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Therapie der lateralen und medialen Epikondylopathie

„Platelet-riched plasma“, Stoßwelle etc. bei beiden Indikationen wirksam?

Treatment of lateral and medial epicondylopathy

Are platelet-rich plasma, shock wave therapy, etc. effective for both?

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Zusammenfassung

Die mediale und die laterale Epikondylopathie stellen zwar gutartige, weil in der Regel nach 1–2 Jahren selbstlimitierende Erkrankungen dar, können aber für die Betroffenen zu einer massiven Einschränkung der Lebensqualität und Arbeitsfähigkeit führen. Die Verwendung von „platelet-riched plasma“ nutzt einen biologischen Therapieansatz, bei dem, anders als bei rein antiinflammatorischen Therapien, durch eine Optimierung des Gewebsmilieus eine Regeneration und Reparation des geschädigten Sehnenansatzes angestrebt wird. Die Studienlage ist bezüglich der allgemeinen als auch hinsichtlich eines Kurz- oder Langzeiteffekts different. Die Stammzelltherapie ist ein neues und bisher kaum verwendetes Therapieverfahren. Erste Fallserien erscheinen vielversprechend. Die Stoßwellentherapie stellt eine zwar nicht neue und etablierte, aber anhaltend kontrovers diskutierte Behandlungsform bei der Epikondylopathie dar.

Abstract

Lateral and medial epicondylopathy (epicondylitis), which are common and in most cases self-limiting, frequently result in relevant reduction of quality of life and may also affect the ability to work. Recently, the use of orthobiologics, such as platelet-rich plasma (PRP), has been proposed to promote tendon regeneration and is supposed to be a valuable treatment option. However, scientific data are conflicting and the short- and long-time results are controversial. The use of stem cells is new approach and preliminary clinical data are promising. Shock wave therapy is widely used and part of the daily routine in treating lateral epicondylopoathy, although it is questionable for medial epicondylopathy.

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Abbreviations

ADSC:

„Adipose-derived progenitor cells“

bFGF:

„Basic fibroblast growth factor“

BMAC:

„Bone marrow aspirate concentrate“

CFO:

„Common flexor origin“

CSES:

Canadian Shoulder and Elbow Society

DASH:

„Disabilities of arm, shoulder and hand”

ECRB:

Musculus extensor carpi radialis brevis

IGF:

„Insulin-like growth factor“

LCL:

„Lateral collateral ligament“

MSC:

Mesenchymale Stammzellen

NSAR:

Nichtsteroidales Antirheumatikum

PDGF:

„Platelet-derived growth factor“

PDGFB:

„Platelet-derived growth factor subunit B“

PRP:

„Platelet-riched plasma“

PRPLP :

Leukozytenarmes PRP

PRPLR :

Leukozytenreiches PRP

PRTEE:

Patient-Rated Tennis Elbow Evaluation

RCT:

Randomisierte kontrollierte Studie

TGF:

„Transforming growth factor“

VAS:

Visuelle Analogskala

VEGF:

„Vascular endothelial growth factor“

Literatur

  1. Alberta F (2015) CORR insights(R): does nonsurgical treatment improve longitudinal outcomes of lateral epicondylitis over no treatment? A meta-analysis. Clin Orthop Relat Res 473:1108–1110

    Article  PubMed  Google Scholar 

  2. Alessio-Mazzola M, Repetto I, Biti B et al (2018) Autologous US-guided PRP injection versus US-guided focal extracorporeal shock wave therapy for chronic lateral epicondylitis: a minimum of 2‑year follow-up retrospective comparative study. J Orthop Surg (Hong Kong) 26:2309499017749986

    Article  PubMed  Google Scholar 

  3. Alzahrani WM (2022) Platelet-rich plasma injections as an alternative to surgery in treating patients with medial epicondylitis: a systematic review. Cureus 14:e28378

    PubMed  PubMed Central  Google Scholar 

  4. Amin NH, Kumar NS, Schickendantz MS (2015) Medial epicondylitis: evaluation and management. J Am Acad Orthop Surg 23:348–355

