Joost Peerbooms

58 Chapter 4 In 2003, Edwards and Calandruccio 22 reported a 79% success rate in treating a group of patients with respect to treating a group of patients with refractory chronic epicondylitis. Twenty-two of the 28 patients were reported to be pain-free after autologous blood injection therapy. They injected whole blood that had not been centrifuged, which is different than the preparation for PRP. No adverse events and no recurrences were reported. However, the authors do not comment on the discomfort level at the site of injection in a large portion of their patients in the immediate period following the autologous blood injection. This is a Level 4 study with a small sample size and no control group; consequently, it is difficult to draw definitive conclusions. The authors of this review have demonstrated in a recent double blind randomized study that the use of PRP after 26 weeks and 1 year follow up has a significant difference in decrease of pain and disability of function in favour of the platelet application measured by the Visual Analogue Scale and Disabilities of the Arm, Shoulder and Hand score compared with the use of corticosteroids for patients with chronic symptoms of tennis elbow (alpha = 0.05 and power 0.9). 23 SUBACROMIAL IMPIGMENT Open subacromial decompression (OSD) treatment for chronic impingement syndrome of the shoulder has been well documented. 23-25 The space between the acromion and humeral head is normally narrow and decreases with abduction of the arm. Overuse leads to the development of tendinosis and the formation of granulation tissue in an attempt to repair the damaged tendon. This creates the ‘impingement’. Most common symptoms of shoulder impingement are pain, weakness and limitation in the range of motion. During and after OSD surgery, the patients’ own defence mechanism is activated to reduce bleeding and initiate wound healing. Platelets play a pivotal role in this process through the formation of a platelet plug and activation of the blood coagulation cascade. Activated platelets at the wound site release several platelet growth factors, which initiate connective tissue healing and increase mitogenesis, angiogenesis and macrophage migration. 26,27 Treatment with PRP provides a source of concentrated platelets, with granules that contain PDGF and TGF. These growth factors augment the wound healing process. 28,29 Everts et al. 30 report the results of a randomized controlled trial that evaluated PRP application in patients undergoing open subacromial decompression. The purpose of their study was to evaluate the effect of PRP on surgical wound healing with emphasis on the restoration of range of motion, activities of daily living, pain and pain medication, as part of the treatment of the impingement syndrome (Neer grade II) using the American Shoulder and Elbow Surgeons shoulder assessment method to evaluate the study objectives. 31 In the PRP-treated group, patients had a statistically faster recovery with less pain medication requirement, greater range of motion, and greater ability to perform activities of daily living.