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Current Reviews in Musculoskeletal Medicine

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Open Access 01-12-2018 | Protein-Rich Plasma: From Bench to Treatment of Arthritis (S Choate and J Tokish, section editors)

Platelet-Rich Plasma for Elbow Pathologies: a Descriptive Review of Current Literature

Authors: Adam Kwapisz, Sharad Prabhakar, Riccardo Compagnoni, Aleksandra Sibilska, Pietro Randelli

Published in: Current Reviews in Musculoskeletal Medicine | Issue 4/2018

Abstract

Purpose of Review

Platelet-rich plasma is used in many orthopedic pathologies such as tendinopathies and ligament injuries. The clinical results reported in the scientific literature are, however, confusing. The aim of this manuscript is to provide a narrative literature review regarding the role of PRP in the most common elbow soft tissue pathologies.

Recent Findings

The response to PRP seems to be favorable when compared to steroid injection for pain management and for patient-reported outcomes in lateral epicondylitis. PRP injection does not seem to have the potential complications associated with a steroid injection such as skin atrophy, discoloration, and secondary tendon tears. Only a few manuscripts comparing the results of PRP treatment with either extracorporeal shockwave (ESW), dry needling, or even surgical treatments in lateral epicondylitis exist. The use of PRP in other elbow pathologies such as golfer’s elbow, ulnar collateral ligament injury, and distal biceps and triceps pathology is examined in few studies, with unclear recommendations.

Summary

Regarding elbow pathologies, PRP injections in tennis elbow seems to be the best-studied intervention. A major limitation in these studies is the significant heterogeneity in the methods used for preparing PRP, for example employing leukocyte-rich, leukocyte-poor preparations, PRP with or without activation, which makes the results of the studies difficult to compare. Results of this review show that more studies on larger cohorts, with comparable formulations, and with longer follow-up are required to give optimal suggestions concerning the use of PRP in elbow pathologies.

Chen X, Jones A, Park C, Vangsness CT Jr. The efficacy of platelet-rich plasma on tendon and ligament healing: a systematic review and meta-analysis with bias assessment. Am J Sports Med 2018;46(8):2020–2032. https://doi.org/10.1177/0363546517743746.CrossRefPubMedPubMedCentral

Andia I, Rubio-Azpeitia E, Maffulli N. Platelet-rich plasma modulates the secretion of inflammatory/angiogenic proteins by inflamed tenocytes. Clin Orthop Relat Res. 2015;473(5):1624–34. https://doi.org/10.1007/s11999-015-4179-z.CrossRefPubMedPubMedCentral

Galatz LM, Gerstenfeld L, Heber-Katz E, Rodeo SA. Tendon regeneration and scar formation: the concept of scarless healing. J Orthop Res. 2015;33(6):823–31. https://doi.org/10.1002/jor.22853.CrossRefPubMedPubMedCentral

Hudgens JL, Sugg KB, Grekin JA, Gumucio JP, Bedi A, Mendias CL. Platelet-rich plasma activates proinflammatory signaling pathways and induces oxidative stress in tendon fibroblasts. Am J Sports Med. 2016;44(8):1931–40. https://doi.org/10.1177/0363546516637176.CrossRefPubMedPubMedCentral

McCarrel T, Fortier L. Temporal growth factor release from platelet-rich plasma, trehalose lyophilized platelets, and bone marrow aspirate and their effect on tendon and ligament gene expression. J Orthop Res. 2009;27(8):1033–42. https://doi.org/10.1002/jor.20853.CrossRefPubMed

De Mos M, van der Windt AE, Jahr H, van Schie HT, Weinans H, Verhaar JA, et al. Can platelet-rich plasma enhance tendon repair? A cell culture study. Am J Sports Med. 2008;36(6):1171–8. https://doi.org/10.1177/0363546508314430. CrossRefPubMed

De Mos M, Koevoet W, van Schie HT, Kops N, Jahr H, Verhaar JA, et al. In vitro model to study chondrogenic differentiation in tendinopathy. Am J Sports Med. 2009;37(6):1214–22. https://doi.org/10.1177/0363546508331137.CrossRefPubMed

Filardo G, Kon E. PRP: product rich in placebo? Knee Surg Sports Traumatol Arthrosc. 2016;24(12):3702–3. https://doi.org/10.1007/s00167-015-3778-2.CrossRefPubMed

Taylor DW, Petrera M, Hendry M, Theodoropoulos JS. A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and ligament injuries. Clin J Sport Med. 2011;21(4):344–52. https://doi.org/10.1097/JSM.0b013e31821d0f65.CrossRefPubMed

10.

