Results of Platelet-Rich Plasma (PRP) Applications for Chronic Lateral Elbow Epicondylitis That are Resistant to Corticosteroid Injections

Yıl 2013, Cilt: 20 Sayı: 4, 128 - 132, 30.12.2013

Yener Erken Davud Yasmin Halil Burç İbrahim Akmaz Ahmet Kıral

Öz

Results of Platelet-Rich Plasma (PRP) Applications for Chronic Lateral Elbow Epicondylitis That are Resistantto Corticosteroid Injections.Aim: The main goal of the study is to present 1-year follow-up results of patients with chronic lateralepicondylitis that are resistant to corticosteroid injections in whom we applied platelet rich plasma (PRP).Material and Methods: We applied PRP once to the patients who did not benefit from corticosteroid injections.We prospectively evaluated patients between 2010 and 2012. We evaluated patients with visual analog score(VAS) and patient rated tennis elbow evaluation (PRTEE) score at the pre-treatment once, post-treatment1st, 3rd, 6th and 12th month follow-ups. Results: Nine patients were female, three was male. The mean ageof patients was 48.6. The average pre-treatment VAS and PRTEE scores were 8.7 and 83 respectively. Theaverage VAS scores improved to 6.6, 3.8, 1.85, 1.47 at the post-treatment 1st, 3rd, 6th, and 12th month followups respectively. The average PRTEE scores improved to 61.3, 34.9, 19.8, 17.9 at the post-treatment 1st, 3rd,6th and 12th month follow-ups respectively. At the 12th month follow-up, six patients rated their treatmentas excellent, five as good, and one as poor. Discussion: There are promising results in the literature regardingPRP applications for lateral epicondylitis, plantar fasciitis, and chondral lesions. In this study, we observedthat pain and function scores of patients that are resistant to corticosteroid injections improved after PRPapplication

Anahtar Kelimeler

Corticosteroid, Lateral epicondylitis, Platelet rich plasma

KORTİKOSTEROİD ENJEKSIYONUNA DİRENÇLİ KRONİK LATERAL DİRSEK EPİKONDİLİTİ OLGULARINDA TROMBOSİTTEN ZENGİN PLAZMA (TZP) UYGULAMALARININ SONUÇLARI

Öz

Amaç: Bu çalışmanın amacı daha önce kortikosteroid uygulanmış, şikayetleri geçmemiş veya geçtikten sonra tekrar başlamış kronik lateral epikondilitli hastalardaki trombositten zengin plazma (TZP) uygulamalarının 1 yıllık klinik sonuçları bildirmektir.
Hastalar ve Yöntem: Daha once lateral epikondilit nedeniyle kortikosteroid uygulanmış ve şikayetleri geçmemiş veya tekrar başlamış 12 hastaya 2010-2012 yılları arasında 1 kez TZP uygulandı, hastalar prospektif olarak takip edildi. İşlem öncesi ve sonrası 1 ay, 3 ay , 6 ay ve 12 ay (Visual Analog Score) VAS skorları ve Patient Rated Tennis Elbow Evaluation (PRTEE) skorlarını değerlendirildi.
Sonuçlar: Hastaların 9'u bayan 3'ü erkekti. Yaş ortalaması 48.6 idi. İşlem öncesi ortalama VAS skoru 8.7, PRTEE skorları ise 83 olarak değerlendirildi. İşlem sonrası 1.ayda ortalama VAS skoru 6,6 PRTEE skorları ise ortalama 61,3, 3. ayda ortalama VAS skoru 3,8 PRTEE skorları ise ortalama 34,9, 6. ayda ortalama VAS skoru 1,85 PRTEE skorları ise ortalama 19,8, 12. ayda ortalama VAS skoru 1,47 PRTEE skorları ise ortalama 17.9 olarak değerlendirildi. 1. yılda hastalar uygulanan tedaviyi değerlendiriken, 6 tanesi çok iyi, 5 tanesi iyi, 1 tanesi kötü olarak değerlendirdi.
Tartışma: Literatürde TZP'nın lateral epikondilit, plantar fasiit ve kıkırdak lezyonlarındaki uygulamalarıyla ilgili umut verici sonuçlar mevcuttur. Bizim 12 hastayla yaptığımız prospektif çalışmada kortikosteroid uygulamasına dirençli lateral dirsek epikondiliti olgularında TZP uygulamasının hastaların ağrılarını azalttığını ve fonksiyonlarını arttırdığı izlenmektedir.

Anahtar Kelimeler

Kortikosteroid, Lateral Epikondilit, Trombositten Zengin Plazma

Kaynakça

• 1- Thanasas C, Papadimitriou G et.al. Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis:a randomized controlled clinical trail. Am J Sports Med 2011; 39(10):2130-4.
• 2- Torp-Pedersen T, Torp-Pedersen S, Bilddal H. Diagnostic value of ultrasonography in epicondylitis. Ann Int Med 2002; 136:781-2.
• 3- KeusSHJ,Smidt N, Asendelft WJJ. Treatment of lateralepicondylitis in general practice: results of a survey.Eur Gen Pract 2002; 8:71-2.
• 4- Solveborn SA, BuchF, Mallmin H. et.al. Cortisone injection with anesthetic additives for radial epicondylalgia (tenis elbow). ClinOrthop 1995; 316:99- 105.
• 5- Price R, Sinclair H, Heinrich I. Gibson T. Local injection treatment of tenis elbow: Hydrocortisone, triamcinolone and lignocain compared. Br J Rheumatol 1991; 30:39- 44.
• 6- EdwardsSG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg Am. 2003; 28(2:)272-8.
• 7- Connell DA, Ali KE, Ahmad M, et al .Ultrasound- guided autologous blood injections for tenis elbow .Skeletal Radiol. 2006; 35(6):371-7.
• 8- Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006; 34(11):1774-8.
• 9- Randelli PS, Arrigoni P, Cabitza P, et al. Autologous platelet rich plasma for arthroscopic rotator cuff repair. A pilot study. Disabil Rehabil 2008; 30:1584–9.
• 10-Mishra A, Harmon K, Woodall J, et al. Sports medicine applications of platelet rich plasma. Curr Pharm Biotechnol 2012; 13(7):1185–95.
• 11- Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg. 2004; 62:489-96.
• 12- Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Ýmplant Dent 2001; 62:489-96.
• 13- Peerbooms JC, Sluimer J, Bruijn DJ, et al. 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 2010; 38:255–62.
• 14- Gosens T, Peerbooms JC, van Laar W, et al. 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; 39:1200–8.
• 15- Creaney L, Wallace A, Curtis M, et al. Growth factor based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med 2011; 45:966–71.
• 16- Wolf J, Ozer K, Scott F, et al. Comparison of autologous blood, corticosteroid and saline injection in the treatment of lateral epicondylitis: a prospective, randomized, controlled multicenter study. J Hand Surg 2011;3 6:1269–72.
• 17-Aðýr Ý, Çaypýnar B, Topkar OM, et al. Lateral epikondilit tedavisinde otolog trombositten zengin plazmanýn etkisi Dicle Medical Jornual 2011; 38(1):40-43.