Skip to main content

Advertisement

Log in

PRP versus steroids in a deadlock for efficacy: long-term stability versus short-term intensity—results from a randomised trial

  • Original Article
  • Published:
MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Purpose

A popular choice for lateral epicondylitis (LE), corticosteroid injections have been associated with prominent side effects, which has led to the conception of modalities like platelet-rich plasma (PRP). This randomised trial aimed to evaluate and compare the 6-week, 3-month and 1-year outcomes with PRP and corticosteroid injections in LE. We hypothesised that PRP would prove more effective in relieving pain and improving function.

Methods

At the sports medicine unit of our tertiary care teaching centre, 80 patients with LE were randomised into either receiving PRP (group A) or corticosteroids (group B) injections. Pre-injection visual analogue scale (VAS), disabilities of the arm, shoulder and hand (DASH) score, Mayo elbow performance score (MEPS) and grip strength score (GSS) were recorded. Common extensor origins were identified and infiltrated with 3 ml of either PRP or corticosteroid (triamcinolone in 2% xylocaine) using a peppering technique. Follow-up scores and extent of pain relief were recorded and compared.

Results

At 6 weeks, there were greater improvements in group B versus A in mean VAS (13.8 vs. 44.5; p < 0.001), DASH (64.2 vs. 53.3; p < 0.001), MEPS (88.0 vs. 74.5; p = 0.004) and GSS (89.3 vs. 73.4; p = 0.039). These scores showed a reversed pattern at 3 months when group A outcomes superseded group B (VAS p = 0.002; DASH p < 0.001; MEPS p = 0.002; GSS p = 0.045). At 1-year follow-up, group A continued to enjoy better pain relief and function (VAS p = 0.024; DASH p < 0.001; MEPS p = 0.009; GSS p = 0.028).

Conclusions

Albeit corticosteroid injections show good short-term results at 6 weeks, patients receiving PRP injections fare better at 3 and 12 months.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hamilton PG (1986) The prevalence of humeral epicondylitis: a survey in general practice. J R Coll Gen Pract 36(291):464–465

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Descatha A, Dale AM, Jaegers L, Herquelot E, Evanoff B (2013) Self-reported physical exposure association with medial and lateral epicondylitis incidence in a large longitudinal study. Occup Environ Med 70(9):670–673. https://doi.org/10.1136/oemed-2012-101341

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kraushaar BS, Nirschl RP (1999) Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am 81(2):259–278

    Article  CAS  Google Scholar 

  4. Struijs PA, Kerkhoffs GM, Assendelft WJ, Van Dijk CN (2004) Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both-a randomized clinical trial. Am J Sports Med 32(2):462–469. https://doi.org/10.1177/0095399703258714

    Article  CAS  PubMed  Google Scholar 

  5. Krogh TP, Bartels EM, Ellingsen T, Stengaard-Pedersen K, Buchbinder R, Fredberg U, Bliddal H, Christensen R (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(6):1435–1446. https://doi.org/10.1177/0363546512458237

    Article  PubMed  Google Scholar 

  6. Brinks A, Koes BW, Volkers AC, Verhaar JA, Bierma-Zeinstra SM (2010) Adverse effects of extra-articular corticosteroid injections: a systematic review. BMC Musculoskelet Disord 13(11):206. https://doi.org/10.1186/1471-2474-11-206

    Article  Google Scholar 

  7. Seetharamaiah VB, Gantaguru A, Basavarajanna S (2017) A comparative study to evaluate the efficacy of platelet-rich plasma and triamcinolone to treat tennis elbow. Indian J Orthop 51(3):304–311. https://doi.org/10.4103/ortho.IJOrtho_181_16

    Article  PubMed  PubMed Central  Google Scholar 

  8. Niedermeier SR, Crouser N, Speeckaert A, Goyal KS (2018) A survey of fellowship-trained upper extremity surgeons on treatment of lateral epicondylitis. Hand (N Y) 1:1558944718770212. https://doi.org/10.1177/1558944718770212

  9. Arirachakaran A, Sukthuayat A, Sisayanarane T, Laoratanavoraphong S, Kanchanatawan W, Kongtharvonskul J (2016) Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis. J Orthop Traumatol 17(2):101–112. https://doi.org/10.1007/s10195-015-0376-5

    Article  PubMed  Google Scholar 

  10. Dhurat R, Sukesh M (2014) Principles and methods of preparation of platelet-rich plasma: a review and author’s perspective. J Cutan Aesthet Surg 7(4):189–197. https://doi.org/10.4103/0974-2077.150734

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mishra A, Pavelko T (2006) Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med 34(11):1774–1778. https://doi.org/10.1177/0363546506288850

    Article  PubMed  Google Scholar 

  12. Kaux JF, Crielaard JM (2013) Platelet-rich plasma application in the management of chronic tendinopathies. Acta Orthop Belg 79(1):10–15