    Article  PubMed  Google Scholar 

  5. Anitua E, Andia I, Sanchez M et al (2005) Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res 23:281–286

    Article  CAS  PubMed  Google Scholar 

  6. Arirachakaran A, Sukthuayat A, Sisayanarane T et al (2016) Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis. J Orthop Traumatol 17:101–112

    Article  PubMed  Google Scholar 

  7. Ball CM, Meunier M, Galatz LM et al (2002) Arthroscopic treatment of post-traumatic elbow contracture. J Shoulder Elbow Surg 11:624–629

    Article  PubMed  Google Scholar 

  8. Bhabra G, Wang A, Ebert JR et al (2016) Lateral elbow tendinopathy: development of a pathophysiology-based treatment algorithm. Orthop J Sports Med 4:2325967116670635

    Article  PubMed  PubMed Central  Google Scholar 

  9. Boden AL, Scott MT, Dalwadi PP et al (2019) Platelet-rich plasma versus Tenex in the treatment of medial and lateral epicondylitis. J Shoulder Elbow Surg 28:112–119

    Article  PubMed  Google Scholar 

  10. Bohlen HL, Schwartz ZE, Wu VJ et al (2020) Platelet-rich plasma is an equal alternative to surgery in the treatment of type 1 medial epicondylitis. Orthop J Sports Med 8:2325967120908952

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bosch G, de Mos M, van Binsbergen R et al (2009) The effect of focused extracorporeal shock wave therapy on collagen matrix and gene expression in normal tendons and ligaments. Equine Vet J 41:335–341

    Article  CAS  PubMed  Google Scholar 

  12. Calfee RP, Patel A, Dasilva MF et al (2008) Management of lateral epicondylitis: current concepts. J Am Acad Orthop Surg 16:19–29

    Article  PubMed  Google Scholar 

  13. Chaudhury S, de La Lama M, Adler RS et al (2013) Platelet-rich plasma for the treatment of lateral epicondylitis: sonographic assessment of tendon morphology and vascularity (pilot study). Skelet Radiol 42:91–97

    Article  Google Scholar 

  14. Connell D, Datir A, Alyas F et al (2009) Treatment of lateral epicondylitis using skin-derived tenocyte-like cells. Br J Sports Med 43:293–298

    Article  CAS  PubMed  Google Scholar 

  15. Coombes BK, Bisset L, Brooks P et al (2013) Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA 309:461–469

    Article  CAS  PubMed  Google Scholar 

  16. Defoort S, De Smet L, Brys P et al (2021) Lateral elbow tendinopathy: surgery versus extracorporeal shock wave therapy. Hand Surg Rehabil 40:263–267

    Article  CAS  PubMed  Google Scholar 

  17. Dohan Ehrenfest DM, Andia I, Zumstein MA et al (2014) Classification of platelet concentrates (Platelet-Rich Plasma-PRP, Platelet-Rich Fibrin-PRF) for topical and infiltrative use in orthopedic and sports medicine: current consensus, clinical implications and perspectives. Muscles Ligaments Tendons J 4:3–9

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dragoo JL, Meadows MC (2019) The use of biologics for the elbow: a critical analysis review. J Shoulder Elbow Surg 28:2053–2060

    Article  PubMed  Google Scholar 

  19. Evans JP, Maffulli N, Smith C et al (2021) Even experts cannot agree on the optimal use of platelet-rich plasma in lateral elbow tendinopathy: an international Delphi study. J Orthop Traumatol 22:47

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ford RD, Schmitt WP, Lineberry K et al (2015) A retrospective comparison of the management of recalcitrant lateral elbow tendinosis: platelet-rich plasma injections versus surgery. Hand (N Y) 10:285–291

    Article  PubMed  Google Scholar 

  21. Glanzmann MC, Audige L (2015) Platelet-rich plasma for chronic lateral epicondylitis: is one injection sufficient? Arch Orthop Trauma Surg 135:1637–1645

