Skeletal Radiology

, Volume 42, Issue 1, pp 91–97

Platelet-rich plasma for the treatment of lateral epicondylitis: sonographic assessment of tendon morphology and vascularity (pilot study)

  • Salma Chaudhury
  • Mauricio de La Lama
  • Ronald S. Adler
  • Lawrence V. Gulotta
  • Brendan Skonieczki
  • Anthony Chang
  • Peter Moley
  • Frank Cordasco
  • Jo Hannafin
  • Stephen Fealy
Scientific Article

Abstract

Objective

To investigate the efficacy of using contrast-enhanced ultrasound to assess the relationship of altered vascularity and tendon morphology following injection of platelet-rich plasma (PRP) for lateral epicondylitis.

Materials and methods

This study prospectively evaluated six patients who had a baseline ultrasound confirming tendinosis of the common extensor tendon. Patients received a single 3-ml PRP injection under ultrasound guidance. Grayscale images of the injected elbow were obtained at baseline and were repeated at 1 and 6 months after injection. DEFINITY® contrast was also injected after by 2 sets of wrist-extension exercises in order to obtain contrast-enhanced images of the elbow. Qualitative and quantitative analyses of the level of enhancement to the regions of interest were performed using off-line quantitative analysis software.

Results

All patients had either moderate or severe common extensor tendinosis as determined on clinical examination and baseline imaging. Five patients demonstrated improved tendon morphology using ultrasound imaging 6 months after PRP injection (one patient was lost to follow-up). At baseline, there was evidence of increased vascularity at the myotendinous junction (MT) of the common extensor tendon when compared to its footprint (FP). There was a trend towards no change in FP vascularity between baseline and 6 months (p = 0.062) and between 1 and 6 months (p = 0.288). There was a trend for increased vascularity to the MT region from baseline to 6 months (p = 0.433) and from 1 to 6 months (p = 0.783).

Conclusions

Contrast-enhanced ultrasound provides a sensitive method the display alterations in vascularity in the common extensor tendon of the elbow. PRP therapy for lateral epicondylitis can improve extensor tendon morphology. Corresponding increased extensor tendon FP vascularity, however, was not seen. There is a trend for increased vascularity at the MT up to 6 months following PRP injection, based on limited pilot data.

