Autologous Platelet Rich Plasma (PRP) in the treatment of elbow epicondylitis and plantar fasciitis: medium to long term clinical outcome: PRP in P. Fasciitis and epicondylitis

Autologous Platelet Rich Plasma (PRP) in the treatment of elbow epicondylitis and plantar fasciitis: medium to long term clinical outcome

PRP in P. Fasciitis and epicondylitis

Authors

  • Massimiliano Leigheb Orthopaedics and Traumatology, A.O.U. "Maggiore d.c."Universiy of Eastern Piedmont, Novara http://orcid.org/0000-0002-7818-2209
  • Matteo MASSA Department of Orthopaedics and Traumatology, “Maggiore della Carità” Hospital, Department of Health Sciences, University of Piemonte Orientale (UPO), Novara, Italy. Specialization School in Orthopaedics and Traumatology, University of Pavia, Pavia, Italy.
  • Michela BOSETTI Department of “Scienze del Farmaco”, University of Eastern Piedmont, Novara, Italy.
  • Piergiuseppe NICO Department of Orthopaedics and Traumatology, “Maggiore della Carità” Hospital, Department of Health Sciences, University of Piemonte Orientale (UPO), Novara, Italy.
  • Luigi TARALLO Department of Orthopedics and Traumatology, Policlinico di Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy.
  • Francesco POGLIACOMI Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy.
  • Federico Alberto GRASSI Department of Orthopaedics and Traumatology, “Maggiore della Carità” Hospital, Department of Health Sciences, University of Piemonte Orientale (UPO), Novara, Italy.

Keywords:

PRP, Platelet Rich Plasma, epicondylitis, plantar fasciitis, regenerative medicine, growth factors.

Abstract

Background and aim:

Platelet-Rich-Plasma (PRP) is a popular biological therapy especially used to regenerate different musculoskeletal tissues by releasing growth-factors and cytokines promoting cell proliferation, chemotaxis, differentiation, and angiogenesis.

The aim was to evaluate the clinical effectiveness and safety of PRP for Lateral-Epicondylitis (LE) of the elbow and Plantar-Fasciitis (PF).

Methods:

A retrospective study was conducted including patients treated with a single topic autologous-PRP-injection between 1-1-2009 and 7-18-2019 for LE or PF at our institution; patients operated for the same problem, patients refusing the study or not traceable were excluded. Patients were assessed with VAS for pain and clinical scales.

Results:

33 patients were treated with PRP and 13 (8F, 5M) included: 4LE and 9PF for a total of 16 cases. The average pain level was 0.61±0.63: 1±1.41 for LE and 0,44±0 for PF. No significant side effect was reported. 4 PRP-treatments failed: 2LE and 2PF. OES and PRTEE gave excellent results for elbow. Average foot scores were AOFAS 98.2±5 and FADI 91.3±1. Patients were stratified and compared according to plantar arch conformation, follow-up length, healing time, time from diagnosis to PRP-treatment, therapies before PRP (physiotherapy, steroid infiltration or shock-waves), risk factors (standing work, sport, age, sex).

Conclusions:

As in other studies, our results do not allow to draw sufficiently valid conclusions regarding the effectiveness and safety of PRP in the treatment of LE and PF: in particular the statistical significance is limited by the small sample size. PRP can be chosen as a non-first-line treatment for LE and PF.

References

Kibler WB, Goldberg C, Chandler TJ. Functional biomechanical deficits in running athletes with plantar fasciitis. Am J Sports Med 1991;19(1):66-71.

Nejati P, Ghahremaninia A, Naderi F, Gharibzadeh S & Mazaherinezhad A. Treatment of subacromial impingement syndrome: Platelet-rich plasma or exercise therapy?: A randomized controlled trial. J Orthop Sport Med 2017;5(5):366.

Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med2002;36(2):95-101.

Verhaar J A N Tennis elbow - Anatomical, epidemiological and therapeutic aspects. Int Orthop 1994; 18(5): 263–267.

