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Needle tenotomy with PRP versus lidocaine in epicondylopathy: clinical and ultrasonographic outcomes over twenty months

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Abstract

Objective

To investigate whether pathological changes in elbow epicondylopathy, as assessed by conventional ultrasonography and clinical outcomes, could be modified following tenotomy with platelet-rich plasma (PRP) versus tenotomy with lidocaine.

Methods

This prospective sub-study was part of a patient- and assessor-blinded, superiority-type, randomized, lidocaine-controlled trial that was performed in a tertiary hospital to assess the effectiveness of PRP versus lidocaine as tenotomy adjuvants in patients with epicondylopathy. Patients were followed after two sessions of tenotomy with either PRP or lidocaine adjuvants (4 ml) within a 2-week interval. Tendon thickness, echotexture, and neovascularization were assessed as secondary outcome measurements at baseline and at 3, 6, 12, and 20 months after treatment, and correlations with clinical outcomes were examined.

Results

Twenty months after treatment, tenotomy induced changes in tendon structure, thickness (± = 0.0006), vascularity (p < 0.0001), and echotexture (p < 0.0001). In Disabilities of the Arm, Shoulder and Hand (DASH-E) and pain (VAS-P) scores, 80.85% and 90.91% of patients showed a meaningful clinical improvement, respectively, without differences between PRP and lidocaine. There were significant differences in between-group changes in vascularity over time, p = 0.037 and p = 0.049 in the unadjusted and adjusted models, respectively. There was no relationship between pain or function and sonographic entities at the various time points.

Conclusions

Two successive needle tenotomies induced structural changes in recalcitrant epicondylopathy, with PRP displaying more vascularization and increased thickness over time compared to lidocaine. PRP compared with lidocaine did not result in improved function or decreased pain over 20 months.

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Acknowledgements

The authors thank Igor Gonzalez for helping in recruitment, Nuria Zuazo for monitoring data acquisition, and Mercedes Moreno and Julio del Bosque for nursing assistance.

Funding

This work was supported by “Instituto de Salud Carlos III”, ISCIII (grant number PI13/01707 to I.A.) and co-financed by FEDER funds.

Author information

Authors and Affiliations

  1. Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain

    Jose Ignacio Martin, Leire Atilano & Gotzon Iglesias

  2. Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain

    Jose Ignacio Martin, Leire Atilano, Gotzon Iglesias, Josu Merino & Isabel Andia

  3. Primary Care Research Unit of Bizkaia, BioCruces Health Research Institute, Bilbao, Spain

    Paola Bully & Gonzalo Grandes

  4. Department of Orthopedic Surgery, Cruces University Hospital, Barakaldo, Spain

    Josu Merino

  5. Enkarterrri-Ezkerraldea-Cruces Health Region, Basque Health Service (Osakidetza), Basque, Spain

    Gonzalo Grandes

Authors
  1. Jose Ignacio Martin
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  2. Leire Atilano
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  3. Paola Bully
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  7. Isabel Andia
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Corresponding author

Correspondence to Isabel Andia.

Ethics declarations

Clinical trial registration: Ethics approval and consent to participate

This study was approved by the Ethics Committee of Hospital Universitario Cruces (No. CEIC 13/04). All enrolled patients provided written informed consent. The study protocol was registered at ClinicalTrials.gov (identifier NCT01945528) EUDRACT No.2013–000478-32.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Martin, J.I., Atilano, L., Bully, P. et al. Needle tenotomy with PRP versus lidocaine in epicondylopathy: clinical and ultrasonographic outcomes over twenty months. Skeletal Radiol 48, 1399–1409 (2019). https://doi.org/10.1007/s00256-019-03193-1

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  • DOI: https://doi.org/10.1007/s00256-019-03193-1

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