Functional outcome of autologus platelet rich plasma injection as treatment for patients with lateral epicondylitis

Abstract

Background: Lateral epicondylitis is the most common chronic disabling painful condition affecting 1% to 3% of the population predominantly those between 35 and 55 years of age. Elbow pain with tenderness and restricted wrist extension is its common manifestations. Although a few conservative methods of treatment are available, recent studies have suggested platelet-rich plasma (PRP) to be a safe and effective therapy in relieving pain and improving function for tennis elbow. Aim: This study aims to study the efficacy of autologous PRP in tennis elbow. Materials and Methods: A prospective observational study was conducted in our hospital. Fifty patients with chronic lateral epicondylitis aged above 18 years were included in the study. All the patients had a minimum of 3 months of symptoms, were selected based on the inclusion and exclusion criteria and underwent the same method of treatment. All patients had a baseline assessment of numerical pain score and were repeated at 2 weeks, 4 weeks, 8 weeks, 3 months, and 6 months posttreatment. The PRP was prepared from venous whole blood. All patients had a single-dose injection of autologous PRP in their extensor tendons at the elbow through a peppering needling technique. Results: The patients were more often successfully treated. When baseline numerical pain scores were compared with those at 8 weeks, 12 weeks, and 24 weeks follow-up, they showed improvement over time. There were no complications observed related to the use of PRP. The difference between 1-, 2-, 4-, and 6-month pain reduction was tested for significance by Friedman's test and found that there was no significant difference in pain reduction between 2 months and 3 months, 2 months and 6 months, and 3 months and 6 months scores. However, there was a statistically significant difference in pain score in 1 and 2 months. Duration of symptoms suggests the chronic nature of disease. In this study, analysis was done based on the duration of symptoms. Thirty-two out of the 50 patients had pain for <6 months, 16 out of 50 patients between 6 and 12 months, and 2 out of 50 had symptoms of >1 year. In our study, it was found that mean pain score at the end of 6 months for patients with symptoms <6 months was 0.59, whereas the mean pain score of patients with symptoms from 6 to 12 months was 1.81. This indicates that duration of symptoms had a significant correlation with the clinical outcome after injection. Conclusion: Autologous PRP injection is a safe and useful modality of treatment in the treatment of tennis elbow. Maximum benefit after PRP injection was observed at 2 months and had sustained for at least 6 months. More trials are required to optimize the technique for separating PRP. These improvements were maintained over in our follow-up period without any significant complications. Long-term follow-up with more number of patients is needed to evaluate the lasting benefits of pain relief and functional improvement in lateral epicondylitis.