Silverstein B, Welp E, Nelson N & Kalat J. Claims incidence of work-related disorders of the upper extremities: Washington State, 1987 through 1995. Am. J. Public Health. 1998;88(12):1827–1833

Smidt N, van der Windt DAWM. Tennis elbow in primary care. BMJ 2006;333(7575):927-928.

Arirachakaran A, Sukthuayat A, Sisayanarane T, Laoratanavoraphong S, Kanchanatawan W, Kongtharvonskul J. Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis. J Orthop Traumatol 2016;17(2):101-112.

Lenoir H, Mares O, Carlier Y. Management of lateral epicondylitis. Orthop Traumatol Surg Res OTSR 2019;105(8S):S241-S246.

Le ADK, Enweze L, DeBaun MR, Dragoo JL. Current Clinical Recommendations for Use of Platelet-Rich Plasma. Curr Rev Musculoskelet Med 2018;11(4):624-634.

Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF).Trends Biotechnol 2009; 27 (3): 158-167.

Simonpieri A, Del Corso M, Vervelle A, et al. Current Knowledge and Perspectives for the Use of Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF) in Oral and Maxillofacial Surgery Part 2: Bone Graft, Implant and Reconstructive Surgery. Curr Pharm Biotechnol 2012;13(7):1231-1256.

Bosetti M, Boffano P, Marchetti A, Leigheb M, Colli M, Brucoli M. The Number of Platelets in Patient’s Blood Influences the Mechanical and Morphological Properties of PRP-Clot and Lysophosphatidic Acid Quantity in PRP. Int J Mol Sci 2019;21(1):139.

Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-Rich Plasma: From Basic Science to Clinical Applications. Am J Sports Med 2009;37(11):2259-2272.

Schliephake H. Bone growth factors in maxillofacial skeletal reconstruction. Int J Oral Maxillofac Surg 2002;31(5):469-484.

Yin W, Xu H, Sheng J, et al. Optimization of pure platelet-rich plasma preparation: A comparative study of pure platelet-rich plasma obtained using different centrifugal conditions in a single-donor model. Exp Ther Med 2017;14(3):2060-2070.

Croisé B, Paré A, Joly A, Louisy A, Laure B, Goga D. Optimized centrifugation preparation of the platelet rich plasma: Literature review. J Stomatol Oral Maxillofac Surg2020;121(2):150-154.

Alkhatib N, Motasem S, Galib A et al. Platelet-Rich Plasma Versus Corticosteroids in the Treatment of Chronic Plantar Fasciitis: A Systematic Review and Meta-analysis of Prospective Comparative Studies. J Foot Ankle Surg Off Publ Am Coll Foot Ankle Surg 2020;59(3):546-552.

Sims S E G., Miller K, Elfar J C & Hammert W C. Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials. Hand. 2014; 9(4):419–446

De Vos R-J, Windt J, Weir A. Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review. Br J Sports Med 2014;48(12):952-956.

Vetrano M, Castorina A, Vulpiani M et al. Platelet-rich plasma versus focused shock waves in the treatment of

Jumper’s knee in athletes. Am. J. Sports Med. 2013; 41(4):795–803.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. Int J Surg 2014; 12 (12): 1495-1499.

Leigheb M, Sabbatini M, Baldrighi M, Hasenboehler EA, Briacca L, Grassi F, Cannas M, Avanzi G, Castello LM. Prospective analysis of pain and pain management in an Emergency Department. Acta Biomed 2017; 88(S4): 19-30.

Franchignoni F, Vercelli S, Giordano A, Sartorio F, Bravini E, Ferriero G. Minimal Clinically Important Difference of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH) and Its Shortened Version (QuickDASH). J Orthop Sports Phys Ther 2014;44(1):30-39.

Leigheb M, Rava E, Vaiuso D, Samaila EM, Pogliacomi F, Bosetti M, Grassi FA and Sabbatini M. Translation, cross-cultural adaptation, reliability, and validation of the italian version of the Foot and Ankle Disability Index (FADI). Acta Biomed 2020; 91(S4): 159-165.