Keywords

Elbow Epicondylitis Platelet-rich plasma Ultrasound Contrast-enhanced ultrasound 

References

  1. 1.
    Altay T, Günal I, Oztürk H. Local injection treatment for lateral epicondylitis. Clin Orthop Relat Res. 2002;398:127–30.PubMedCrossRefGoogle Scholar
  2. 2.
    Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751–67.PubMedCrossRefGoogle Scholar
  3. 3.
    Orchard J. Corticosteroid injection for lateral epicondylalgia is helpful in the short term, but harmful in the longer term; data for non-corticosteroid injections and other tendinopathies are limited. Evid Based Med. 2011;16(4):116–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Stefanou A, Marshall N, Holdan W, Siddiqui A. A randomized study comparing corticosteroid injection to corticosteroid iontophoresis for lateral epicondylitis. J Hand Surg Am. 2012;37(1):104–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Gandhi A, Dumas C, O’Connor JP, Parsons JR, Lin SS. The effects of local platelet-rich plasma delivery on diabetic fracture healing. Bone. 2006;38(4):540–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Pietrzak WS, Eppley BL. Platelet-rich plasma: biology and new technology. J Craniofac Surg. 2005;16(6):1043–54.PubMedCrossRefGoogle Scholar
  7. 7.
    Castillo TN, Pouliot MA, Kim HJ, Dragoo JL. Comparison of growth factor and platelet concentration from commercial platelet-rich plasma separation systems. Am J Sports Med. 2010.Google Scholar
  8. 8.
    Mishra A, Gosens T. Clinical indications and techniques for the use of platelet-rich plasma in the elbow. Oper Tech Sports Med. 2011;19(3):170–6.CrossRefGoogle Scholar
  9. 9.
    Wolf JM, Ozer K, Scott F, Gordon MJV, Williams AE. Comparison of autologous blood, corticosteroid, and saline injection in the treatment of lateral epicondylitis: a prospective, randomized, controlled multicenter study. J Hand Surg Am. 2011;36(8):1269–72.PubMedCrossRefGoogle Scholar
  10. 10.
    Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med. 2010;38(2):255–62.PubMedCrossRefGoogle Scholar
  11. 11.
    Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis. Am J Sports Med. 2011;39(6):1200–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Thanasas C, Papadimitriou G, Charalambidis C, Paraskevopoulos I, Papanikolaou A. Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. Am J Sports Med. 2011 Aug 2.Google Scholar
  13. 13.
    Creaney L, Wallace A, Curtis M, Connell D. Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med. 2011;45(12):966–71.PubMedCrossRefGoogle Scholar
  14. 14.
    McShane JM, Shah VN, Nazarian LN. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow—is a corticosteroid necessary? J Ultrasound Med. 2008;27(8):1137–44.PubMedGoogle Scholar
  15. 15.
    Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006;34(11):1774–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Connell D, Burke F, Coombes P, McNealy S, Freeman D, Pryde D, et al. Sonographic examination of lateral epicondylitis. Am J Roentgenol. 2001;176(3):777–82.Google Scholar
  17. 17.
    Levin D, Nazarian LN, Miller TT, O’Kane PL, Feld RI, Parker L, et al. Lateral epicondylitis of the elbow: US findings. Radiology. 2005;237(1):230–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Rudzki JR, Adler RS, Warren RF, Kadrmas WR, Verma N, Pearle AD, et al. Contrast-enhanced ultrasound characterization of the vascularity of the rotator cuff tendon: age- and activity-related changes in the intact asymptomatic rotator cuff. J Should Elb Surg. 2008;17(1 SUPPL.).Google Scholar
  19. 19.
    Cadet ER, Adler RS, Gallo RA, Gamradt SC, Warren RF, Cordasco FA, et al. Contrast-enhanced ultrasound characterization of the vascularity of the repaired rotator cuff tendon: short-term and intermediate-term follow-up. J Should Elb Surg. 2011.Google Scholar
  20. 20.
    Adler RS, Fealy S, Rudzki JR, Kadrmas W, Verma NN, Pearle A, et al. Rotator cuff in asymptomatic volunteers: contrast-enhanced US depiction of intratendinous and peritendinous vascularity. Radiology. 2008;248(3):954–61.PubMedCrossRefGoogle Scholar
  21. 21.
    Gamradt SC, Gallo RA, Adler RS, Maderazo A, Altchek DW, Warren RF, et al. Vascularity of the supraspinatus tendon 3 months after repair: characterization using contrast-enhanced ultrasound. J Should Elb Surg. 2010;19(1):73–80.CrossRefGoogle Scholar
  22. 22.
    Fealy S, Adler RS, Drakos MC, Kelly AM, Allen AA, Cordasco FA, et al. Patterns of vascular and anatomical response after rotator cuff repair. Am J Sports Med. 2006;34(1):120–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Kuenen MPJ, Mischi M, Wijkstra H. Contrast-ultrasound diffusion imaging for localization of prostate cancer. IEEE Trans Med Imaging. 2011;30(8):1493–502.PubMedCrossRefGoogle Scholar
  24. 24.
    Hascoet S, Brierre G, Caudron G, Cardin C, Bongard V, Acar P. Assessment of left ventricular volumes and function by real time three-dimensional echocardiography in a pediatric population: a TomTec versus QLAB comparison. Echocardiography. 2010;27(10):1263–73.PubMedCrossRefGoogle Scholar
  25. 25.
    Connell DA, Ali KE, Ahmad M, Lambert S, Corbett S, Curtis M. Ultrasound-guided autologous blood injection for tennis elbow. Skeletal Radiol. 2006;35(6):371–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg A. 1979;61(6):832–9.Google Scholar
  27. 27.
    Budoff JE, Kraushaar BS, Ayala G. Flexor carpi ulnaris tendinopathy. J Hand Surg Am. 2005;30A(1):125–9.CrossRefGoogle Scholar

Copyright information

© ISS 2012

Authors and Affiliations

  • Salma Chaudhury
    • 1
  • Mauricio de La Lama
    • 1
  • Ronald S. Adler
    • 2
  • Lawrence V. Gulotta
    • 1
  • Brendan Skonieczki
    • 1
  • Anthony Chang
    • 1
  • Peter Moley
    • 1
  • Frank Cordasco
    • 1
  • Jo Hannafin
    • 1
  • Stephen Fealy
    • 1
  1. 1.Hospital for Special SurgeryNew YorkUSA
  2. 2.Hospital for Joint DiseasesNYU Langone Medical CenterNew YorkUSA

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