    Article  PubMed  Google Scholar 

  22. Greiner S, Lawton R, Voss A (2022) Cell-based therapy of the elbow: evidence for lateral tendinopathy‑a review on current treatments. Knee Surg Sports Traumatol Arthrosc 30:1152–1160

    Article  PubMed  Google Scholar 

  23. Haake M, Konig IR, Decker T et al (2002) Extracorporeal shock wave therapy in the treatment of lateral epicondylitis : a randomized multicenter trial. J Bone Joint Surg Am 84:1982–1991

    Article  CAS  PubMed  Google Scholar 

  24. Hardy R, Tori A, Fuchs H et al (2021) To improve pain and function, platelet-rich plasma injections may be an alternative to surgery for treating lateral epicondylitis: a systematic review. Arthroscopy 37:3360–3367

    Article  PubMed  Google Scholar 

  25. Hastie G, Soufi M, Wilson J et al (2018) Platelet rich plasma injections for lateral epicondylitis of the elbow reduce the need for surgical intervention. J Orthop 15:239–241

    Article  PubMed  PubMed Central  Google Scholar 

  26. Houck DA, Kraeutler MJ, Thornton LB et al (2019) Treatment of lateral epicondylitis with autologous blood, platelet-rich plasma, or corticosteroid injections: a systematic review of overlapping meta-analyses. Orthop J Sports Med 7:2325967119831052

    Article  PubMed  PubMed Central  Google Scholar 

  27. Karaduman M, Okkaoglu MC, Sesen H et al (2016) Platelet-rich plasma versus open surgical release in chronic tennis elbow: a retrospective comparative study. J Orthop 13:10–14

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kemp JA, Olson MA, Tao MA et al (2021) Platelet-rich plasma versus corticosteroid injection for the treatment of lateral epicondylitis: a systematic review of systematic reviews. Int J Sports Phys Ther 16:597–605

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kia C, Baldino J, Bell R et al (2018) Platelet-rich plasma: review of current literature on its use for tendon and ligament pathology. Curr Rev Musculoskelet Med 11:566–572

    Article  PubMed  PubMed Central  Google Scholar 

  30. Krischek O, Hopf C, Nafe B et al (1999) Shock-wave therapy for tennis and golfer’s elbow—1 year follow-up. Arch Orthop Trauma Surg 119:62–66

    Article  CAS  PubMed  Google Scholar 

  31. Krischek O, Rompe JD, Hopf C et al (1998) Extracorporeal shockwave therapy in epicondylitis humeri ulnaris or radialis—a prospective, controlled, comparative study. Z Orthop Ihre Grenzgeb 136:3–7

    Article  CAS  PubMed  Google Scholar 

  32. Krogh TP, Bartels EM, Ellingsen T et al (2013) Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med 41:1435–1446

    Article  PubMed  Google Scholar 

  33. Krogh TP, Fredberg U, Stengaard-Pedersen K et al (2013) Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial. Am J Sports Med 41:625–635

    Article  PubMed  Google Scholar 

  34. Lapner P, Alfonso A, Hebert-Davies J et al (2022) Nonoperative treatment of lateral epicondylitis: a systematic review and meta-analysis. JSES Int 6:321–330

    Article  PubMed  Google Scholar 

  35. Lapner P, Alfonso A, Herbert-Davies J et al (2022) Position statement: nonoperative management of lateral epicondylitis in adults. Can J Surg 65:E625–E629

    Article  PubMed  PubMed Central  Google Scholar 

  36. Lee SS, Kang S, Park NK et al (2012) Effectiveness of initial extracorporeal shock wave therapy on the newly diagnosed lateral or medial epicondylitis. Ann Rehabil Med 36:681–687

    Article  PubMed  PubMed Central  Google Scholar 

  37. Lee SY, Kim W, Lim C et al (2015) Treatment of lateral epicondylosis by using allogeneic adipose-derived mesenchymal stem cells: a pilot study. Stem Cells 33:2995–3005

    Article  CAS  PubMed  Google Scholar 

  38. Lim W, Park SH, Kim B et al (2018) Relationship of cytokine levels and clinical effect on platelet-rich plasma-treated lateral epicondylitis. J Orthop Res 36:913–920

