Podium (Sports) 04

Comparison Of Minimal Invasive Combined Technique with PRP Treatment in the Treatment of Treatment-Resistant Chronic Lateral Epicondilitis

Bulent Kilic, MD
Health Sciences University, Istanbul Kanuni Sultan S�leyman Training and Research Hospital, Orthopedics and Traumatology Clinic, Istanbul, Turkey

Aim: Lateral epicondylitis (LE) is a common disorder (1-3%) in the community. Especially in people who use the wrist extensor muscles excessively; It is considered to occur as a result of degeneration of the tendons adhering to the epicondyle due to repetitive damage. Clinically, it is diagnosed with pain in the epicondyle with palpation and forced extension of the wrist. Usually, the musculotendinous region of the extensor carpi radialis brevis (ECRB) tendon is affected. In our study; Comparing the results of the combined application (percutaneous ECRB tenotomy, drilling the epicondyle with a needle (to ensure the flow of bone marrow stem cells) and whole blood injection) with platelet-rich plasma (PRP) injection, which we applied especially to chronic LE patients who did not respond to non-invasive treatments, and which is considered to be effective, We aimed to present an effective and low-cost treatment in the treatment of LE.

Method: Patients with LE who were treated by us and who did not respond to noninvasive treatments applied for at least 6 months were included in the study. Elbow tissues of our patients were examined radiologically. Forty-eight patients diagnosed with chronic LE were included in the study and were investigated retrospectively. Patients with additional factors adversely affecting recovery, such as diabetes mellitus, rheumatological disease, thyroid dysfunction, smokers, etc. were excluded from the study. 2 groups were created. Group 1 (n=25), (mean age: 41.72 years), (13 males, 12 females) consisted of patients who underwent percutaneous ECRB tenotomy, needle drilling of the lateral epicondyle, and whole blood injection. Group 2 (n=23), (mean age: 42.26), (14 males, 9 females) consists of patients who received a single dose of PRP injection. The applications were made in the outpatient clinic intervention room. Group 1 patients were administered local anesthesia with 5 ml of lidocaine, percutaneous ECRB tenotomy with a 22 gauge needle, 3 drillings into the epicondyle with the same needle and 5 ml of whole blood injection were performed. PRP was applied to group 2 patients. The patients were evaluated at the 4th week, 12th week and 1st year after the application. Visual analog scale (VAS) and arm-shoulder-hand (DASH) scoring were used for evaluation.

Results: There was no significant difference between the demographics and clinical features of the patients in group 1 and group 2. It was determined that the mean VAS values ​​of group 1 (8,12) and group 2 (8) before treatment were similar. 1st month VAS values ​​were found as group 1:7.24, group 2:6.21, 3rd month VAS values ​​were found as group 1:3, group 2:3.73, group 1 VAS value: 1.4, group 2 VAS value: 7.217 at 1st year. In the calculation of DASH scores, it was determined that the positive change in the 1st month was in favor of group 2, the changes in the 3rd month were similar in the positive direction in both groups, the positive change increased in favor of group 1 at the end of the 1st year, and a decrease in the positive changes in group 2. Inferences: According to our 1-year follow-up; The combined application of percutaneous ECRB tenotomy, epicondyle drilling with a needle, and whole blood injection provides a more effective and permanent treatment for LE at a lower cost than PRP treatment. Keywords: Lateral epicondylitis, platelet-rich plasma, tenotomy, drilling, whole blood