Joost Peerbooms

93 2-year follow-up of PRP in lateral epicondylitis initial worsening of pain because of the activation of the inflammation cycle, which usually lasted for 1 to 2 weeks. Table 4 Baseline Characteristics of the Protocol-Compliant and the Reintervention Group α Protocol-Compliant (n = 80) Reintervention (n = 20) P Value Age, mean ± SD 46.5 ± 8.2 49.2 ± 7.6 .206 Sex, male/female, no. (%) 41 (51.2)/39 (48.8) 5 (25.0)/15 (75.0) .015 Side, right/left, no. (%) 46 (57.5)/34 (43.5) 16 (80.0)/4 (20.0) .027 Treatment, PRP/corticosteroid, no. (%) 45 (56.3)/35 (44.7) 6 (30.0)/14 (70.0) .036 VAS, mean ± SD 68.1 ± 14.9 70.8 ± 11.9 .464 DASH, mean ± SD 50.4 ± 18.2 48.2 ± 17.2 .663 α SD, standard deviation; PRP, platelet-rich plasma; VAS, visual analogue scale; DASH, Disabilities of the Arm, Shoulder and Hand outcome measure DISCUSSION This randomized, double-blind study was designed to compare the use of concentrated autologous platelets to corticosteroid in patients with lateral epicondylitis; its application proved to be both safe and easy. The corticosteroid group was actually better initially and then declined, returning to baseline level concerning functional impairment, while the PRP group progressively improved. There was a significant difference in decrease of pain and disability of function after the platelet application even after 2 years. Comparing the results presented here with the results of the 1-year follow up, the effect in the corticosteroid group declined, whereas the result in the PRP group was maintained. A remarkable finding was that the PRP group had worse DASH scores before treatment and better ones after 26 weeks of the initial treatment. This adds to the power of our conclusion that that PRP was helpful. Lateral epicondylitis is a common problem with many available treatment methods. The most commonly recommended treatment is physiotherapy and bracing. Approximately 87% of the patients benefit from this combination of treatment methods. 30 Corticosteroid injection, nowadays seen as controversial, was considered the gold standard in the treatment of lateral epicondylitis. However, studies show it is merely the best treatment option in the short term, when compared with physiotherapy and a wait-and-see policy. Often, poor results are seen after 12 weeks of follow-up. 28 Treatment with corticosteroids has a high frequency of relapse and recurrence, probably because intratendinous injection may lead to permanent adverse changes within the structure of the tendon and because patients tend to overuse the arm after injection as a result of direct pain relief. 28 In our study, the recurrence rate and need for repeated 6