Joost Peerbooms

57 PRP in upper limb conditions Table 2 Platelet-Rich Plasma Preparation Systems PDGF, platelet-derived growth factor; TGF, transforming growth factor; IGF, insulin-like growth factor; EGF, epithelial growth factor VEGF, vascular endothelial growth factor; (?), concentration of the growth factor is not known LATERAL EPICONDYLITIS A PRP injection can be used for patients with refractory lateral epicondylitis of the elbow who have failed conservative treatment, including physical therapy, a counter-force brace, and corticosteroid injections. It is recommended that imaging studies including either magnetic resonance imaging or ultrasound should confirm extensor carpi radialis brevis tendinopathy. The post-injection protocol includes standard rehabilitation for eccentric strengthening and functional progressions, with a gradual return to activities over 6 weeks to 8 weeks. It is not necessary to immobilize the elbow after the injection. The criteria for return to sports may include painless full range of motion with no localized pain or tenderness. Mishra and Pavelko 17 evaluated a series of 140 patients with chronic lateral epicondylar elbow pain. Of those patients, 20 met the inclusion criteria and were offered PRP injection as an alternative to surgery. Fifteen patients underwent PRP injection, and five patients served as controls by undergoing local anaesthetic injection only. The patients undergoing PRP therapy were noted to have 60% improvement at 8 weeks, 81% at 6 months, and 93% at final follow-up (range, 12 months to 38 months). At 8 weeks, three of the five patients in the control group sought treatment outside the study or formally withdrew from the study, limiting the possible comparisons. Therefore, the final outcome data reflects only the patients who were treated with PRP. At the final follow-up (range 12 months to 38 months), 93% of patients were completely satisfied with the treatment, 94% (range 90% to 100%) were able to return to work and sports, and 99% were able to return to activities of daily living. No adverse events or complications were reported. This study has significant design flaws; the sample size is small, and the attrition rate approaches 60%. However, it is one of the few studies performed in a prospective fashion and includes a control group. 4