Do blood growth factors offer additional benefit in refractory lateral epicondylitis? A prospective, randomized pilot trial of dry needling as a stand-alone procedure versus dry needling and autologous conditioned plasma
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To evaluate whether autologous conditioned plasma offers any therapeutic advantage over ultrasound-guided dry needling as a stand-alone procedure in the treatment of refractory lateral epicondylitis.
Materials and methods
Prospective, randomized pilot study of 28 patients (11 men, 17 women, mean age, 49.1 years) with refractory lateral epicondylitis (mean symptom duration, 19.1 months) who underwent either dry needling (n = 13) or dry needling combined with autologous conditioned plasma (ACP) injection (n = 15). Each patient received two separate injections (0 weeks and 1 month) and analysis of visual analogue pain scores (VAS) and Nirschl scores were performed pre-procedure, at 2 months and final evaluation at 6 months. Successful treatment was defined as more than a 25 % reduction in pain scores without re-intervention. Data was analyzed using the Mann–Whitney test and local research ethics committee approval was obtained.
At 2 months, the mean VAS improvement was 0.85 (12.3 %) in the dry needling group compared to 2.19 (27.1 %) in the ACP group (p = 0.76) and there was a 5.83-point and 20.3-point Nirschl score improvement respectively (p = 0.72). At the final follow-up of 6 months, the mean VAS improvement was 2.37 (34 %) in the dry needling group compared to 3.92 (48.5 %) in the ACP group (p = 0.74) and there was a 22.5-point and 40-point Nirschl score improvement, respectively (p = 0.82).
There is a trend to greater clinical improvement in the short term for patients treated with additional ACP, however no significant difference between the two treatment groups was demonstrated at each follow-up interval. A larger, multicenter, randomized controlled trial is required to corroborate the results of this pilot study.
KeywordsUltrasound Autologous conditioned plasma Lateral epicondylitis Dry needling Treatment
Conflict of interest
- 3.Creaney L, Wallace A, Curtis M, Connell D. Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, double-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med. 2011;45:966–71.PubMedCrossRefGoogle Scholar
- 4.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;38:255–62.PubMedCrossRefGoogle Scholar
- 6.Bisset L, Coombes B, Vicenzino B. Tennis elbow. Clinical Evidence BMJ Publishing Group Ltd 2011.Google Scholar
- 8.Dingemanse R, Randsdorp M, Koes BW, Huisstede BM. Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: a systematic review. Br J Sports Med 2013 Jan 18. [Epub ahead of print]Google Scholar
- 13.Buchbinder R, Johnston RV, Barnsley L, Assendelft WJJ, Bell SN, Smidt N. Surgery for lateral elbow pain. Cochrane Database Syst Rev. 2011;(3)CD003525. doi: 10.1002/14651858.CD003525.pub2.
- 16.Alsousou J, Thompson M, Hulley P, Noble A, et al. The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery. J Bone Joint Surg. 2009;91(8):987–96.Google Scholar
- 20.Urbaniak GC, Plouse S. Research Randomizer (Version 4.0) [Computer software]. Retrieved on June 22, 2013, from http://www.randomizer.org.
- 25.Arthrex ACP Double Syringe System Autologous Conditioned Plasma [homepage on the internet]. Available from: http://www.deviceinnovation.com/images/sub_1332905727/Arthrex-ACP-Double-Syringe-System.pdf.
- 28.Nirschl RP, Pettrone FA. Tennis elbow: the surgical treatment of lateral epicondylitis. J Bone Joint Surgery Am. 1979;61:832–9.Google Scholar