Platelet-rich plasma versus lidocaine as tenotomy adjuvants in people with elbow epicondylopathy: a randomized controlled trial

Abstract

Objectives To determine the efficacy of platelet-rich plasma (PRP) compared to lidocaine as a tenotomy adjuvant for people with elbow tendinopathy. Methods Our study was a parallel-group, double-blind, randomized trial involving 71 patients with recalcitrant elbow tendinopathy who received two sessions of ultrasound-guided tenotomy with either PRP or lidocaine in a tertiary public hospital. The primary end point was the percentage of patients with an improvement exceeding 25% reduction in disability (Spanish version of the Disabilities of the Arm, Shoulder and Hand questionnaires–DASH-E) at 6 and 12 months; the secondary outcome was the percentage of patients exceeding 25% reduction in pain (VAS-P). Results There was no evidence of significant differences in the proportion of patients who experienced clinically relevant improvements. After 6 months, 18 patients (78.59%) in the lidocaine group and 19 patients (73.08%) in the PRP group showed improved function above 25% (unadjusted odds ratio, 0.90; 95% confidence interval [CI], 0.90 (0.17 to 4.60)); 21 patients (72.21%) in the lidocaine group versus 22 patients (84.62%) in the PRP group achieved more than 25% pain reduction (unadjusted odds ratio, 0.48; 95% CI, 0.10 to 2.37). After 12 months, 17 patients (70.83%) in the lidocaine group versus 19 patients (76%) in the PRP group had improved function (unadjusted odds ratio, 0.71; 95% CI, 0.13 to 3.84), and 19 patients (76%) in the lidocaine group versus 20 patients (90.91%) in the PRP group had improved pain above 25% (unadjusted odds ratio, 0.35; 95% CI, 0.06 to 2.51). Hypercholesterolemia and baseline vascularization influenced outcomes. There were no differences between groups in the adjusted odds ratios. Conclusion PRP results in similar improvements to those obtained with lidocaine. Selecting patients according to their pretreatment status can improve treatment efficacy. Trial registration NCT01945528 , EudraCT 2013-000478-32. Registered 18 August 2013, enrolment of the first participant 10 March 2014

Tennis elbow, study protocol for a randomized clinical trial: needling with and without platelet-rich plasma after failure of up-to-date rehabilitation

“…Rather, the efficacy of PRP in addition to tendon fenestration compared to tendon fenestration alone remains controversial. Martin et al [14] found in a partially blinded randomized controlled trial (RCT) involving 71 patients no clinical differences at 6 months of follow-up between 2 sessions of fenestration with either saline + local anesthetic or PRP + local anesthetic. In a similar blinded RCT involving 50 patients, Schöffl et al [15] found no clinical differences at 6 months of follow-up.…”

“…However, the potential benefits of PRP are discordant, especially concerning the elbow. Even if the superiority of PRP over corticosteroids is well established [13], the efficacy of PRP in addition to tendon needling or fenestration compared to tendon needling or fenestration alone is still controversial [14][15][16][17][18][19].…”

Tennis Elbow, study protocol for a randomized clinical trial: Needling With and Without Platelet-rich Plasma After Failure of Up-to-date Rehabilitation

“…Rather, the e cacy of PRP in addition to tendon fenestration compared to tendon fenestration alone remains controversial. Martin et al (14) found in a partially blinded randomized controlled trial (RCT) involving 71 patients, no clinical differences at 6 months of follow-up between 2 sessions of fenestration with either saline + local anesthetic or PRP + local anesthetic. In a similar blinded RCT involving 50 patients, Schö et al (15) found no clinical differences at 6 months of follow-up.…”

“…However, the potential bene ts of PRP are discordant, especially concerning the elbow. Even if the superiority of PRP over corticosteroids is well established (13), the e cacy of PRP in addition to tendon needling or fenestration compared to tendon needling or fenestration alone is still controversial (14)(15)(16)(17)(18)(19).…”

Tennis Elbow, Study Protocol for Randomized Clinical Trial: Needling With and Without Platelet-Rich Plasma After Failure of Up-to-Date Rehabilitation

“…Even if the superiority of PRP over corticosteroids is well established (13), the superiority of PRP on tendon needling or peppering is still controversial. Martin et al (14) found in a partially blinded randomized controlled trial (RCT) involving 71 patients no clinical differences at 6 months of follow-up between 2 sessions of peppering with saline + local anesthetic and PRP + local anesthetic. In a similar blinded RCT involving 50 patients, Schö et al (15) found no clinical differences at 6 months of follow-up.…”