    CAS  PubMed  Google Scholar 

  39. Mazzocca AD, Mccarthy MB, Intravia J et al (2013) An in vitro evaluation of the anti-inflammatory effects of platelet-rich plasma, ketorolac, and methylprednisolone. Arthroscopy 29:675–683

    Article  PubMed  Google Scholar 

  40. Merolla G, Dellabiancia F, Ricci A et al (2017) Arthroscopic debridement versus platelet-rich plasma injection: a prospective, randomized, comparative study of chronic lateral epicondylitis with a nearly 2‑year follow-up. Arthroscopy 33:1320–1329

    Article  PubMed  Google Scholar 

  41. Molloy T, Wang Y, Murrell G (2003) The roles of growth factors in tendon and ligament healing. Sports Med 33:381–394

    Article  PubMed  Google Scholar 

  42. Moretti B, Iannone F, Notarnicola A et al (2008) Extracorporeal shock waves down-regulate the expression of interleukin-10 and tumor necrosis factor-alpha in osteoarthritic chondrocytes. BMC Musculoskelet Disord 9:16

    Article  PubMed  PubMed Central  Google Scholar 

  43. Morrey B (2014) Master techniques in orthopaedic surgery: the elbow. Lippincott Williams Wilkins

    Google Scholar 

  44. Muthu S, Patel S, Selvaraj P et al (2021) Comparative analysis of leucocyte poor vs leucocyte rich platelet-rich plasma in the management of lateral epicondylitis: systematic review meta-analysis of randomised controlled trials. J Clin Orthop Trauma 19:96–107

    Article  PubMed  PubMed Central  Google Scholar 

  45. Niemiec P, Szyluk K, Balcerzyk A et al (2021) Why PRP works only on certain patients with tennis elbow? Is PDGFB gene a key for PRP therapy effectiveness? A prospective cohort study. BMC Musculoskelet Disord 22:710

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. O’dwyer KJ, Howie CR (1995) Medial epicondylitis of the elbow. Int Orthop 19:69–71

    PubMed  Google Scholar 

  47. Olaussen M, Holmedal O, Lindbaek M et al (2013) Treating lateral epicondylitis with corticosteroid injections or non-electrotherapeutical physiotherapy: a systematic review. BMJ Open 3:e3564

    Article  PubMed  PubMed Central  Google Scholar 

  48. Paoletta M (2022) Are autologous whole blood or platelet-rich plasma (PRP) injection effective and safe for lateral elbow pain?—A Cochrane Review summary with commentary. J Musculoskelet Neuronal Interact 22:428–430

    PubMed  PubMed Central  Google Scholar 

  49. Paramanantham M, Seenappa H, Venkataraman S et al (2022) Functional outcome of platelet-rich plasma (PRP) intra-lesional injection for tennis elbow—a prospective cohort study. Cureus 14:e22974

    PubMed  PubMed Central  Google Scholar 

  50. Park GY, Kwon DR, Cho HK et al (2017) Distribution of platelet-rich plasma after ultrasound-guided injection for chronic elbow tendinopathies. J Sports Sci Med 16:1–5

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Pittenger MF, Mackay AM, Beck SC et al (1999) Multilineage potential of adult human mesenchymal stem cells. Science 284:143–147

    Article  CAS  PubMed  Google Scholar 

  52. Radwan YA, Elsobhi G, Badawy WS et al (2008) Resistant tennis elbow: shock-wave therapy versus percutaneous tenotomy. Int Orthop 32:671–677

    Article  PubMed  Google Scholar 

  53. Rodik T, Mcdermott B (2016) Platelet-rich plasma compared with other common injection therapies in the treatment of chronic lateral epicondylitis. J Sport Rehabil 25:77–82

    Article  PubMed  Google Scholar 

  54. Rompe JD, Decking J, Schoellner C et al (2004) Repetitive low-energy shock wave treatment for chronic lateral epicondylitis in tennis players. Am J Sports Med 32:734–743

