Joost Peerbooms

70 Chapter 5 an independent person certified for blood management, without the investigator or the patient present. Injection Technique Approximately 1 mL of PRP or corticosteroids (kenacort 40 mg/mL triamcinolone acetonide) with bupivacaine hydrochloride 0.5% with epinephrine (1:200000) was injected directly into the area of maximum tenderness. Then, using a 22-gauge needle and a peppering technique, the investigator injected the remaining PRP or corticosteroids with bupivacaine hydrochloride 0.5% with epinephrine (1:200000, ± 4 mL) into the common extensor tendon. This technique involved a single skin portal and 5 penetrations of the tendon. Postprocedure Protocol Immediately after the injection, the patient was kept in a supine position without moving the arm for 15 minutes. Patients were sent home with instructions to rest the arm for approximately 24 hours. If necessary, patients were allowed to use acetaminophen, but the use of nonsteroidal anti-inflammatory medication was prohibited. After 24 hours, patients were given a standardized stretching protocol to follow for 2 weeks under the supervision of a physiotherapist. A formal eccentric muscle- and tendon-strengthening program was initiated after this stretching. At 4 weeks after the procedure, patients were allowed to proceed with normal sporting or recreational activities as tolerated. The VAS and DASH function scores were measured before injection and at 4, 8, 12, 26, and 52 weeks after injection. The DASH score is a validated upper limb functional score. 22 STATISTICAL ANALYSIS All data analysis was carried out according to a preestablished analysis plan, on a last-observation-carried-forward basis. The categorical values are compared with the Pearson Chi-square test. The preoperative continuous variables are compared with the t test. The VAS and DASH scores are compared with an analysis of variance with repeated measurements test. The significance level was set at P = .05 for all tests, and SPSS 16.0 was used. RESULTS FromMay 2006 to January 2008, a total of 100 eligible patients with lateral epicondylitis were randomized into groups. Eight patients were lost to follow-up or had incomplete data sets; however, they needed no reintervention (Figure 1). Their data are included in the analysis until their last visit. Analysis of the demographics (sex, side, and centre) between the protocol-compliant patients and those lost to follow-up showed no significant differences (Table 1).