Platelet Rich Plasma vs. Corticosteroid Injections in ...
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Platelet Rich Plasma vs. Corticosteroid Injections in Treatment of Tendinopathies Sallie Elliott, PA-S and Jennifer Hoskins, PA-S James Madison University, Harrisonburg ,VA METHODS RESULTS CONCLUSIONS REFERENCES INTRODUCTION In the past, corticosteroid (CS) injections have been a treatment method for lateral epicondylitis and plantar fasciitis 1 . However, these have been shown to cause tendon damage and rupture and do not usually produce long-lasting results, with patients often having reoccurrences of symptoms. More recently, platelet-rich plasma (PRP) has emerged as a new treatment method for these conditions. PRP is created by spinning down a person’s own blood in a centrifuge and then extracting the plasma rich layer, which contains 5-10 times the amount of platelets found in normal blood 2 . PRP also contains growth factors, which promote injury healing. Study 1 Study 2 Study 3 Study 4 Patients 100 60 40 30 Tendonopathy Lateral epicondylitis Plantar fasciitis Plantar fasciitis Lateral epicondylitis PRP amount 3 mL 3 mL 3 mL 2 mL Corticosteroid type and dosage Unspecified Methyl- prednisolone, 40 mg Methyl- prednisolone, 40 mg Methyl- prednisolone, 80 mg Outcomes measured VAS, DASH scores VAS, Roles and Maudsley scores AOFAS scores VAS, DASH, Oxford Elbow, Modified Mayo scores; grip strength, ultrasound Figure 2.1. Graph compares the Disabilities of A rm, S houlder, and Hand (DA S H) scores of study 1 and 4. A lower DA S H score means less disability and therefore better outcome. Figure 2.3. Graph shows the A merican Orthopedic Foot and A nkle S ociety (A OFA S ) scores for study 3. A higher A OFA S score indicates better functionality and less pain. PICO ACKNOWLEDGEMENTS We would like to thank Dr. Kancler, Ms. Carolyn Schubert, Mr. Jerry Weniger, and the JMU Communications Centerfor their assistance with this capstone project. Study 2: The Comparison of the effect of corticosteroid and platelet- rich plasma (PRP) for the treatment of plantar fasciitis 5 . • Results: There were no statistically significant differences between the PRP group and the corticosteroid group in the VAS scores or Roles and Maudsley scores. • Critique: This study did not discuss patient compliance in the post injection treatment (ice, elevation), which might have had an effect on the scores. The VAS scores and Roles and Maudsley scores were also subjective. Study 3: Platelet-Rich Plasma Efficacy Versus Corticosteroid Injection Treatment for Chronic Severe Plantar Fasciitis 6 . • Results: The PRP group had consistently higher AOFAS scores after receiving the injections. The differences between the corticosteroid group and PRP group were statistically significant with a P-value of 0.001 over the 2 year follow-up period. • Critique: It was a very small study with only 40 participants. The study was only blinded to examiners and evaluated the efficacy of treatment based on subjective reporting of pain. Study 4: Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation 7 . • Results: The VAS, DASH, Oxford Elbow, modified Mayo, and hand grip strength scores all improved for both the PRP and CS groups. However, the CS scores started to decline by 6 months follow up. The P-value was <0.05, except at the 3 month follow up. Positive ultrasound findings generally decreased by 6 months, but the number of patients with side effects in the CS group increased. • Critique: There were only 30 patients involved in the study. Patients were not blinded to the treatment method. The VAS, Oxford Elbow, and Mayo scores were based on patients rating their pain. Study 1: Ongoing Positive Effect of Platelet-Rich Plasma Versus Corticosteroid Injection in Lateral Epicondylitis 4 . • Results: The PRP group progressively improved throughout the study. The CS group initially had better scores than the PRP group, but then declined back to baseline scores. The scores were statistically significant by the 26 week, 52 week, and 104 week follow ups, with P-values of <.0001. • Critique: The VAS and DASH scores were subjective so their might have been some patient bias in the study results. Figure 2.2. Graph displays the Roles and Maudsley scores for study 2. These scores were based on patient reporting on their satisfaction of the treatment. 