Nourissat G, Ornetti P, Berenbaum F, Sellam J, Richette P, Chevalier X. Does platelet-rich plasma deserve a role in the treatment of tendinopathy? Joint Bone Spine. 2015;82(4):230–4. https://doi.org/10.1016/j.jbspin.2015.02.004.CrossRefPubMed

11.

• Mishra A, Randelli P, Barr C, Talamonti T, Ragone V, Cabitza P. Platelet-rich plasma and the upper extremity. Hand Clin. 2012;28(4):481–91. https://doi.org/10.1016/j.hcl.2012.08.008. Significant pain improvement at 24 weeks compared with controls. No difference in PRTEE scores. CrossRefPubMed

12.

• Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial. Am J Sports Med. 2010;38(2):255–32. https://doi.org/10.1177/0363546509355445. Significant decrease in pain and improvement in VAS and DASH scores at 1 year in PRP group (Steroid group had better initial results which declined subsequently). CrossRefPubMed

13.

Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am. 1999;81(2):259–78.CrossRefPubMed

14.

Verhaar JA. Tennis elbow. Anatomical, epidemiological and therapeutic aspects. Int Orthop. 1994;18(5):263–7.CrossRefPubMed

15.

Chard MD, Hazleman BL. Tennis elbow--a reappraisal. Br J Rheumatol. 1989;28(3):186–90.CrossRefPubMed

16.

Arirachakaran A, Sukthuayat A, Sisayanarane T, Laoratanavoraphong S, Kanchanatawan W, Kongtharvonskul J. Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis. J OrthopTraumatol. 2016;17(2):101–12. https://doi.org/10.1007/s10195-015-0376-5.CrossRef

17.

Nirschl RP, Pettrone FA. Tennis elbow The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 1979;61(6A):832–9.CrossRefPubMed

18.

Arrigoni P, Cucchi D, D’Ambrosi R, Butt U, Safran MR, Denard P, et al. Intra-articular findings in symptomatic minor instability of the lateral elbow (SMILE). Knee Surg Sports Traumatol Arthrosc. 2017;25(7):2255–63. https://doi.org/10.1007/s00167-017-4530-x.CrossRefPubMed

19.

• Lebiedziński R, Synder M, Buchcic P, Polguj M, Grzegorzewski A, Sibinski M. A randomized study of autologous conditioned plasma and steroid injections in the treatment of lateral epicondylitis. Int Orthop 2015;39(11):2199–2203. https://doi.org/10.1007/s00264-015-2861-0. Mean DASH score at 1 year was significantly better in the PRP group although at 6 weeks and 6 months it was significantly better in the steroid group. CrossRefPubMed

20.

• Krogh TP, Bartels EM, Ellingsen T, Stengaard-Pedersen K, Buchbinder R, Fredberg U, et al. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med. 2013;41(6):1435–46. https://doi.org/10.1177/0363546512458237. No significant improvement in pain at 3 months compared to saline or steroids. CrossRefPubMed

21.

• Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. 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. 2011;39(6):1200–8. https://doi.org/10.1177/0363546510397173. Significant improvement in VAS and DASH scores at 2 years of PRP group (DASH scores of steroid group returned to baseline levels while those of the PRP group improved). CrossRefPubMed

22.

Mi B, Liu G, Zhou W, Lv H, Liu Y, Wu Q, et al. Platelet rich plasma versus steroid on lateral epicondylitis: meta-analysis of randomized clinical trials. Phys Sportsmed. 2017;45(2):97–104. https://doi.org/10.1080/00913847.2017.1297670. CrossRefPubMed

23.

• Gautam VK, Verma S, Batra S, Bhatnagar N, Arora S. Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. J Orthop Surg (Hong Kong). 2015;23(1):1–5All scores improved significantly from pre-injection to the 6-month follow-up in the PRP and CS groups. However, in the CS group, the scores generally peaked at 3 months and then deteriorated at 6 months indicating recurrence. Higher incidence of reduced tendon thickness and condylar erosions in the CS group. CrossRefPubMed

24.

• Yadav R, Kothari SY, Borah D. Comparison of local injection of platelet rich plasma and corticosteroids in the treatment of lateral epicondylitis of humerus.J Clin Diagn Res 2015;9(7):RC05-7. At 3 months, significant improvement in pain and function scores in the PRP group (Steroid group had better initial pain relief which declined subsequently).

25.

• P B, Dhillon M, Aggarwal S, Marwaha N, Prakash M. Leukocyte-poor platelet-rich plasma versus bupivacaine for recalcitrant lateral epicondylar tendinopathy. J Orthop Surg (Hong Kong). 2015;23(1):6–10. Significant improvement in all scores in the PRP group at 3 months (Steroid group had better initial results which declined subsequently). CrossRef

26.