Leigheb M, Janicka P, Andorno S, Marcuzzi A, Magnani C, Grassi F. Italian translation, cultural adaptation and validation of the “American Orthopaedic Foot and Ankle Society’s (AOFAS) ankle-hindfoot scale.” Acta Biomed2016;87(1):38-45.

Cacchio A, Necozione S, MacDermid JC, et al. Cross-Cultural Adaptation and Measurement Properties of the Italian Version of the Patient-Rated Tennis Elbow Evaluation (PRTEE) Questionnaire. Phys Ther 2012;92(8):1036-1045.

Dawson J, Doll H, Boller I, et al. The development and validation of a patient-reported questionnaire to assess outcomes of elbow surgery. J Bone Joint Surg Br2008;90-B(4):466-473.

Mohammed W, Farah S, Nassiri M, McKenna J. Therapeutic efficacy of platelet-rich plasma injection compared to corticosteroid injection in plantar fasciitis: A systematic review and meta-analysis. J Orthop 2020;22:124-134.

Rodik T, McDermott B. Platelet-Rich Plasma Compared With Other Common Injection Therapies in the Treatment of Chronic Lateral Epicondylitis. J Sport Rehabil 2016;25(1):77-82.

Pogliacomi F, Visigalli A, Valenti PG, Pedrazzini A, Bernuzzi G, Concari G, Vaienti E, Ceccarelli F. Rectus femoris myotendinous lesion treated with PRP: a case report. Acta Biomed. 2019; 90 (12-S): 178-83.

Bernuzzi G, Petraglia F, Pedrini MF, De Filippo M, Pogliacomi F, Verdano MA, Costantino C. Use of platelet-rich plasma in the care of sports injuries: our experience with ultrasound-guided injection. Blood Transfusion. 2014; 12 (Suppl.1): s229-34.

Xu Q, Chen J, Cheng L. Comparison of platelet rich plasma and corticosteroids in the management of lateral epicondylitis: A meta-analysis of randomized controlled trials. Int J Surg Lond Engl 2019;67:37-46.

Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T. Treatment of Lateral Epicondylitis With Platelet-Rich Plasma, Glucocorticoid, or Saline: A Randomized, Double-Blind, Placebo-Controlled Trial. Am J Sports Med2013;41(3):625-635.

Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996;29(6):602-608.

Longo UG, Franceschi F, Loppini M, Maffulli N, Denaro V. Rating systems for evaluation of the elbow. Br Med Bull 2008;87(1):131-161.

Busija L, Pausenberger E, Haines TP, Haymes S, Buchbinder R, Osborne RH. Adult measures of general health and health-related quality of life: Medical Outcomes Study Short Form 36-Item (SF-36) and Short Form 12-Item (SF-12) Health Surveys, Nottingham Health Profile (NHP), Sickness Impact Profile (SIP), Medical Outcomes Study Short Form 6D (SF-6D), Health Utilities Index Mark 3 (HUI3), Quality of Well-Being Scale (QWB), and Assessment of Quality of Life (AQoL). Arthritis Care Res 2011;63 Suppl 11:S383-412.

Lins L, Carvalho FM. SF-36 total score as a single measure of health-related quality of life: Scoping review. SAGE Open Med 2016;4:20

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res2011;63 Suppl 11:S240-252.

Harvey CK. Fibromyalgia. Part II. Prevalence in the podiatric patient population. J Am Podiatr Med Assoc 1993;83(7):416-417.

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Published

30-12-2020

How to Cite

1.
Leigheb M, MASSA M, BOSETTI M, et al. Autologous Platelet Rich Plasma (PRP) in the treatment of elbow epicondylitis and plantar fasciitis: medium to long term clinical outcome: PRP in P. Fasciitis and epicondylitis. Acta Biomed. 2020;91(14-S):e2020029. doi:10.23750/abm.v91i14-S.11002