Tennis Elbow Platelet-rich plasma Injection Study
Platelet-rich plasma (PRP) versus autologous whole blood versus saline injection in the treatment of resistant tennis elbow – a pilot study.
Cormac Kelly, Johanna Wales, Jan Herman Kuiper, Megan Hyne, Leighann Sharp, Julie Lloyd Evans, Charlotte Perkins, Jean Denton, Tessa Rowlands, Claire Nicholas
Funded by the Orthopaedic Institute and the British Elbow and Shoulder Society. Consumables and equipment are being provided free of charge by Lavender Medical.
Tennis elbow is a common condition that causes lateral elbow pain. It is associated with repetitive activity at work and play and is thought to be caused by micro-tears in the tendons of the elbow. Although many cases resolve over a period of 3 months, either with or without non-surgical treatments such as rest, exercises and bracing, other treatments may be necessary such as corticosteroid injections or surgery.
In an autologous blood injection, blood is taken from the patient and re-injected around the affected tendon. Autologous blood injection is thought to promote healing through the action of growth factors on the affected tendon.
The injection is given using a technique called needle barbotage that disrupts tendon fibres and is also thought to promote the healing process.
Either whole blood can be injected, or a fragment known as platelet-rich plasma (PRP) can be separated from the red blood cells and then injected. PRP may have a more effective tendon repair potential compared to whole blood however there is a lack of well-designed studies to support this.
Autologous blood injection has been identified by the National Institute of Clinical Excellence (NICE) as a technology that requires further research.
We chose to carry out a pilot study of 30 patients initially, in order to ensure a well-designed study that will reach its recruitment targets, help to inform the number of participants needed in future studies and investigate measures that are both clinically relevant and important to patients. All participants will be required to complete a standardised program of physiotherapy prior to enrolment in the study to ensure that their symptoms cannot be relieved by more conservative means. Participants will then be allocated to one of three treatment groups at random, (an injection of whole blood, PRP or saline). Assessments of pain and elbow function will be carried out at 6 weeks, 12 weeks, 6 months and 1 year. We will also collect information on any side effects experienced, use of pain medications, quality of life and satisfaction with treatment.
Recruitment has progressed more slowly than we anticipated, with 28 of the target of 30 enrolled; we anticipate that recruitment will be complete by December 2019. Currently a total of 127 patients have been screened for the study.