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Effects of platelet-rich plasma on lateral epicondylitis of the elbow: prospective randomized controlled trial

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Journal Revista brasileira de ortopedia
Year 2016
Links Pubmed DOI PubMed Central LILACS

This article is included in 5 Systematic reviews Systematic reviews (5 references)

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To evaluate the effects of platelet-rich plasma (PRP) infiltration in patients with lateral epicondylitis of the elbow, through analysis of the Disabilities of the Arm, Shoulder and Hand (DASH) and Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaires. METHODS: Sixty patients with lateral epicondylitis of the elbow were prospectively randomized and evaluated after receiving infiltration of three milliliters of PRP, or 0.5% neocaine, or dexamethasone. For the scoring process, the patients were asked to fill out the DASH and PRTEE questionnaires on three occasions: on the day of infiltration and 90 and 180 days afterwards. RESULTS: Around 81.7% of the patients who underwent the treatment presented some improvement of the symptoms. The statistical tests showed that there was evidence that the cure rate was unrelated to the substance applied (p = 0.62). There was also intersection between the confidence intervals of each group, thus demonstrating that the proportions of patients whose symptoms improved were similar in all the groups. CONCLUSION: At a significance level of 5%, there was no evidence that one treatment was more effective than another, when assessed using the DASH and PRTEE questionnaires.

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Effectiveness of platelets rich plasma versus corticosteroids in lateral epicondylitis.

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Authors Khaliq A , Khan I , Inam M , Saeed M , Khan H , Iqbal MJ
Journal JPMA. The Journal of the Pakistan Medical Association
Year 2015
Links Pubmed

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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OBJECTIVE: To compare the treatment modalities of lateral epicondylitis in terms of pain relief. METHODS: The randomised controlled study was conducted at Hayatabad Medical Complex, Peshawar, Pakistan, from April 2013 to March 2014, and comprised cases of lateral epicondylitis. The patients were selected through consecutive sampling from the outpatient department and were randomly allocated to two equal groups; group A receiving corticosteroid injections, and group B receiving injection of platelet-rich plasma. The patients were followed up for three weeks to determine the effectiveness of intervention. RESULTS: The 102 patients in the study were divided into two groups of 51(50%) each. The over mean age was 33.9±10.3 years. Mean age of patients in the corticosteroid group was 34.2±10.2 years and in the other group it was 33.6±10.5 years. Mean baseline visual analogue score in group A were 6.5±1.2 and in group B it was 6.7±1.4. In group A, 74.5% of patients presented in moderate pain category and 25.5% presented in severe pain category. In group B, 70.6% presented in moderate with 29.4% presented in severe pain category. On follow-up, the mean pain score in group A was 4.0±2.6 and in group B it was 3.5±2.61. Group A showed effectiveness in 52.9% patients and group B showed effectiveness in 82.3% (p=0.001). CONCLUSIONS: PRP is an effective alternate to corticosteroid in the treatment of lateral epicondylitis (tennis elbow).

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In Vitro Comparison of Apically Extruded Debris during Root Canal Preparation of Mandibular Premolars with Manual and Rotary Instruments.

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Authors Soi S , Yadav S , Sharma S , Sharma M
Journal Journal of dental research, dental clinics, dental prospects
Year 2015
Links Pubmed DOI PubMed Central

This article is included in 1 Systematic review Systematic reviews (1 reference)

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Background and aims. During root canal preparation, debris extruded beyond the apical foramen may result in periapical inflammation and postoperative pain. To date no root canal preparation method has been developed that extrudes no periapical debris. The purpose of this study was to identify a system leading to minimal extrusion of debris from the apical foramen. The study was conducted to comparatively evaluate the amount of apical extrusion of debris during root canal preparation using hand ProTaper and GT rotary and RaCe rotary instruments using crown-down technique. Materials and methods. Ninety freshly extracted human single-rooted mandibular premolars were equally assigned to three groups (n=30). The root canals were instrumented using hand ProTaper, GT rotary and RaCe rotary systems. Debris and irrigant extruded from the apical foramen were collected into vials. The mean weight of the remaining debris was calculated for each group and subjected to statistical analysis. Results. ANOVA was used to compare the mean dry weights of the debris extruded in the three groups, followedby post hoc Tukey tests for multiple comparisons the between groups. Highly significant differences were found in the amount of debris extruded among all the groups (P<0.001). The ProTaper group exhibited the highest mean debris weight (0.8293±0.05433 mg) and the RaCe system exhibited the lowest mean debris weight (0.1280±0.01606 mg). Conclusion. All the systems tested resulted in apical extrusion of debris. However, the hand ProTaper files extruded a significantly higher amount of debris than GT and RaCe systems.