    Article  PubMed  Google Scholar 

  55. Sahbaz T, Medin Ceylan C, Karacay BC et al (2021) Comparison of platelet-rich plasma and extracorporeal shock wave therapy in patients with chronic lateral epicondylitis: a prospective, randomized-controlled study. Turk J Phys Med Rehabil 67:490–501

    Article  PubMed  PubMed Central  Google Scholar 

  56. Savnik A, Jensen B, Norregaard J et al (2004) Magnetic resonance imaging in the evaluation of treatment response of lateral epicondylitis of the elbow. Eur Radiol 14:964–969

    Article  PubMed  Google Scholar 

  57. Sayegh ET, Strauch RJ (2015) Does nonsurgical treatment improve longitudinal outcomes of lateral epicondylitis over no treatment? A meta-analysis. Clin Orthop Relat Res 473:1093–1107

    Article  PubMed  Google Scholar 

  58. Shiri R, Viikari-Juntura E, Varonen H et al (2006) Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol 164:1065–1074

    Article  PubMed  Google Scholar 

  59. Sims SE, Miller K, Elfar JC et al (2014) Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials. Hand (N Y) 9:419–446

    Article  PubMed  Google Scholar 

  60. Singh A, Gangwar DS, Singh S (2014) Bone marrow injection: a novel treatment for tennis elbow. J Nat Sci Biol Med 5:389–391

    Article  PubMed  PubMed Central  Google Scholar 

  61. Smidt N, Lewis M, Da VDW et al (2006) Lateral epicondylitis in general practice: course and prognostic indicators of outcome. J Rheumatol 33:2053–2059

    PubMed  Google Scholar 

  62. Smidt N, van der Windt DA, Assendelft WJ et al (2002) Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet 359:657–662

    Article  CAS  PubMed  Google Scholar 

  63. Staples MP, Forbes A, Ptasznik R et al (2008) A randomized controlled trial of extracorporeal shock wave therapy for lateral epicondylitis (tennis elbow). J Rheumatol 35:2038–2046

    PubMed  Google Scholar 

  64. Stasinopoulos D (2018) Can extracorporeal shock-wave therapy be used for the management of lateral elbow tendinopathy? World J Methodol 8:37–39

    Article  PubMed  PubMed Central  Google Scholar 

  65. Suresh SP, Ali KE, Jones H et al (2006) Medial epicondylitis: is ultrasound guided autologous blood injection an effective treatment? Br J Sports Med 40:935–939 (discussion 939)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Suzuki T, Hayakawa K, Nakane T et al (2022) Repeated magnetic resonance imaging at 6 follow-up visits over a 2-year period after platelet-rich plasma injection in patients with lateral epicondylitis. J Shoulder Elbow Surg 31:1581–1587

    Article  PubMed  Google Scholar 

  67. Trentini R, Mangano T, Repetto I et al (2015) Short- to mid-term follow-up effectiveness of US-guided focal extracorporeal shock wave therapy in the treatment of elbow lateral epicondylitis. Musculoskelet Surg 99(1):S91–97

    Article  PubMed  Google Scholar 

  68. Yao G, Chen J, Duan Y et al (2020) Efficacy of extracorporeal shock wave therapy for lateral epicondylitis: a systematic review and meta-analysis. Biomed Res Int 2020:2064781

    Article  PubMed  PubMed Central  Google Scholar 

  69. Yoon SY, Kim YW, Shin IS et al (2020) Does the type of extracorporeal shock therapy influence treatment effectiveness in lateral epicondylitis? A systematic review and meta-analysis. Clin Orthop Relat Res 478:2324–2339

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Orthopaedicum Wiesbaden – Praxis für Orthopädie, Unfallchirurgie und Sportmedizin, Zentrum für Ellenbogenchirurgie, Friedrichstr. 29, 65185, Wiesbaden, Deutschland

    Kay Schmidt-Horlohé

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Schmidt-Horlohé, K. Therapie der lateralen und medialen Epikondylopathie. Orthopädie 52, 371–378 (2023). https://doi.org/10.1007/s00132-023-04372-8

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