Joost Peerbooms

66 Chapter 5 ABSTRACT Background: Platelet-rich plasma (PRP) has shown to be a general stimulation for repair. Purpose: To determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis. Study Design: Randomized controlled trial; Level of evidence, 1. Patients: The trial was conducted in 2 teaching hospitals in the Netherlands. One hundred patients with chronic lateral epicondylitis were randomly assigned in the PRP group (n = 51) or the corticosteroid group (n = 49). A central computer system carried out randomization and allocation to the trial group. Patients were randomized to receive either a corticosteroid injection or an autologous platelet concentrate injection through a peppering technique. The primary analysis included visual analogue score and DASH Outcome Measure scores (DASH: Disabilities of the Arm, Shoulder, and Hand). Results: Successful treatment was defined as more than a 25% reduction in visual analogue score or DASH score without a reintervention after 1 year. The results showed that, according to the visual analogue scores, 24 of the 49 patients (49%) in the corticosteroid group and 37 of the 51 patients (73%) in the PRP group were successful, which was significantly different ( P <.001). Furthermore, according to the DASH scores, 25 of the 49 patients (51%) in the corticosteroid group and 37 of the 51 patients (73%) in the PRP group were successful, which was also significantly different ( P = .005). The corticosteroid group was better initially and then declined, whereas the PRP group progressively improved. Conclusion: Treatment of patients with chronic lateral epicondylitis with PRP reduces pain and significantly increases function, exceeding the effect of corticosteroid injection. Future decisions for application of the PRP for lateral epicondylitis should be con- firmed 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; pian; function