As recent knowledge proved that pathology of lateral epicondylitis is no more an inflammatory condition, but angiofibroblastic degeneration, steroid injection is no more recommended for lateral epicondylitis. It seems to be inappropriate that most of the comparative study used steroid injection as control group, as steroid injection is no more accepted as a treatment option. As control group should be treated with widely accepted proven method, the authors concluded that physiotherapy is the optimal control group treatment in designing prospective randomized control study. Ideal treatment option for lateral epicondylitis should have potential to promote healing of collagen fibres as basic pathology of lateral epicondylitis is the presence of degenerative changes including disorganized collagen fibres. Among recently highlighted treatments which have healing potential theoretically. The authors chose PRP (Platelet-Rich Plasma), prolotherapy and ESWT (Extracorpeal Shockwave Therapy) considering accessibility and national regulations. Consecutive patients who had refractory elbow pain more than 6 months were recruited into the study and randomized into 4 groups. Group A: Physiotherapy, B: ESWT, C: Prolotherapy, D: PRP. A power analysis performed before data collection indicated that a sample size of 200 patients (50 patients per group) will have 80% power which is able to detect 30% difference in DASH scoring system at a significance level of .05 (effect size=0.64). Mean and standard deviation for power analysis was determined according to preliminary study. Mean age was 52 years and mean Follow-up was 29 months (24–39). All 4 groups showed a decrease of DASH score after treatments (A: from 41.2 to 33.2, B: from 41.3 to 28.0, C: from 37.1to 16.3, D: from 41.2 to 10.6). Difference among DASH scores were not significant at initial point, 3 months and 6 months after the treatments (p>0.01). Post hoc comparisons at 18 and 24 months after treatment indicated that DASH score was better in the PRP group (p<0.01) than in the ESWT or the physiotherapy group and in the prolotherapy group (p<0.01) than in the physiotherapy group. In summary, prolotherapy and PRP showed better clinical outcome compared to ESWT and physiotherapy group and PRP showed most superior results.
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