1) Cordone D, Tallia A . Http://Www.aafp.org/afp/2002/0715/p283.pdf. A merican Family P hysician. 2002;15(66):283-289. http://www.aafp.org/afp/2002/0715/p283.html. 2) P RP platelet rich plasma therapy - ThriveMD vail & aspen, CO. Thrive.md.com Web site. https://thrivemdvail.com/prp-platelet-rich- plasma-therapy/. Updated 2015. A ccessed November 5, 2015. 3) Platelet rich plasma injections. Preventative Medical Clinic Web site. http://omahapmc.com/services/platelet-rich-plasma- therapy/injections/. A ccessed November 15, 2015. 4) Gosens T, P eerbooms JC, van Laar W, den Oudsten B L. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: A double-blind randomized controlled trial with 2-year follow-up. The A merican Journal of S ports Medicine. 2011;39(6):1200-1208. http://ajs.sagepub.com/lookup/doi/10.1177/0363546510397173. 5) A kşahin E , Doğruyol D, Y üksel HY , et al. The comparison of the effect of corticosteroids and platelet-rich plasma (P RP ) for the treatment of plantar fasciitis. A rchives of Orthopaedic and Trauma S urgery. 2012;132(6):781-785. http://link.springer.com/10.1007/s00402-012-1488- 5http://www.springerlink.com/index/pdf/10.1007/s00402-012-1488-5. 6) Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis.Foot & Ankle International. 2014;35(4):313-318. http://fai.sagepub.com/lookup/doi/10.1177/1071100713519778. 7) Gautam V K , V erma S , B atra S , B hatnagar N, A rora S . P latelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: Clinical and ultrasonographic evaluation. - P ubMed - NCB I. Journal of Orthopedic S urgery (Hong K ong). 2015;23(1):1- 5. http://www.ncbi.nlm.nih.gov/pubmed/25920633. In conclusion, 3 out of the 4 studies found that PRP led to better improvement of pain and less disability than corticosteroid injections. The effects of PRP also lasted longer. One of the studies did not find any statistically significant difference between the two treatment methods, but it did not find that PRP was any less successful than corticosteroid injections. PRP also had fewer side effects and was therefore a safer treatment method. PRP is more expensive than corticosteroid injections, averaging at $300- $800, but the benefits of the treatment outweigh the cost. Therefore, PRP should be considered as a treatment for patients with tendinopathies. Patient population Patients aged 19 or older with lateral epicondylitis or plantar fasciitis Intervention Platelet-rich plasma Comparison Corticosteroid injections Outcome More relief of pain, longer duration of effects, fewer side effects Records identified through Pub Med database searching (n = 57) Additional records identified (n = 0) R ec ords after duplic ates removed (n = 57) Records screened (n = 57) Full-text articles as s es sed for eligibility (n = 22) Studies included in qualitative synthesis (n = 10) Studies included in quantitative synthesis (meta-analysis) (n = 4) Records excluded (n = 35) by adding filters: -English language -Human studies -Ages 19 and older Full-tex t artic les exc luded, w ith reasons (n = 12) -If s tudy was done for a medical condition other than lateral epic ondylitis or plantar fasciitis -In vitro study -Inv olv ing surgical procedure not relevant to study question -C as e s tudy or cohort study that was still ongoing -D idn’t c ompare PR P to c ortic os teroid injections Identification Screening Eligibility Included 0 10 20 30 40 50 60 70 80 DASH score Figure 2.1 St udy 1 CS i nj ect i on St udy 1 PRP i nj ect i on St udy 4 CS i nj ect i on St udy 4 PRP i nj ect i on 0 2 4 6 8 10 12 14 16 18 PRP at 3 weeks PRP at 6 m ont hs Cort i cost er oi d at 3 weeks cor t i cost er oi d at 6 m ont hs Roles and Maudsley S cor e Figure 2.2 Excel ent G ood Accept abl e Poor 0 10 20 30 40 50 60 70 80 90 100 Pr e- t r eat m ent 3 m ont hs post 6 m ont hs post 12 m ont hs post 24 m ont hs post AOFAS S cor e Figure 2.3 CS gr oup PRP gr oup DISCUSSION Figure 1. This figure illustrates the process of creating plasma-rich protein 3 .
