Neutrophil-Reduced Platelet Rich Plasma with Optimal Platelets Concentrations for Epicondylitis of the Elbow

Abstract

Background. Autologous platelet-rich plasma (PRP) therapy has been applied in treatment of medial or lateral elbow epicondylitis; however, its efficacy is variable possibly due to differences in PRP platelet or neutrophil concentrations. We prepared neutrophil-reduced PRP with optimized platelet concentrations, and investigated therapeutic effects of the platelet-optimized PRP for elbow epicondylitis. Methods. We treated 65 elbows of 60 patients (9 women and 51 men) with mean age of 50 years. Neutrophil-reduced PRP with optimized platelet concentrations were used in 41 lateral epicondylitis and 24 medial epicondylitis cases. Visual analogue pain scores (VAS) and modified Mayo Elbow Performance scores (MEPS) were obtained for each elbow at pre-PRP therapy and at 3, 6 or 12 months after the treatment. Results. In 57 enthesopathies (34 lateral and 23 medial elbow epicondylitis), VAS or modified MEPS values at 3 months after treatment were significantly lower or higher, respectively, than those obtained before treatment; and this tendency was more manifested at 6 and 12 months after treatment. The PRP therapies were relatively less effective in 3 cases with complete tears at insertional site(s) of common tendons, 3 cases of lateral epicondylitis with synovial fringes, one with entrapment of the posterior interosseous nerve and in one welfare-reliant patient. Following the treatment with platelet-optimized PRP, VAS or modified MEPS values were lower or higher, respectively, than those reported in previous studies where not optimized PRP preparations were used. Conclusions. The platelet-optimized PRP therapy is effective for treatment of enthesopathy in elbow epicondylitis and this efficacy is higher than with PRP therapies without optimized platelet concentrations.