and are active at multiple stages of the healing process. IGF-I has been shown to be highly expressed during the early inflammatory phase in a number of animal tendon healing models, and appears to aid in the proliferation and migration of fibroblasts and to subsequently increase collagen production. TGFβ is also active during inflammation, and has a variety of effects including the regulation of cellular migration and proliferation, and fibronectin binding interactions. VEGF is produced at its highest levels only after the inflammatory phase, at which time it is a powerful stimulator of angiogenesis. PDGF is produced shortly after tendon
923 citations
"Treatment of Lateral Epicondylitis ..." refers methods in this paper
...Platelet-rich plasma (PRP) is blood plasma with an increased concentration of autologous platelets, which is now being used as a part of wound treatment, bone healing, alloplastic surgery, and muscle/ tendon damage.(2,38,51) It can potentially enhance tendon healing and tissue regeneration by delivering various growth factors and cytokines, thereby effecting cell proliferation, chemotaxis, cell differentiation, and angiogenesis....
[...]