http://ajs.sagepub.com/ Medicine The American Journal of Sports http://ajs.sagepub.com/content/39/6/1200 The online version of this article can be found at: DOI: 10.1177/0363546510397173 2011 39: 1200 originally published online March 21, 2011 Am J Sports Med Taco Gosens, Joost C. Peerbooms, Wilbert van Laar and Brenda L. den Oudsten Epicondylitis : A Double-Blind Randomized Controlled Trial With 2-year Follow-up Ongoing Positive Effect of Platelet-Rich Plasma Versus Corticosteroid Injection in Lateral Published by: http://www.sagepublications.com On behalf of: American Orthopaedic Society for Sports Medicine can be found at: The American Journal of Sports Medicine Additional services and information for http://ajs.sagepub.com/cgi/alerts Email Alerts: http://ajs.sagepub.com/subscriptions Subscriptions: http://www.sagepub.com/journalsReprints.nav Reprints: http://www.sagepub.com/journalsPermissions.nav Permissions: What is This? - Mar 21, 2011 OnlineFirst Version of Record - Jun 2, 2011 Version of Record at Bio Medical Library, University of Minnesota Libraries on May 4, 2012 ajs.sagepub.com Downloaded from

Ongoing Positive Effect of Platelet-Rich Plasma Versus Corticosteroid Injection in Lateral Epicondylitis A Double-Blind Randomized Controlled Trial With 2-year Follow-up Taco Gosens,*y MD, PhD, Joost C. Peerbooms,z MD, Wilbert van Laar,z and Brenda L. den Oudsten,y PhD Investigation performed at St Elisabeth Hospital, Tilburg, the Netherlands, and Haga Hospital, The Hague, the Netherlands Background: Platelet-rich plasma (PRP) has been shown to be a general stimulation for repair and 1-year results showed prom- ising success percentages. Purpose: This trial was undertaken to determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis with a 2-year follow-up. Study Design: Randomized controlled trial Level of evidence, 1. Methods: The trial was conducted in 2 Dutch teaching hospitals. One hundred patients with chronic lateral epicondylitis were randomly assigned to a leukocyte-enriched PRP group (n = 51) or the corticosteroid group (n = 49). Randomization and allocation to the trial group were carried out by a central computer system. Patients received either a corticosteroid injection or an autol- ogous platelet concentrate injection through a peppering needling technique. The primary analysis included visual analog scale (VAS) pain scores and Disabilities of the Arm, Shoulder and Hand (DASH) outcome scores. Results: The PRP group was more often successfully treated than the corticosteroid group (P \ .0001). Success was defined as a reduction of 25% on VAS or DASH scores without a reintervention after 2 years. When baseline VAS and DASH scores were compared with the scores at 2-year follow-up, both groups significantly improved across time (intention-to-treat principle). How- ever, the DASH scores of the corticosteroid group returned to baseline levels, while those of the PRP group significantly improved (as-treated principle). There were no complications related to the use of PRP. Conclusion: Treatment of patients with chronic lateral epicondylitis with PRP reduces pain and increases function significantly, exceeding the effect of corticosteroid injection even after a follow-up of 2 years. Future decisions for application of PRP for lateral epicondylitis should be confirmed by further follow-up from this trial and should take into account possible costs and harms as well as benefits. Keywords: lateral epicondylitis platelet-rich plasma corticosteroids pain disability Lateral epicondylitis is the most commonly diagnosed con- dition of the elbow and affects approximately 1% to 3% of the population. The condition mostly occurs in patients whose activities require strong gripping or repetitive wrist movements. Individuals between the ages of 35 and 50 years are at high risk. The dominant arm is most fre- quently affected.11,12,19 The cause of lateral epicondylitis is unknown. It is thought that lesions occur in the common origin of the wrist and finger extensors on the lateral epicondyle because of a combination of mechanical overloading and abnormal microvascular responses.18,29,34 Numerous methods have been advocated for treating elbow tendinosis, including rest, nonsteroidal anti-inflammatory *Address correspondence to Taco Gosens, MD, PhD, Department of Orthopaedic Surgery, St Elisabeth Hospital, Tilburg, the Netherlands (e-mail: t.gosens@elisabeth.nl). yDepartment of Orthopaedic Surgery, St Elisabeth Hospital, Tilburg, the Netherlands. zDepartment of Orthopaedic Surgery, Haga Hospital, The Hague, the Netherlands. One or more of the authors has declared the following potential con- flict of interest or source of funding: Biomet sponsored the study by sup- plying the Recover system used at a discounted rate however, Biomet did not have any influence on the collection and analysis of the data from this study. The American Journal of Sports Medicine, Vol. 39, No. 6 DOI: 10.1177/0363546510397173 �� 2011 The Author(s) 1200 at Bio Medical Library, University of Minnesota Libraries on May 4, 2012 ajs.sagepub.com Downloaded from