Platelet Rich Plasma Helps Tennis Elbow

March 10, 2010 – Platelet rich plasma (PRP) -- the latest,
still-controversial treatment for tendon injuries -- heals tennis elbow better
than corticosteroid shots, a new study suggests.
Because they get very little blood, injured tendons heal notoriously slowly.
Blood platelets attract healing growth factors -- so the idea of PRP is to
inject a patients own platelets at the site of a tendon injury.
To date, small studies suggest that PRP works for tennis elbow. However, a
recent study in patients with Achilles tendon injuries yielded disappointing
results.
At the same time, corticosteroid shots have been losing favor. They are
great at relieving acute pain in the short term, but they don't promote healing
-- and may lead to further tendon breakdown.
So what are tennis elbow sufferers supposed to do for their aching arms? A
strong hint comes from Taco Gosens, MD, PhD, and colleagues at St. Elisabeth
Hospital, Tilburg, Netherlands.
The researchers randomly assigned patients with chronic lateral
epicondylitis -- tennis elbow lasting longer than six months and pain ranking
at least 5 on a 10-point scale -- to get either a PRP or corticosteroid
injection.
Both injections were given directly into the area of maximum tenderness and
also into the tendon using a "peppering" technique in which the needle, after
being passed through the skin, is inserted several times into the tendon.
What happened? Patients who got the corticosteroid had much faster pain
relief. But 26 weeks after treatment, patients in the PRP arm were much more
likely to have less pain and more function than those who received the
corticosteroid.
And they kept getting better over the next year. By this time, PRP-treated
patients reported a 64% improvement in pain and an 84% improvement in
disability. Corticosteroid-treated patients reported a 24% improvement in pain
and a 17% improvement in disability.
Moreover, only three of the 51 patients in the PRP group went on to get
tennis-elbow surgery, and only two went back for a corticosteroid shot. Among
the 49 patients in the corticosteroid group, six went on to surgery, six went
back for PRP treatment, and one returned for another corticosteroid shot.
"We know that in the natural history of lateral epicondylitis 80% of
patients are healed in one year, but all patients had complaints for at least
six months," Gosens and colleagues report. "In our [study], significant results
were achieved only after 26 weeks [with PRP]."
Kenneth Mautner, MD, of Emory University's sports medicine center says he
gets even better results than the Dutch researchers reported. He was not
involved in the Gosens study.
"Their results would have been better if they had consistently used
ultrasound before treatment to show whether there really was damage to the
tendon," Mautner tells WebMD. "And they did not do PRP injections with
ultrasound guidance, which I always do. If they did, they could have been in
the 90% success range reported in a previous study."
http://www .webmd.com/news/20100310/platelet-rich-plasma-helps-tennis-elbow?src=RSS_PUBLIC