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Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation.

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Journal Journal of orthopaedic surgery (Hong Kong)
Year 2015
Links Pubmed DOI

This article is included in 5 Systematic reviews Systematic reviews (5 references)

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PURPOSE: To evaluate the clinical and ultrasonographic changes in the morphology and vascularity of the common extensor tendon after injecting platelet-rich plasma (PRP) or corticosteroid (CS) for recalcitrant lateral epicondylitis (LE). METHODS: 30 patients aged 18 to 60 years with recalcitrant (>6 months) LE not responsive to oral medication or non-invasive treatment were randomised to receive PRP (n=15) or CS (n=15) injection. Patients were assessed using the visual analogue scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand Scale (DASH) score, Oxford Elbow Score, modified Mayo Clinic performance index for the elbow (modified Mayo score), and hand grip strength. Ultrasonography was performed by a musculoskeletal ultrasonologist to evaluate for tear at the common extensor origin, oedema at the common extensor origin, cortical erosion, probe-induced tenderness, and thickness of the tendon. RESULTS: The VAS for pain, DASH score, Oxford Elbow Score, modified Mayo score, and hand grip strength all improved significantly from pre-injection to the 6-month follow-up in the PRP and CS groups. However, in the CS group, the scores generally peaked at 3 months and then deteriorated slightly at 6 months indicating recurrence of symptoms, which involved 46.7% of the CS patients. At 6 months, the number of patients positive for various ulrasonographic findings generally decreased. However, in the CS group, the number of patients with reduced thickness of the common extensor tendon increased from 2 to 12, and the number of patients with cortical erosion at the lateral epicondyle increased from 9 to 11. CONCLUSION: PRP appeared to enable biological healing of the lesion, whereas CS appeared to provide short-term, symptomatic relief but resulted in tendon degeneration.

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Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis.

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Authors Beyazal MS , Devrimsel G
Journal Journal of physical therapy science
Year 2015
Links Pubmed DOI PubMed Central

This article is included in 1 Systematic review Systematic reviews (1 reference)

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[Purpose] This study aimed to determine and compare the effectiveness of extracorporeal shock wave therapy and local corticosteroid injection in patients with lateral epicondylitis. [Subjects and Methods] Sixty-four patients with lateral epicondylitis were randomly divided into extracorporeal shock wave therapy and steroid injection groups. Patients were evaluated using hand grip strength, visual analog scale, and short-form McGill pain questionnaire at baseline and at 4 and 12 weeks post-treatment. [Results] Both groups showed statistically significant increase in hand grip strength and decreases on the visual analog scale and short form McGill pain questionnaire overtime. There was no statistically significant difference in the percentage of improvement in hand grip strength and on the short-form McGill pain questionnaire between groups at 4 weeks post-treatment, whereas the extracorporeal shock wave therapy group showed better results on the visual analog scale. The percentages of improvements in all 3 parameters were higher in the extracorporeal shock wave therapy group than in the injection group at 12 weeks post-treatment. [Conclusion] Both the extracorporeal shock wave therapy and steroid injection were safe and effective in the treatment of lateral epicondylitis. However, extracorporeal shock wave therapy demonstrated better outcomes than steroid injection at the long-term follow-up.

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A randomized study of autologous conditioned plasma and steroid injections in the treatment of lateral epicondylitis.