• Khaliq A, Khan I, Inam M, Saeed M, Khan H, Iqbal MJ. Effectiveness of platelets rich plasma versus corticosteroids in lateral epicondylitis. J Pak Med Assoc. 2015;65(11 Suppl 3):S100–4. Significant improvement in VAS scores in the PRP group. PubMed

27.

• Palacio EP, Schiavetti RR, Kanematsu M, Ikeda TM, Mizobuchi RR, Galbiatti JA. Effects of platelet-rich plasma on lateral epicondylitis of the elbow: prospective randomized controlled trial. Rev Bras Ortop. 2016;51(1):90–5. https://doi.org/10.1016/j.rboe.2015.03.014. No significant difference in scores among both groups. CrossRefPubMedPubMedCentral

28.

Mishra A, Harmon K, Woodall J Jr, Vieira A. Sports medicine applications of platelet rich plasma. Curr Pharm Biotechnol. 2012;13(7):1185–95.CrossRefPubMed

29.

Mishra AK, Skrepnik NV, Edwards SG, Jones GL, Sampson S, Vermillion DA, et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med. 2014;42(2):463–71. https://doi.org/10.1177/0363546513494359.CrossRefPubMed

30.

• Creaney L. Platelet-rich plasma and the biological complexity of tissue regeneration. Br J Sports Med. 2011;45(8):611. https://doi.org/10.1136/bjsm.2010.082594. No significant difference at 6 months. Higher conversion rate to surgery in ABI group. CrossRefPubMed

31.

• Raeissadat SA, Rayegani SM, Hassanabadi H, Rahimi R, Sedighipour L, Rostami K. Is platelet-rich plasma superior to whole blood in the management of chronic tennis elbow: one year randomized clinical trial. BMC Sports Sci Med Rehabil 2014;6(1):12. doi: 10.1186/2052-1847-6-12. Although scores of both groups improved over 12 months, no significant difference between PRP vs ABI.

32.

Chou LC, Liou TH, Kuan YC, Huang YH, Chen HC. Autologous blood injection for treatment of lateral epicondylosis: a meta-analysis of randomized controlled trials. Phys Ther Sport. 2016;18:68–73. https://doi.org/10.1016/j.ptsp.2015.06.002.CrossRefPubMed

33.

• Thanasas C, Papadimitriou G, Charalambidis C et al. Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis - a randomized controlled clinical trial. Am J Sports Med 2011;39(10):2130–4. Significant pain improvement at 6 weeks. No significant difference in function. CrossRefPubMed

34.

Ford RD, Schmitt WP, Lineberry K, Luce P. A retrospective comparison of the management of recalcitrant lateral elbow tendinosis: platelet-rich plasma injections versus surgery. Hand. 2015;10(2):285–91. https://doi.org/10.1007/s11552-014-9717-8.CrossRefPubMed

35.

Alessio-Mazzola M, Repetto I, Biti B, Trentini R, Formica M, Felli L. Autologous US-guided PRP injection versus US-guided focal extracorporeal shock wave therapy for chronic lateral epicondylitis: a minimum of 2-year follow-up retrospective comparative study. J OrthopSurg (Hong Kong). 2018;26(1):230949901774998. https://doi.org/10.1177/2309499017749986.CrossRef

36.

Lim W, Park SH, Kim B, Kang SW, Lee JW, Moon YL. Relationship of cytokine levels and clinical effect on platelet-rich plasma-treated lateral epicondylitis. J Orthop Res. 2018;36(3):913–20.PubMed

37.

Gaspar MP, Motto MA, Lewis S, Jacoby SM, Culp RW, Lee Osterman A, et al. Platelet-rich plasma injection with percutaneous needling for recalcitrant lateral epicondylitis: comparison of tenotomy and fenestration techniques. Orthop J Sports Med. 2017;5(12):232596711774207. https://doi.org/10.1177/2325967117742077.CrossRef

38.

MertKaraduman, Mustafa Caner Okkaoglu, HakanSesen, Anil Taskesen, MahmutOzdemir, Murat Altay. Platelet-rich plasma versus open surgical release in chronic tennis elbow: a retrospective comparative study. J Orthop 2016;13(1):10–14. https://doi.org/10.1016/j.jor.2015.12.005.CrossRefPubMedPubMedCentral

39.

Merolla G, Dellabiancia F, Ricci A, Mussoni MP, Nucci S, Zanoli G, et al. Arthroscopic debridement versus platelet-rich plasma injection: a prospective, randomized, comparative study of chronic lateral epicondylitis with a nearly 2-year follow-up. Arthroscopy. 2017;33(7):1320–9. https://doi.org/10.1016/j.arthro.2017.02.009.CrossRefPubMed

40.

