Is Ultrasound (US)-Guided Platelet-Rich Plasma Injection More Efficacious as a Treatment Modality for Lateral Elbow Tendinopathy Than US-Guided Steroid Injection?: A Prospective Triple-Blinded Study with Midterm Follow-up

Abstract

Background Lateral elbow tendinopathy (LET) has an array of modalities described for its management. The present study analyzed two modalities used for managing the condition. Methods The present study included 64 non-athletes with LET who failed conservative treatment that included avoiding strenuous activities, ice-fomentation, non-steroidal anti-inflammatory drugs, bracing, and physiotherapy for 6 months. A random allocation of the participants was done, with one group injected with platelet-rich plasma (PRP) and the other group with corticosteroids. The procedure was performed by the same blinded orthopedic surgeon after localizing the pathology using ultrasound. Visual analog scale (VAS) scores, disabilities of the arm, shoulder and hand (DASH) scores, Patient-Rated Tennis Elbow Evaluation (PRTEE) scores, and handgrip strengths were recorded by blinded observers other than the surgeon administering the injection. Results The average age of the patients was 40 years. The mean VAS score at the latest follow-up of 2 years in the PRP group was 1.25 and it was significantly better than the score of 3.68 in the steroid group ( p < 0.001). The mean DASH score at the latest follow-up of 2 years in the PRP group was 4.00 and it was significantly better than the score of 7.43 in the steroid group ( p < 0.001). The mean PRTEE score at the latest follow-up of 2 years in the PRP group was 3.96 and it was significantly better than the score of 7.53 in the steroid group ( p < 0.001). The scores were better in the steroid group at a short-term follow-up of 3 months ( p < 0.05), while they were better in the PRP group at a long-term follow-up of 2 years ( p < 0.05). Hand-grip strength was comparable in the PRP group (84.43 kg force) and steroid group (76.71 kg force) at the end of the 2-year follow-up with no statistically significant difference ( p = 0.149). Conclusions Corticosteroid injections alleviated symptoms of LET over short-term follow-up providing quicker symptomatic relief; however, the effect faded off over the long term. PRP injections provided a more gradual but sustained improvement over the long-term follow-up, indicating the biological healing potential of PRP.

Efficiency of applying platelet-rich plasma (PRP) in the regeneration of tendinopathy: a systematic review study

“…Discussion: In the studies by Gautam et Al, (2015), Cai et Al, ( 2019) and Kamble et Al, (2022) USguided application was used, demonstrating more positive results compared to the study by Keene et Al, (2019), which used the application guided by the doctor's palpation. Regarding the preparation method, the double centrifugation demonstrated in the studies by Cai et Al, (2019) and Kamble et Al, (2022), was also associated with greater benefits compared to a single centrifugation in the study by Keene et Al, (2019). Conclusion: Most studies have demonstrated the effectiveness of using PRP in the regeneration of tendinopathies.…”

“…Methodology: To carry out this study, a systematic review of the literature was carried out, using as a basis the Preferred Reporting Items for Systematic review and Meta-Analysis, and adopting the following descriptors from the Medical Subject Headings, in English: platelet-rich plasma (plasma rich in platelets), physiotherapy, tendinopathy and tendon injury, in the Pubmed electronic database. Results: In this study, 4 articles were selected, 3 of which showed significant efficacy in improving function and pain in the injured limb after the application of PRP (GAUTAM, et al, 2015;CAI, et al, 2019;KAMBLE, et al, 2022), however, the study by Keene et al, (2019), did not detect a significant improvement with the use of PRP in relation to placebo, considering that the application of PRP in this study was guided only by the doctor's palpation. Discussion: In the studies by Gautam et Al, (2015), Cai et Al, ( 2019) and Kamble et Al, (2022) USguided application was used, demonstrating more positive results compared to the study by Keene et Al, (2019), which used the application guided by the doctor's palpation.…”

A Terapia Ocupacional E Seus Benefícios No Ambiente Aquático Com Pacientes Amputados: Uma Revisão Integrativa Da Literatura

“…Metodologia: Para a realização deste estudo foi feita uma revisão sistemática da literatura, utilizando como base o Preferred Reporting Items for Systematic review and Meta-Analysis, e adotando os seguintes descritores da Medical Subject Headings, em língua inglesa: platelet-rich plasma (plasma rico em plaquetas), physiotherapy (fisioterapia), tendinopathy (tendinopatia) e tendon injury (lesões no tendão), na base de dados eletrônica Pubmed. Resultados: Neste estudo foram selecionados 4 artigos, os quais 3 apresentaram eficácia significativa na melhora da função e do quadro álgico no membro lesionado após a aplicação de PRP(GAUTAM, et al, 2015; CAI, et al, 2019;KAMBLE, et al, 2022), contudo, o estudo deKeene et al, (2019), não detectou melhora significativa com o uso do PRP em relação ao placebo, considerando que a aplicação de PRP neste estudo foi guiada apenas pela palpação do médico. Discussão: Nos estudos deGautam et Al, (2015), Cai et Al, (2019) eKamble et Al, (2022) foi utilizado aplicação guiada por US, demonstrando resultados mais positivos em comparação ao estudo deKeene et Al, (2019), que utilizou a aplicação guiada pela palpação do médico.…”

“…Resultados: Neste estudo foram selecionados 4 artigos, os quais 3 apresentaram eficácia significativa na melhora da função e do quadro álgico no membro lesionado após a aplicação de PRP(GAUTAM, et al, 2015; CAI, et al, 2019;KAMBLE, et al, 2022), contudo, o estudo deKeene et al, (2019), não detectou melhora significativa com o uso do PRP em relação ao placebo, considerando que a aplicação de PRP neste estudo foi guiada apenas pela palpação do médico. Discussão: Nos estudos deGautam et Al, (2015), Cai et Al, (2019) eKamble et Al, (2022) foi utilizado aplicação guiada por US, demonstrando resultados mais positivos em comparação ao estudo deKeene et Al, (2019), que utilizou a aplicação guiada pela palpação do médico. Quanto ao método de preparo, a dupla centrifugação demonstrada nos estudos de Cai et Al, (2019) eKamble et Al, (2022), também foi associada a maiores benefícios em comparação a uma única centrifugação do estudode Keene et Al, (2019).…”

“…Discussão: Nos estudos deGautam et Al, (2015), Cai et Al, (2019) eKamble et Al, (2022) foi utilizado aplicação guiada por US, demonstrando resultados mais positivos em comparação ao estudo deKeene et Al, (2019), que utilizou a aplicação guiada pela palpação do médico. Quanto ao método de preparo, a dupla centrifugação demonstrada nos estudos de Cai et Al, (2019) eKamble et Al, (2022), também foi associada a maiores benefícios em comparação a uma única centrifugação do estudode Keene et Al, (2019). Conclusão: Os estudos demonstraram, em sua maioria, eficácia da utilização de PRP na regeneração de tendinopatias.…”