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Athletes had longer lateral epicondylitis pain relief with PRP vs. steroids, lasers
Steroid injection initially decreased pain, but the effects wore off after 6 weeks.
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Platelet-rich plasma and steroid injections provided patients with lateral epicondylitis with better outcomes than laser therapy, according to results of a recently presented study.
“Both platelet-rich plasma and steroid injections gave significant pain relief compared to laser therapy,” Ankit Goyal, MBBS, DNB(Ortho), MCh(Ortho), MNAMS, Diploma SICOT, of Sports Injury Centre at Safdarjung Hospital, in New Delhi, India, said.
“The pain relief was significantly more for a longer duration with platelet-rich plasma injection,” he said.
Three modalities compared
Goyal and colleagues randomized 150 athletes with lateral epicondylitis into three groups for a study conducted between January 2008 and January 2011. One group received laser therapy twice weekly for 5 minutes with the Omega XP system (Omega Laser Systems; Essex, United Kingdom). A second group received one corticosteroid injection of methylprednisolone acetate and the third group received one platelet-rich plasma (PRP) injection (Arthrex Autologous Conditioned Plasma [ACR] Double Syringe System; Naples, Fla., USA). Patients were included in the study if their lateral epicondylitis lasted more than 4 weeks and their DASH scores were greater than 40 points.
The researchers spun 9 mL blood per patient in the PRP group in a centrifuge for 5 minutes and obtained a final PRP volume of 3 mL with a final platelet concentration that was 2.5 times normal.
“There were no leukocytes or activators in the platelet-rich plasma,” Goyal said.
Laser was less effective
The patients who underwent laser therapy showed no significant improvements in VAS, DASH or Mayo Elbow Scale (MES) scores, Goyal said. Patients who received a steroid injection had significant postoperative pain relief for 6 weeks, but after that their pain failed to improve any further. The mean VAS scores in this group improved from 7.1 points at day one to 4.2 points at 6 weeks.
“The steroid-only acts by reducing the inflammation and does not actually cure the ailment itself,” Goyal told Orthopaedics Today Europe. “It has some adverse effects like wasting of the muscles, local discoloration and infection in the form of an abscess, which we had in one patient.”
The mean VAS scores in the patients who received PRP injection showed significant improvement. They increased from 6.4 points at day one to 1.8 points at 6 months. The DASH and MES scores also significantly improved in the groups that received steroids or PRP, based on the results.
“Why do steroid injections fail long-term?” Goyal said. “One reason is that it reduces pain without fixing the underlying problem, so patients are more likely to resume their activity too soon. This is still a debated topic. Defining the details of indications that are best for platelet-rich plasma concentration, number and time of injection, as well as rehabilitation protocol, might increase the efficacy of this treatment modality,” he said.
All the patients included in the study received the same post-injury advice to rest and take oral anti-inflammatories in the first 2 weeks. – by Renee Blisard Buddle
- Reference:
- Goyal A. Paper #13-1719. Presented at: EFORT Congress; June 5-8, 2013; Istanbul.
- Reference:
- Ankit Goyal, MBBS, DNB(Ortho), MCh(Ortho), MNAMS, Diploma SICOT, can be reached at Safdarjung Hospital, New Delhi, DL 110029, India; email: ankit.ortho@gmail.com.
Disclosure: Goyal has no relevant financial disclosures.
Perspective
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Jeno Kiss, MD, PhD, CSc
Lateral epicondylitis clearly is an annoying disease. Some of the patients heal quickly and easily with any type of treatment and some others do not heal. This is a big nice series which [the investigators] did. I think it is important, as [the investigators] concluded, that more studies should be done with repetition of the injections and more patients. One shot is not enough using platelet-rich plasmas. Steroids are just covering the symptoms, not curing the disease.
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