Study finds PRP injection more beneficial than corticosteroid injection for chronic lateral epicondylitis

Issue: September 2010

A platelet-rich plasma injection reduced pain and increased function significantly more than a corticosteroid injection in patients with chronic lateral epicondylitis, according to a double-blind, randomized controlled trial with 1-year follow-up.

The 100-patient study from the Netherlands defined successful treatment as more than a 25% reduction in the Visual Analog Scale (VAS) or Disabilities of the Arm, Shoulder and Hand (DASH) score, without a reintervention during the first year.

For the VAS score, the results showed that 76% of patients in the platelet-rich plasma (PRP) group were successful, as compared to only 47% in the corticosteroid group. There was also a statistically significant difference with the DASH score: 76% of patients in the PRP group demonstrated success as opposed to 50% in the corticosteroid group.

Inflammatory response

“All methods known and practiced for degenerating tendon tissue, like in tennis elbow, but also in [rotator] cuff, Achilles tendon, patellar tendon and other conditions, are focused on diminishing the inflammatory response – the actual healing response of the body trying to regenerate this tissue,” said study author Taco Gosens, MD, PhD, of St. Elisabeth Hospital Tilburg. “The use of steroids, surgical release, sclerotherapy, etc., is aimed for destruction of neovascularization and this healthy response.” However, upon further investigation, “patients have a problem because of the continued failing of this repair mechanism. So why not try to ‘turbo-boost’ this reaction? Why not jump-start the reaction instead of killing the natural healing reaction?”

Gosens told Orthopedics Today that PRP therapy is more effective than corticosteroid injection because “the platelets are full of growth factors and other mediators that are important in starting up the inflammation and tissue regeneration cascade.” He also said that although he did not use sonography in the study, “this might improve efficacy even more.

“There is a debate whether a repeated injection can cause even more success. The timing of a second injection is also controversial. But as of yet, there is no evidence that a second injection is beneficial,” he noted.

Better reporting

Despite Gosens’ encouraging results with PRP, which were presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons, he pointed to a published Dutch study earlier this year in the Journal of the American Medical Association by Robert Jan de Vos, MD, et al, which compared PRP to placebo at 24 weeks after injection for chronic Achilles tendinopathy.

“The conclusion reached by the media was that PRP was no more effective than saltwater,” Gosens said. “There needs to be a bit of nuance in the reporting.”

Gosens has yet to witness any downside to PRP. “However, patients need to be warned of an initial painful episode lasting 1 to 4 weeks after the injection,” he said. “In my opinion, this is a logical sequel to jump-starting/turbo-blasting the inflammation cascade.”

Gosens and his colleagues are conducting a similar randomized clinical study of PRP to treat plantar fasciitis. In addition, he is currently using PRP for chronic tendinopathies throughout the body “with good results. Sometimes this therapy is part of a randomized trial, but also as cohorts for distal biceps tendinopathy, Achilles tendons, patellar tendons and other indications.” – by Bob Kronemyer

Reference:

Gosens T, Peerbooms J, Sluimer J, et al. Positive effect of an autologous platelet concentrate in lateral epicondylitis. Paper 054. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13. New Orleans.

Taco Gosens, MD, PhD, St. Elisabeth Hospital Tilburg, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands; 31-13 539 2942; e-mail: tgosens@elisabeth.nl.

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