Leukocyte-Poor Platelet-Rich Plasma versus Bupivacaine for Recalcitrant Lateral Epicondylar Tendinopathy

Abstract

Purpose.To compare a single leukocyte-poor (type-4B) platelet-rich plasma (PRP) injection versus bupivacaine injection for recalcitrant lateral epicondylar tendinopathy (LET). Methods. 25 patients aged 27 to 50 years with painful and recalcitrant LET of the humerus were randomised to receive leukocyte-poor (type-4B) PRP (n=15) or bupivacaine (n=10) injection. Outcome measures included visual analogue scale (VAS) for pain, modified Mayo clinic performance index for elbow (MMCPIE) for elbow function, and Nirschl score for activity-related pain at 1, 3, 6, and 12 months by a single assessor. Results. At baseline, the PRP and bupivacaine groups were comparable in terms of age, sex, duration of symptoms, VAS for pain, MMCPIE score, and Nirschl score. After one month, the percentage of improvement was less in the PRP than bupivacaine group in terms of the VAS for pain (17.7% vs. 26.5%), MMCPIE score (24.0% vs. 27.6%), and Nirschl score (20.7% vs.Leukocyte-poor platelet-rich plasma versus bupivacaine for recalcitrant lateral epicondylar tendinopathy 31.1%). Nonetheless, improvement in the respective scores was greater in the PRP than bupivacaine group after 3 months (42.5% vs. 30.9%, 34.1% vs. 27.2%, and 50.7% vs. 39.6%), 6 months (67.3% vs. 20.1%, 40.6% vs. 16.3%, and 71.4% vs. 31.1%), and one year (83.2% vs. 45.6%, 47.0% vs. 21.7%, and 76.6% vs. 56.3%). The differences in scores between groups were significant at 6 months and one year only (p<0.001). Conclusion. Leukocyte-poor (type-4) PRP injection for recalcitrant LET enabled good improvement in pain and function.

Platelet-rich Plasma in Orthopedics: Efficacy, Evidence, and Evolution of Our Understanding over 10 Years

“…Mild complications, such as nausea and dizziness, which were of short duration, were observed in 6 patients (22.2%) in group I and 11 patients (44%) in group II. Tennis elbow study 13 : Improvement in the following functional scores (VAS for pain, mean MMCPIE score, and mean Nirschl score) was greater in the PRP group than in the bupivacaine group after 3 months (42. The difference in scores between groups was significant at 6 months and 1 year only (p < 0.001).…”

“…We have shown that the use of ultrasound for guided injections definitely helps in giving the injection at the right site, and this has also been advised by other authors. 13,29 However, the role of PRP in other tendinopathies like Achilles tendinopathy has not been encouraging, 30,31 despite successful usage of PRP in patellar tendinopathies. 32,33 Plantar fasciitis is also another commonly encountered problem which at times can be frustrating to both the patient and the treating doctor.…”

“…2. Tennis elbow study 13 : Patients presenting to our outpatient department (OPD) from January to December 2011 aged 27 to 50 years with painful (VAS >60) and recalcitrant (failed conservative treatment for >3 months) tennis elbow after ruling out other pathologies were randomized to receive leukocyte poor PRP (type 4B PRP) (n = 15) or bupivacaine (n = 10) injection. The injection was given under ultrasound guidance into the maximum hypoechoic area of the extensor carpi radialis brevis (ECRB) tendon using the peppering technique (Fig.…”

Tendinopathy and Sports: Understanding the Problem and Options of Management-perspectives from Physiotherapy, Sports Medicine, and Orthopedics

“…31 The usage of platelet-rich plasma (PRP) has become relatively frequent, with well-selected indications, in cases that have failed all other physical therapy modalities plus a well-structured rehabilitation protocol. Our work on lateral epicondylitis, 32 compared a single injection of leukocyte-poor (type-4) with bupivacaine injections, and it has shown good improvement in pain and function for recalcitrant lateral epicondylitis. This has also been corroborated by other research ( Table 1 ), 32 -36 although larger multicentric studies are needed to recommend this as the best modality of management.…”

Use of platelet-rich plasma in orthopaedics and traumatology

“…However, in the CS group, the scores peaked at 3 months and then decreased, indicating recurrence of symptoms in 46.7% of the CS patients. Another study carried out by Behera et al [13] was a comparison of PRP injections versus bupivacaine injections for recalcitrant lateral epicondylar tendinopathy. The trial enrolled 25 patients whose condition was assessed with a VAS for pain, the modified Mayo clinic performance index for elbow (MMCPIE) and the Nirschl score for activity-related pain at 1, 3, 6 and 12 months.…”