Medial and lateral epicondylitis are two common elbow conditions that affect a variety of athletes and can significantly impair arm function. While epicondylitis generally responds to conservative treatment, the course can be prolonged and it’s unclear whether some treatments may work better than others. In a study published in the Journal of Shoulder and Elbow Surgery, several authors including TOBI faculty Drs. Kenneth Mautner and Allison Boden compared the effectiveness of platelet-rich plasma (PRP) and Tenex to see whether one of these commonly used treatments was more effective than the other.
PRP and ultrasound-guided percutaneous tenotomy (Tenex in this study) are both non-surgical interventional therapies with good research backing their use in the management of epicondylitis. PRP is derived from whole blood using centrifugation to separate blood components. Plasma highest in platelets is isolated and injected into the area of pathology. Tenex uses ultrasonic energy to break down and remove scar tissue in an injured region, stimulating acute inflammation and facilitating a more appropriate healing response. Treatment can also include tenotomy, where the tendon is fenestrated under ultrasound guidance.
For the current study, the authors treated 75 patients 18 years or older with medial or lateral epicondylitis who had failed at least 3 months of conservative therapy. They were treated with either Tenex or PRP in an unblinded, non-randomized fashion based on clinical decision-making between the physician and patient. PRP was leukocyte-poor and injected using ultrasound guidance. Those treated with Tenex received up to three minutes of debridement. Before and after questionnaires were then completed to follow symptoms and functional improvement after treatment.
A total of 62 patients completed the questionnaires, 32 of whom underwent PRP injection and the other 30 of whom underwent Tenex. All had previously tried a combination of activity modification, physical therapy, massage therapy, or corticosteroid injection. Follow up in the PRP group was 17 months on average and 10 months in the Tenex group. The authors found no difference between groups in patient satisfaction with both reporting approximately 80% satisfaction. Improvement in the Quick Disabilities of the Arm, Shoulder and Hand (QDASH) scale improved to similar degrees in both groups, 20.6 for PRP and 23.4 for Tenex. Ratings on the Visual Analogue Scale (VAS) also improved to similar degrees, decreasing by 4.2 in the PRP group and 5.5 in the Tenex group. Scores on the Euro Quality of Life 5D (EQ5D) questionnaire also improved by similar amounts in both groups. All changes were above the minimal clinically important difference values.
The authors acknowledge several limitations in their study, including the differing follow up times, lack of analysis of the PRP to determine platelet concentrations, and the lack of randomization. They also acknowledge that the difference in cost between the two treatments because of insurance coverage may skew choices regarding therapy.
However, PRP is generally less costly to the system overall since it can be performed more easily in office-based settings with less specialized equipment. The authors surmise that more regular use of PRP as a therapeutic option over Tenex could potentially reduce overall costs of care. They additionally hope that their findings prompt larger, randomized, controlled trials comparing these two treatments to better establish comparative effectiveness.
Please join us in congratulating the authors on their publication and in thanking them for their ongoing contributions to the literature!