Tennis Elbow: Study Finds Saline Injections As Good As PRP – Platelet Rich Plasma

Dr. Patrick Le Goux Rheumatologist Hôpitaux universitaires Paris Ouest France French Tennis Federation medical staffMedicalResearch.com: Interview with:
Dr. Patrick Le Goux
Rheumatologist Hôpitaux universitaires Paris Ouest France
French Tennis Federation medical staff


MedicalResearch: What are the main findings of the study?

Dr. Le Goux: The therapeutic effect of platelet-rich plasma (PRP) of two ultrasound guided PRP injections at 4 weeks interval compared to two saline injections (as placebo or treatment of reference) is similar on a visual analogic scale for epicondylitis of recent evolution (3 months duration maximum) in a prospective randomized double blind study with 12 months follow up. We have no intrinsic or inherent benefit of the PRP injections.

MedicalResearch: Were any of the findings unexpected?

Dr. Le Goux: Despite no confirmation of the own clinical effect of the platelet-rich plasma we could conclude that the similar favorable outcome of the injections in both groups of the study may be connected to the technique Ultrasound guided intra-tendinous injections which can stimulate the tendon repair process. The therapeutic effect may be linked to the mechanical or irritant effect of the injected substance and / or the  effect of the needling by intratendinous injection. This action may be called “prolotherapy”

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Le Goux: There is a gap between outcomes and findings of works in vitro (experimental studies ) which seem to attest the efficiency of growth factors containing PRP,  and the data of clinical randomized trials which conclude to a very conflicting evidence. In clinical practice there is a lack of homogeneity of different preparations of PRP and the platelet concentrate may not work for many reasons (balance of factors pro and anti-angiogenic with neutralization for therapeutic effect, unknown variables concerning the activation these growth factors, platelet count different according to the patients .

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Le Goux: First, we have to improve the preparation of PRP, to find techniques to isolate and activate the pro-angiogenic factors to work better in the healing process of the tendon.

Secondly, we also need to test the efficacy of prolotherapy with trial designed with injected and non -injected groups, or non intra-tendinous injected patients to attest to  the superiority of these techniques on the natural evolution of the tendinopathy.

Citation:

European League Against Rheumatism Congress 2014
Le Goux P, Montalvan B, Leparc JM et al. Treatment Of Epicondylitis By Ultrasound-Guided Local Injections Of Autologous Conditioned Plasma (Acp®): A Double-Blind Placebo-Controlled Randomized Clinical Trial With 1-Year Follow-Up. EULAR 2014; Paris: Abstract OP0013