Transcript of Platelet Rich Plasma vs. Corticosteroid Injections in ...
Platelet Rich Plasma vs. Corticosteroid Injections in Treatment of TendinopathiesSallie Elliott, PA-S and Jennifer Hoskins, PA-S
James Madison University, Harrisonburg ,VA
METHODS
RESULTS
CONCLUSIONS
REFERENCES
INTRODUCTION
In the past, corticosteroid (CS) injections have been a treatment method for lateral epicondylitis and plantar fasciitis1. However, these have been shown to cause tendon damage and rupture and do not usually produce long-lasting results, with patients often having reoccurrences of symptoms.
More recently, platelet-rich plasma (PRP) has emerged as a new treatment method for these conditions. PRP is created by spinning down a person’s own blood in a centrifuge and then extracting the plasma rich layer, which contains 5-10 times the amount of platelets found in normal blood2. PRP also contains growth factors, which promote injury healing.
Study 1 Study 2 Study 3 Study 4Patients 100 60 40 30
Tendonopathy Lateral epicondylitis Plantar fasciitis Plantar fasciitis Lateral
epicondylitis
PRP amount 3 mL 3 mL 3 mL 2 mL
Corticosteroid type and dosage Unspecified
Methyl-prednisolone,
40 mg
Methyl-prednisolone,
40 mg
Methyl-prednisolone,
80 mg
Outcomes measured
VAS, DASH scores
VAS, Roles andMaudsley scores AOFAS scores
VAS, DASH, Oxford Elbow, Modified Mayo
scores; grip strength,
ultrasound
Figure 2.1. Graph compares the Disabilities of Arm, Shoulder, and Hand (DASH) scores of study 1 and 4. A lower DASH score means less disability and therefore better outcome.
Figure 2.3. Graph shows the American Orthopedic Foot and Ankle Society (AOFAS) scores for study 3. A higher AOFAS score indicates better functionality and less pain.
PICO
ACKNOWLEDGEMENTS
We would like to thank Dr. Kancler, Ms. Carolyn Schubert, Mr. Jerry Weniger, and the JMU Communications Centerfor their assistance with this capstone project.
Study 2: The Comparison of the effect of corticosteroid and platelet-rich plasma (PRP) for the treatment of plantar fasciitis5.•Results: There were no statistically significant differences between the PRP group and the corticosteroid group in the VAS scores or Roles and Maudsley scores.•Critique: This study did not discuss patient compliance in the post injection treatment (ice, elevation), which might have had an effect on the scores. The VAS scores and Roles and Maudsley scores were also subjective.
Study 3: Platelet-Rich Plasma Efficacy Versus Corticosteroid Injection Treatment for Chronic Severe Plantar Fasciitis6.•Results: The PRP group had consistently higher AOFAS scores after receiving the injections. The differences between the corticosteroid group and PRP group were statistically significant with a P-value of 0.001 over the 2 year follow-up period.•Critique: It was a very small study with only 40 participants. The study was only blinded to examiners and evaluated the efficacy of treatment based on subjective reporting of pain.
Study 4: Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation7.•Results: The VAS, DASH, Oxford Elbow, modified Mayo, and hand grip strength scores all improved for both the PRP and CS groups. However, the CS scores started to decline by 6 months follow up. The P-value was <0.05, except at the 3 month follow up. Positive ultrasound findings generally decreased by 6 months, but the number of patients with side effects in the CS group increased.•Critique: There were only 30 patients involved in the study. Patients were not blinded to the treatment method. The VAS, Oxford Elbow, and Mayo scores were based on patients rating their pain.
Study 1: Ongoing Positive Effect of Platelet-Rich Plasma Versus Corticosteroid Injection in Lateral Epicondylitis4.•Results: The PRP group progressively improved throughout the study. The CS group initially had better scores than the PRP group, but then declined back to baseline scores. The scores were statistically significant by the 26 week, 52 week, and 104 week follow ups, with P-values of <.0001.•Critique: The VAS and DASH scores were subjective so their might have been some patient bias in the study results.
