PRP Vs AUTOLOGOUS BLOOD LOCAL ADMINISTRATION FOR TENNIS ELBOW, THE BETTER OPTION
Main Article Content
Abstract
Introduction – Through the course of history tennis elbow has been with us and the treatment modality has also altered accordingly with time, usually affecting 1-3% of adult population[1] and more commonly affecting the dominant arm. Tennis elbow or lateral epicondylitis is a common musculoskeletal disorder of extensor origin at lateral humeral epicondyle. Typically repetitive occupational and athletic activities may incite the disease[2]. A study in 2019[1] enlists different treatment modalities such as activity modification, physical therapy, injections and very small percentage of population requiring surgical intervention – release of extensor carpi radialis brevis tendon either through percutaneous, arthroscopic or open approach.
The treatment option entailing local administration of chemical agents at lateral epicondyle to alleviate pain and hopefully to start healing is a topic of controversy as to what is to be given steroid or PRP. Steroid provide immediate pain relief but the effects are short term only[3], PRP injection locally according to current literature is a safe and effective way to reduce symptoms and reducing the need for surgical intervention[4]. The current literature is sparse regarding the role of autologous blood injection locally to enhance healing and decrease symptoms and need for surgical intervention. Though studies have shown its efficacy in short and mid term scenarios and that too for chronic, resistant or recalcitrant cases of lateral epicondylitis[5–9]
The objective of the current study is to assess the effectiveness of PRP vs autologous blood injected locally at lateral epicondyle through assessing the functional outcome.
Materials and methods – It’s a prospective study spanning over 2 years, number of patients included in the study 72, study was conducted in a tertiary care hospital. Inclusion criteria – age 18 to 65 years, including both genders, patient with no pain relief after 3 months of conservative treatment. Exclusion criteria – pain less than 3 months duration, patients who had local steroid injection less than 2 months ago, infection at the injection site, pregnant ladies and patients without any trial of conservative treatment.
Patients were divided randomly into 2 groups, 38 injected with PRP and 34 injected with autologous whole blood, patients were assessed at 2nd, 3rd and 6th month post injection and functional outcome was evaluated using VAS score(Patient related tennis elbow evaluation)[10] and VAS(Visual analogue scale) score[11].
Results – At the end of 6 months of follow up period the PRTEE(Patient related tennis elbow evaluation) score mean was dropped from 82.41 pre injection to 22.43 and VAS score mean 8.61 to 0.84; however in autologous whole blood injection group PRTEE (Patient related tennis elbow evaluation)score did not change significantly 82.4 to 49.46 and VAS score 8.76 to 3.85 at 6 months of follow up period.
Conclusion – PRP therapy showed statistically significant improvement in healing of the chronic tennis elbow in long term, when compared to autologous blood group. Thus autologous blood injection is not a viable option for substituting PRP injection.