Use of Adjunctive Platelet-Rich Plasma for Healing During Arthroscopic Release and Repair for Recalcitrant Lateral Epicondylitis: A Prospective, Double-Blind, Randomized Controlled Trial

Abstract

Background: Whether the use of platelet-rich plasma (PRP) as an adjuvant to extensor carpi radialis brevis (ECRB) repair in recalcitrant lateral epicondylitis (RLE) promotes tendon healing and improves clinical outcomes remains unclear. Purpose: To evaluate the tendon healing and clinical outcomes of arthroscopic ECRB repair combined with PRP injection and compared with arthroscopic ECRB repair alone at early-term follow-up in patients with RLE. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A consecutive series of 80 patients with RLE were enrolled and randomized to the PRP group (arthroscopic ECRB repair followed by 1 PRP injection; n = 40) and the control group (arthroscopic ECRB repair alone; n = 40). Magnetic resonance imaging was performed to assess tendon healing at 3, 6, and 12 months. The visual analog scale (VAS) for pain, the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Patient-Rated Tennis Elbow Evaluation (PRTEE) scale, range of motion, and muscle strength were evaluated at preoperative and follow-up points. The time to return to work was also compared between the 2 groups. Patients and assessors were blinded to the intervention. Results: A total of 80 patients who met the inclusion criteria were enrolled between July 2020 and July 2023, and 73 patients completed follow-up. The PRP group contained 35 patients, 11 men and 24 women, with a mean age of 47.8 ± 8.8 years. The control group contained 38 patients, 13 men and 25 women, with a mean age of 44.5 ± 5.8 years. No significant differences were found in magnetic resonance imaging classification and functional scores between groups at preoperative and follow-up periods. VAS, MEPS, DASH, and PRTEE scores and muscle strength showed significant improvement at 12 months in both groups ( P < .001). However, the PRP group showed a significant improvement in grip and wrist extension muscle strength at 6 weeks postoperatively ( P = .008 and P < .001, respectively), whereas the control group did not ( P = .583 and .056). No complications were associated with PRP injection. Conclusion: PRP used as an adjuvant to ECRB repair did not show a difference in tendon healing and functional outcomes compared with ECRB repair alone for RLE at 12-month follow-up. However, PRP treatment showed a difference in muscle strength at 6-week follow-up compared with ECRB repair alone. Registration: NCT04556825 (ClinicalTrials.gov).