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This Article Full Text Full Text (PDF) All Versions of this Article: 34/11/1774    most recent 0363546506288850v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (18) Citing Articles via Google Scholar Google Scholar Articles by Mishra, A. Articles by Pavelko, T. Search for Related Content PubMed PubMed Citation Articles by Mishra, A. Articles by Pavelko, T. Related Collections Elbow Operative

Treatment of Chronic Elbow Tendinosis With Buffered Platelet-Rich Plasma

From the Department of Orthopedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, Menlo Park, California

^* Address correspondence to Allan Mishra, MD, Menlo Medical Clinic, Stanford University Medical Center, Department of Orthopedic Surgery, 1300 Crane Street, Menlo Park, CA 94025 (e-mail: allan_mishra{at}yahoo.com).

Background: Elbow epicondylar tendinosis is a common problem that usually resolves with nonoperative treatments. When these measures fail, however, patients are interested in an alternative to surgical intervention.

Hypothesis: Treatment of chronic severe elbow tendinosis with buffered platelet-rich plasma will reduce pain and increase function in patients considering surgery for their problem.

Study Design: Cohort study; Level of evidence, 2.

Methods: One hundred forty patients with elbow epicondylar pain were evaluated in this study. All these patients were initially given a standardized physical therapy protocol and a variety of other nonoperative treatments. Twenty of these patients had significant persistent pain for a mean of 15 months (mean, 82 of 100; range, 60–100 of 100 on a visual analog pain scale), despite these interventions. All patients were considering surgery. This cohort of patients who had failed nonoperative treatment was then given either a single percutaneous injection of platelet-rich plasma (active group, n = 15) or bupivacaine (control group, n = 5).

Results: Eight weeks after the treatment, the platelet-rich plasma patients noted 60% improvement in their visual analog pain scores versus 16% improvement in control patients (P =.001). Sixty percent (3 of 5) of the control subjects withdrew or sought other treatments after the 8-week period, preventing further direct analysis. Therefore, only the patients treated with platelet-rich plasma were available for continued evaluation. At 6 months, the patients treated with platelet-rich plasma noted 81% improvement in their visual analog pain scores (P =.0001). At final follow-up (mean, 25.6 months; range, 12–38 months), the platelet-rich plasma patients reported 93% reduction in pain compared with before the treatment (P <.0001).

Conclusion: Treatment of patients with chronic elbow tendinosis with buffered platelet-rich plasma reduced pain significantly in this pilot investigation. Further evaluation of this novel treatment is warranted. Finally, platelet-rich plasma should be considered before surgical intervention.

Key Words: platelet-rich plasma (PRP) • tennis elbow • lateral epicondylitis • tendonitis • tendinosis

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