Fitzpatrick J, Bulsara M, Zheng MH. The effectiveness of platelet-rich plasma in the treatment of tendinopathy: a meta-analysis of randomized controlled clinical trials. Am J Sports Med. 2017;45(1):226–33. https://doi.org/10.1177/0363546516643716.CrossRefPubMed

41.

Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol. 2011;25(1):43–57. https://doi.org/10.1016/j.berh.2011.01.013.CrossRefPubMed

42.

Wolf JM, Mountcastle S, Burks R, Sturdivant RX, Owens BD. Epidemiology of lateral and medial epicondylitis in a military population. Mil Med. 2010;175(5):336–9.CrossRefPubMed

43.

Tyler TF, Nicholas SJ, Schmitt BM, Mullaney M, Hogan DE. Clinical outcomes of the addition of eccentrics for rehabilitation of previously failed treatments of golfers’ elbow. Int J Sports Phys Ther. 2014;9(3):365–70.PubMedPubMedCentral

44.

Varshney A, Maheshwari R, Juyal A, Agrawal A, Hayer P. Autologous platelet-rich plasma versus corticosteroid in the management of elbow epicondylitis: a randomized study. Int J App Basic Med Res. 2017;7(2):125–8.CrossRef

45.

Taylor SA, Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health. 2012;4(5):384–93. https://doi.org/10.1177/1941738112454651.CrossRefPubMedPubMedCentral

46.

Donaldson O, Vannet N, Gosens T, Kulkarni R. Tendinopathies around the elbow part 2: medial elbow, distal biceps and triceps tendinopathies. Should Elb. 2014;6(1):47–56. https://doi.org/10.1111/sae.12022.CrossRef

47.

Dines JS, Williams PN, Attrache N, Conte S, Tomczyk T, Osbahr DC, et al. Platelet-rich plasma can be used to successfully treat elbow ulnar collateral ligament insufficiency in high-level throwers. Am J Orthop. 2016;45(5):296–300.PubMed

48.

Rettig AC, Sherrill C, Snead DS, Mendler JC, Mieling P. Nonoperative treatment of ulnar collateral ligament injuries in throwing athletes. Am J Sports Med. 2001;29(1):15–7. https://doi.org/10.1177/03635465010290010601.CrossRefPubMed

49.

Podesta L, Crow SA, Volkmer D, Bert T, Yocum LA. Treatment of partial ulnar collateral ligament tears in the elbow with platelet-rich plasma. Am J Sports Med. 2013;41(7):1689–94. https://doi.org/10.1177/0363546513487979.CrossRefPubMed

50.

Deal JB, Smith E, Heard W, O’Brien MJ, Savoie FH 3rd. Platelet-rich plasma for primary treatment of partial ulnar collateral ligament tears: MRI correlation with results. Orthop J Sports Med 2017;5(11). https://doi.org/10.1177/2325967117738238, 232596711773823.CrossRef

51.

Hurwit DJ, Garcia GH, Liu J, Altchek DW, Romeo A, Dines J. Management of ulnar collateral ligament injury in throwing athletes: a survey of the American Shoulder and Elbow Surgeons. J Shoulder Elb Surg. 2017;26(11):2023–8. https://doi.org/10.1016/j.jse.2017.08.005.CrossRef

52.

Barker SL, Bell SN, Connell D, Coghlan JA. Ultrasound-guided platelet-rich plasma injection for distal biceps tendinopathy. Should Elb. 2015;7(2):110–4. https://doi.org/10.1177/1758573214567558.CrossRef

53.

Sanli I, Morgan B, van Tilborg F, Funk L, Gosens T. Single injection of platelet-rich plasma (PRP) for the treatment of refractory distal biceps tendonitis: long-term results of a prospective multicenter cohort study. Knee Surg Sports Traumatol Arthrosc. 2016;24(7):2308–12. https://doi.org/10.1007/s00167-014-3465-8.CrossRefPubMed

54.

Cheatham SW, Kolber MJ, Salamh PA, Hanney WJ. Rehabilitation of a partially torn distal triceps tendon after platelet rich plasma injection: a case report. Int J Sports Phys Ther. 2013;8(3):290–9.PubMedPubMedCentral

Title: Platelet-Rich Plasma for Elbow Pathologies: a Descriptive Review of Current Literature
Authors: Adam Kwapisz
Sharad Prabhakar
Riccardo Compagnoni
Aleksandra Sibilska
Pietro Randelli
Publication date: 01-12-2018
Publisher: Springer US
Published in: Current Reviews in Musculoskeletal Medicine / Issue 4/2018
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-018-9520-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Platelet-Rich Plasma for Elbow Pathologies: a Descriptive Review of Current Literature

Abstract

Purpose of Review

Recent Findings

Summary

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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