Skeletal Radiol. 2013 Jan;42(1):91-7. doi: 10.1007/s00256-012-1518-y. Epub 2012 Sep 22.

Platelet-rich plasma for the treatment of lateral epicondylitis: sonographic assessment of tendon morphology and vascularity (pilot study).

Chaudhury S, de La Lama M, Adler RS, Gulotta LV, Skonieczki B, Chang A, Moley P, Cordasco F, Hannafin J, Fealy S.
Source
Hospital for Special Surgery, New York, NY, USA.
Abstract
OBJECTIVE:
To investigate the efficacy of using contrast-enhanced ultrasound to assess the relationship of altered vascularity and tendon morphology following injection of platelet-rich plasma (PRP) for lateral epicondylitis.
MATERIALS AND METHODS:
This study prospectively evaluated six patients who had a baseline ultrasound confirming tendinosis of the common extensor tendon. Patients received a single 3-ml PRP injection under ultrasound guidance. Grayscale images of the injected elbow were obtained at baseline and were repeated at 1 and 6 months after injection. DEFINITY® contrast was also injected after by 2 sets of wrist-extension exercises in order to obtain contrast-enhanced images of the elbow. Qualitative and quantitative analyses of the level of enhancement to the regions of interest were performed using off-line quantitative analysis software.
RESULTS:
All patients had either moderate or severe common extensor tendinosis as determined on clinical examination and baseline imaging. Five patients demonstrated improved tendon morphology using ultrasound imaging 6 months after PRP injection (one patient was lost to follow-up). At baseline, there was evidence of increased vascularity at the myotendinous junction (MT) of the common extensor tendon when compared to its footprint (FP). There was a trend towards no change in FP vascularity between baseline and 6 months (p = 0.062) and between 1 and 6 months (p = 0.288). There was a trend for increased vascularity to the MT region from baseline to 6 months (p = 0.433) and from 1 to 6 months (p = 0.783).
CONCLUSIONS:
Contrast-enhanced ultrasound provides a sensitive method the display alterations in vascularity in the common extensor tendon of the elbow. PRP therapy for lateral epicondylitis can improve extensor tendon morphology. Corresponding increased extensor tendon FP vascularity, however, was not seen. There is a trend for increased vascularity at the MT up to 6 months following PRP injection, based on limited pilot data.
PMID:
23001116
[PubMed - in process]

Hand Clin. 2012 Nov;28(4):481-91. doi: 10.1016/j.hcl.2012.08.008.

Platelet-rich plasma and the upper extremity.

Mishra A, Randelli P, Barr C, Talamonti T, Ragone V, Cabitza P.
Source
Department of Orthopaedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, 1300 Crane Street, Menlo Park, CA 94025, USA. am@totaltendon.com
Abstract
Platelet-rich plasma (PRP) is a fraction of whole blood containing powerful growth factors and cytokines. Preclinical studies suggest PRP may be useful for tendon repair or regeneration. Clinical investigations have focused on the treatment of chronic lateral epicondylar tendinopathy and rotator cuff pathology. Multiple controlled studies support the use of PRP for chronic tennis elbow. Rotator cuff studies, however, have produced conflicting results based on PRP formulation, surgical technique, and size of tendon tear. This article explores the scientific rational for using PRP, its various formulations, and the emerging clinical data. Future potential applications are also explored.
Copyright © 2012 Elsevier Inc. All rights reserved.
PMID:
23101598
[PubMed - in process]

AJSM PreView, published on May 30, 2006 as doi:10.1177/0363546506288850

Treatment of Chronic Elbow Tendinosis With Buffered Platelet-Rich Plasma

Allan Mishra,* MD, and Terri Pavelko, PAC, PT
From the Department of Orthopedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, Menlo Park, California
Background: Elbow epicondylar tendinosis is a common problem that usually resolves with nonoperative treatments. When these measures fail, however, patients are interested in an alternative to surgical intervention.
Hypothesis: Treatment of chronic severe elbow tendinosis with buffered platelet-rich plasma will reduce pain and increase func- tion in patients considering surgery for their problem.
Study Design: Cohort study; Level of evidence, 2.
Methods: One hundred forty patients with elbow epicondylar pain were evaluated in this study. All these patients were initially given a standardized physical therapy protocol and a variety of other nonoperative treatments. Twenty of these patients had sig- nificant persistent pain for a mean of 15 months (mean, 82 of 100; range, 60-100 of 100 on a visual analog pain scale), despite these interventions. All patients were considering surgery. This cohort of patients who had failed nonoperative treatment was then given either a single percutaneous injection of platelet-rich plasma (active group, n = 15) or bupivacaine (control group, n = 5).
Results: Eight weeks after the treatment, the platelet-rich plasma patients noted 60% improvement in their visual analog pain scores versus 16% improvement in control patients (P = .001). Sixty percent (3 of 5) of the control subjects withdrew or sought other treatments after the 8-week period, preventing further direct analysis. Therefore, only the patients treated with platelet-rich plasma were available for continued evaluation. At 6 months, the patients treated with platelet-rich plasma noted 81% improve- ment in their visual analog pain scores (P = .0001). At final follow-up (mean, 25.6 months; range, 12-38 months), the platelet-rich plasma patients reported 93% reduction in pain compared with before the treatment (P < .0001).
Conclusion: Treatment of patients with chronic elbow tendinosis with buffered platelet-rich plasma reduced pain significantly in this pilot investigation. Further evaluation of this novel treatment is warranted. Finally, platelet-rich plasma should be considered before surgical intervention.
Keywords: platelet-rich plasma (PRP); tennis elbow; lateral epicondylitis; tendonitis; tendinosis

PRP vs Steroid Injection in Tennis Elbow Prospective randomized study on the effect of autologous platelets injection in lateral epicondylitis compared with corticosteroid injection.

T. Gosens, et al, Knee Surg Sports Traumatol Arthrosc (2008) 16 ((Suppl 1):S80-S230.
Outcomes: After 24 and 52 weeks the cortisone group did not maintain significantly low pain scores, but the PRP group remained at low in both visual analog scale and DASH pain scores.
Conclusion: Injection of PRP has a positive effect as a treatment for lateral epicondylitis (tennis elbow). The effect actually exceeds the effect of corticosteroids, which was known as the golden standard. It is therefore a worthy alternative to steroidal injections and surgical treatment.