    PubMed  Google Scholar 

  13. Tamimi FM, Montalvo S, Tresguerres I, Blanco Jerez L (2007) A comparative study of 2 methods for obtaining platelet-rich plasma. J Oral Maxillofac Surg 65(6):1084–1093. https://doi.org/10.1016/j.joms.2006.09.012

    Article  PubMed  Google Scholar 

  14. Okçu G, Erkan S, Sentürk M, Ozalp RT, Yercan HS (2012) Evaluation of injection techniques in the treatment of lateral epicondylitis: a prospective randomized clinical trial. Acta Orthop Traumatol Turc 46(1):26–29

    Article  Google Scholar 

  15. Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29(6):602–608

    Article  CAS  Google Scholar 

  16. Morrey BF, An KN, Chao EYS (1993) Functional evaluation of the elbow. In: Morrey BF (ed) The elbow and its disorders, 2nd edn. WB Saunders Co, Philadelphia, pp 1993–1995

    Google Scholar 

  17. Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, Sayer AA (2011) A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing 40(4):423–429. https://doi.org/10.1093/ageing/afr051

    Article  PubMed  Google Scholar 

  18. Yadav R, Kothari SY, Borah D (2015) Comparison of local injection of platelet rich plasma and corticosteroids in the treatment of lateral epicondylitis of humerus. J Clin Diagn Res 9(7):RC05-7. https://doi.org/10.7860/jcdr/2015/14087.6213

    Article  PubMed  Google Scholar 

  19. Mishra TK (1988) Make them equal partners in development. Yojana 32(9):18–20

    CAS  PubMed  Google Scholar 

  20. Lebiedziński R, Synder M, Buchcic P, Polguj M, Grzegorzewski A, Sibiński M (2015) A randomized study of autologous conditioned plasma and steroid injections in the treatment of lateral epicondylitis. Int Orthop 39(11):2199–2203. https://doi.org/10.1007/s00264-015-2861-0

    Article  PubMed  Google Scholar 

  21. Gosens T, Peerbooms JC, van Laar W, den Oudsten BL (2011) Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med 39(6):1200–1208. https://doi.org/10.1177/0363546510397173

    Article  PubMed  Google Scholar 

  22. Chourasia AO, Buhr KA, Rabago DP, Kijowski R, Irwin CB, Sesto ME (2012) Effect of lateral epicondylosis on grip force development. J Hand Ther 25(1):27–37. https://doi.org/10.1016/j.jht.2011.09.003

    Article  PubMed  Google Scholar 

  23. Sayer AA, Syddall HE, Martin HJ, Dennison EM, Roberts HC, Cooper C (2006) Is grip strength associated with health-related quality of life? Findings from the Hertfordshire Cohort Study. Age Ageing 35(4):409–415

    Article  Google Scholar 

  24. Giusti I, D’Ascenzo S, Mancò A, Di Stefano G, Di Francesco M, Rughetti A, Dal Mas A, Properzi G, Calvisi V, Dolo V (2014) Platelet concentration in plateletrich plasma affects tenocyte behavior in vitro. Biomed Res Int. https://doi.org/10.1155/2014/630870

  25. Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T (2010) 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 38(2):255–262. https://doi.org/10.1177/0363546509355445

    Article  PubMed  Google Scholar 

  26. Khaliq A, Khan I, Inam M, Saeed M, Khan H, Iqbal MJ (2015) Effectiveness of platelets rich plasma versus corticosteroids in lateral epicondylitis. J Pak Med Assoc 65(11 Suppl 3):S100–S104

    PubMed  Google Scholar 

  27. Gautam VK, Verma S, Batra S, Bhatnagar N, Arora S (2015) Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. J Orthop Surg (Hong Kong) 23(1):1–5. https://doi.org/10.1177/230949901502300101

    Article  CAS  Google Scholar 

  28. Weibrich G, Hansen T, Kleis W, Buch R, Hitzler WE (2004) Effect of platelet concentration in platelet-rich plasma on peri-implant bone regeneration. Bone 34(4):665–671. https://doi.org/10.1016/j.bone.2003.12.010

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge and appreciate the contributions of Ms. Parul Takkar, our statistician, towards the statistical computation of our data and its analysis.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to P. Kumar Gupta.

Ethics declarations

Conflict of interest

Prateek Kumar Gupta, Ashis Acharya, Vishesh Khanna, Sirshendu Roy, Kamini Khillan and Senthil Nathan Sambandam declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gupta, P.K., Acharya, A., Khanna, V. et al. PRP versus steroids in a deadlock for efficacy: long-term stability versus short-term intensity—results from a randomised trial. Musculoskelet Surg 104, 285–294 (2020). https://doi.org/10.1007/s12306-019-00619-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12306-019-00619-w

Keywords

Navigation