Comparative Study of Local Injection of Platelet Rich Plasma versus Corticosteroids in the Treatment of Lateral Epicondylitis (Tennis Elbow)

Abstract

Background: Lateral epicondylitis, also known as 'tennis elbow', is a very common condition affecting mainly middle-aged patients that is associated with local tendon pathology, alteration in pain perception and motor impairment. Several approaches to treatment have been proposed, the most frequently used is PRP. Platelet-rich plasma (PRP) is a growing modality for tissue healing, regeneration and has more pain relief lasting effect. Aim of the work: was to estimate the clinical efficacy of local injection of Platelet Rich Plasma compared to local injection of corticosteroids in cases of lateral epicondylitis. Patients and Methods: This study was a prospective clinical trial study in which 80 patients with lateral epicondylitis of both sexes between 2l - 60 years of age were recruited for the study. The included patients were divided into two groups: 1- Platelet Rich Plasma group (40 patients) were received a two injections of 1 ml of PRP with one month interval between the two injections, with absolute platelet count of 1 million platelets/ mm3 as confirmed by automated cell counter. . PRP were prepared under complete aseptic conditions. 2- Corticosteroids group (40 patients) were received a two injections of corticosteroid (methyl-prednisolone, 40mg in l ml) with one month interval between the two injections. The site of injection and the technique used was same in both the groups. Results: Affected side was higher in right hand than left hand in both studied groups. In PRP group, there were 92.5 % right hand and 7.5 % left handed patients. Whereas, in corticosteroid group, there were 95.0 % right handed and 5.0 % left handed patients; and there was no significant difference between the studied groups. Visual Analog Scale (VAS) was significantly improved at 1 and 3 months in PRP patients compared to only significant improvement at 3 months in corticosteroid group. Both studied groups showed significant improvement of grip strength at 1 and 3 months. qDASH at 1 and 3 months was significantly better in the PRP group, but it statically not reached. On the other hand, significant improvement of US edema was estimated in the corticosteroid group at 3 months when compared with PRP group. In addition, slight improvement of US tears was appeared in both groups after 3 months. Conclusion: It could be concluded that both PRP and corticosteroids showed better improvement of pain, grip strength and qDASH at 3 months. However, PRP is suggested to be an effective treatment for lateral epicondylitis. PRP provides better improvement in all parameters with nearly durable effect when compared to corticosteroids. On the other hand, corticosteroids treatment resulted in better improvement of US detected edema.