Figure 2.2. Graph displays the Roles and Maudsley scores for study 2. These scores were based on patient reporting on their satisfaction of the treatment.
1) Cordone D, Tallia A. Http://Www.aafp.org/afp/2002/0715/p283.pdf. American Family Physician. 2002;15(66):283-289. http://www.aafp.org/afp/2002/0715/p283.html.2) PRP platelet rich plasma therapy - ThriveMD vail & aspen, CO. Thrive.md.com Web site. https://thrivemdvail.com/prp-platelet-rich-plasma-therapy/. Updated 2015. Accessed November 5, 2015. 3) Platelet rich plasma injections. Preventative Medical Clinic Web site. http://omahapmc.com/services/platelet-rich-plasma-therapy/injections/. Accessed November 15, 2015.4) Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: A double-blind randomized controlled trial with 2-year follow-up. The American Journal of Sports Medicine. 2011;39(6):1200-1208. http://ajs.sagepub.com/lookup/doi/10.1177/0363546510397173.5) Akşahin E, Doğruyol D, Yüksel HY, et al. The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis. Archives of Orthopaedic and Trauma Surgery. 2012;132(6):781-785. http://link.springer.com/10.1007/s00402-012-1488-5http://www.springerlink.com/index/pdf/10.1007/s00402-012-1488-5.6) Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis.Foot & Ankle International. 2014;35(4):313-318. http://fai.sagepub.com/lookup/doi/10.1177/1071100713519778.7) Gautam VK, Verma S, Batra S, Bhatnagar N, Arora S. Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: Clinical and ultrasonographic evaluation. - PubMed - NCBI. Journal of Orthopedic Surgery (Hong Kong). 2015;23(1):1-5. http://www.ncbi.nlm.nih.gov/pubmed/25920633.
In conclusion, 3 out of the 4 studies found that PRP led to better improvement of pain and less disability than corticosteroid injections. The effects of PRP also lasted longer. One of the studies did not find any statistically significant difference between the two treatment methods, but it did not find that PRP was any less successful than corticosteroid injections. PRP also had fewer side effects and was therefore a safer treatment method. PRP is more expensive than corticosteroid injections, averaging at $300-$800, but the benefits of the treatment outweigh the cost. Therefore, PRP should be considered as a treatment for patients with tendinopathies.
Patientpopulation
Patients aged 19 or older with lateral epicondylitis or plantar fasciitis
Intervention Platelet-rich plasma
Comparison Corticosteroid injections
Outcome More relief of pain, longer duration of effects, fewer side effects
Records identified through Pub Med
database searching (n = 57)
Additional records identified (n = 0)
Records after duplicates removed (n = 57)
Records screened (n = 57)
Full-text artic les assessed for eligibility
(n = 22)
Studies included in qualitative
synthesis (n = 10)
Studies included in quantitative synthesis (meta-analysis) (n = 4)
Records excluded(n = 35) by adding filters:
-English language-Human studies
-Ages 19 and older
Full-text artic les excluded, with reasons(n = 12)
-If study was done for a medical condition other than lateral
epicondylitis or plantar fasciitis-In v itro study
-Involv ing surgical procedure not relevant to study question
-Case study or cohort study that was still ongoing
-Didn’t compare PRP to corticosteroid injections
Iden
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reen
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Elig
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yIn
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Figure 2.1
St udy 1 CS inject ionSt udy 1 PRP inject ionSt udy 4 CS inject ionSt udy 4 PRP inject ion
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PRP at 3 weeks PRP at 6 m ont hs Cor t icost er oid at 3 weeks
cor t icost er oid at 6 m ont hs
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Figure 2.2
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Figure 2.3
CS gr oup
PRP gr oup
DISCUSSION
Figure 1. This figure illustrates the process of creating plasma-rich protein3.
![A single intra-articular injection of 2.0% non-chemically ... · i.e., much longer than intra-articular corticosteroid injections [14–27]. Intra-articular HA even seems to offer](https://static.fdocuments.net/doc/165x107/5e6e7a63d7b9dc553774f316/a-single-intra-articular-injection-of-20-non-chemically-ie-much-longer.jpg)
