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PRP versus steroids in a deadlock for efficacy: long-term stability versus short-term intensity-results from a randomised trial.

Authors
  • Gupta, P Kumar1
  • Acharya, A2
  • Khanna, V3
  • Roy, S2
  • Khillan, K4
  • Sambandam, S Nathan5
  • 1 Department of Sports Medicine, Sir Ganga Ram Hospital, New Delhi, India. [email protected] , (India)
  • 2 Department of Sports Medicine, Sir Ganga Ram Hospital, New Delhi, India. , (India)
  • 3 Department of Orthopaedics, Sir Ganga Ram Hospital, New Delhi, India. , (India)
  • 4 Department of Blood Transfusion Medicine, Sir Ganga Ram Hospital, New Delhi, India. , (India)
  • 5 Department of Orthopedics, Louis A Johnson VA Medical Center, Clarksburg, WV, USA.
Type
Published Article
Journal
Musculoskeletal surgery
Publication Date
Dec 01, 2020
Volume
104
Issue
3
Pages
285–294
Identifiers
DOI: 10.1007/s12306-019-00619-w
PMID: 31448392
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

A popular choice for lateral epicondylitis (LE), corticosteroid injections have been associated with prominent side effects, which has led to the conception of modalities like platelet-rich plasma (PRP). This randomised trial aimed to evaluate and compare the 6-week, 3-month and 1-year outcomes with PRP and corticosteroid injections in LE. We hypothesised that PRP would prove more effective in relieving pain and improving function. At the sports medicine unit of our tertiary care teaching centre, 80 patients with LE were randomised into either receiving PRP (group A) or corticosteroids (group B) injections. Pre-injection visual analogue scale (VAS), disabilities of the arm, shoulder and hand (DASH) score, Mayo elbow performance score (MEPS) and grip strength score (GSS) were recorded. Common extensor origins were identified and infiltrated with 3 ml of either PRP or corticosteroid (triamcinolone in 2% xylocaine) using a peppering technique. Follow-up scores and extent of pain relief were recorded and compared. At 6 weeks, there were greater improvements in group B versus A in mean VAS (13.8 vs. 44.5; p < 0.001), DASH (64.2 vs. 53.3; p < 0.001), MEPS (88.0 vs. 74.5; p = 0.004) and GSS (89.3 vs. 73.4; p = 0.039). These scores showed a reversed pattern at 3 months when group A outcomes superseded group B (VAS p = 0.002; DASH p < 0.001; MEPS p = 0.002; GSS p = 0.045). At 1-year follow-up, group A continued to enjoy better pain relief and function (VAS p = 0.024; DASH p < 0.001; MEPS p = 0.009; GSS p = 0.028). Albeit corticosteroid injections show good short-term results at 6 weeks, patients receiving PRP injections fare better at 3 and 12 months.

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