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Journal International orthopaedics
Year 2015
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This article is included in 4 Systematic reviews Systematic reviews (4 references)

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<b>PURPOSE: </b>Chronic tendinopathy of lateral epicondyle of the humerus, commonly known as "tennis elbow" is one of the most frequent tendinopathies caused by recurrent overload of the muscle origins. The aim of the study was to assess the effectiveness of treating lateral epicondylitis (LE) with autologous conditioned plasma (ACP) and betamethasone injections, and to compare these methods over the course of a one year follow-up.<b>METHODS: </b>Patients were randomly placed into one of into two groups: 53 were treated with ACP, and 46 with 1 ml betamethasone injections and 2 ml of 1 % lignocaine. Both those groups were comparable in terms of initial DASH score.<b>RESULTS: </b>After six weeks and six months, the mean DASH score was significantly better in the betamethasone group, but was better in ACP group after one year. Full recovery (patients with no symptoms) at all time points was more common in the betamethasone group. A comparison of grouped DASH scores revealed more very good and good results in the ACP group after one year. More patients had pain symptoms related to injection in the ACP group than the betamethasone group.<b>CONCLUSIONS: </b>ACP therapy of LE allows better results to be obtained at 12 months. Betamethasone injections give more rapid improvement, but the therapeutic effect is longer lasting in the ACP group.

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Effect of platelet-rich plasma (PRP) versus autologous whole blood on pain and function improvement in tennis elbow: a randomized clinical trial

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Authors Raeissadat , S. A. , Sedighipour , L. , Rayegani , S. M. , Bahrami , M. H. , Bayat , M. , Rahimi , R
Journal Pain research and treatment
Year 2014

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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Is platelet-rich plasma superior to whole blood in the management of chronic tennis elbow: One year randomized clinical trial

Journal BMC sports science, medicine and rehabilitation
Year 2014
Links Pubmed DOI PubMed Central

This article is included in 6 Systematic reviews Systematic reviews (6 references)

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Background: Lateral humeral epicondylitis, or 'tennis elbow', is a common condition with a variety of treatment options. Platelet-rich plasma (PRP) and Autologous Whole Blood (AWB) represent new therapeutic options for chronic tendinopathies including tennis elbow. The aim of the present study was to compare the long term effects of PRP versus autologous whole blood local injection in patients with chronic tennis elbow. Methods: Seventy six patients with chronic lateral humeral epicondylitis with duration of symptoms more than 3 months were included in this study and randomized into 2 groups. Group 1 was treated with a single injection of 2 mL of autologous leukocyte rich PRP (4.8 times of plasma) and group 2 with 2 mL of AWB. Tennis elbow strap, stretching and strengthening exercises were administered for both groups. Pain and functional improvements were assessed using visual analogue scale (VAS), Mayo score (modified Mayo Clinic performance index for the elbow) and pressure pain threshold (PPT) at 0, 4, 8 weeks and 6 and 12 months. Results: All pain variables including VAS, PPT and Mayo scores improved significantly in both groups at each follow up intervals compared to baseline. No statistically significant difference was noted between groups regarding pain, functional scores and treatment success rates in all follow up examinations (P >0/05). Conclusion: PRP and autologous whole blood injections are both effective methods to treat chronic lateral epicondylitis and their efficacy persisted during long term follow up. PRP was not superior to AWB in long term follow up.

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Injection of autologous blood versus corticosteroid for lateral epicondylitis: A randomised controlled study.

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Authors Arik HO , Kose O , Guler F
Journal J Orthop Surg (Hong Kong)
Year 2014

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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Comparison of short term results of single injection of autologous blood and steroid injection in tennis elbow: a prospective study.

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Journal Journal of orthopaedic surgery and research
Year 2013
Links Pubmed DOI PubMed Central

This article is included in 4 Systematic reviews Systematic reviews (4 references)

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BACKGROUND: It has been recently reported that local injection of autologous blood in tennis elbow offers a significant benefit by virtue of various growth factors contained therein. The objective of our study was assessment of efficacy of autologous blood injection versus local corticosteroid injection in the treatment of tennis elbow. METHODS AND TRIAL DESIGN: A single blinded, prospective parallel group trial was undertaken. 50 consecutive patients of untreated lateral epicondylitis were enrolled. Randomisation was done on alternate basis and two groups were constituted, first one receiving steroid injection and second one injection of autologous blood. Both groups were evaluated at 2 and 6 weeks for pain relief and stage of disease. RESULTS: Baseline evaluation showed no difference between the two groups (chi square test, P > 0.05). Between group analysis at 2 weeks showed no difference in pain relief and Nirschl stage (unpaired t test, P > 0.05). Evaluation at 6 weeks demonstrated a significant decrease in pain levels and stage of disease in blood group (unpaired t test, p < 0.05). CONCLUSIONS: Autologous blood injection was more effective than steroid injection in the short term follow up in tennis elbow.