Platelet-Rich Plasma Injection with Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques
Michael P. Gaspar, MD1, Patrick M. Kane, MD1, Sarah Lewis, MD, D.P.T. 2, Sidney M. Jacoby, MD1, Randall W. Culp, MD1; A. Lee Osterman, MD1
1Thomas Jefferson University, Philadelphia, PA; 2Southern California Permanente Medical Group, Fontana, CA
Background: Recalcitrant lateral epicondylitis (LE) is a common debilitating condition with numerous treatment options of varying success. Injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear if the method of needling used in conjunction with PRP injection is of clinical importance.
Purpose: To determine if percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with PRP injection for the treatment of
Methods: Ninety-three patients with recalcitrant LE were treated with PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data including visual analog scaled pain (VAS-P) scores, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strengths were obtained from chart review and compared to postoperative values obtained prospectively. Secondary outcomes included incidence of complications, need for additional intervention, return to work and patient satisfaction.
Results: At a mean follow-up duration of 40 months, significant improvements in VAS-P (-6.1, 95% confidence interval [CI], -6.8 to -5.5; P < .0001 ), QuickDASH scores (-46, 95% CI, -52 to -40; P < .0001 ), PRTEE scores (-57, 95% CI, -64 to -50; P < .0001 ) and grip strength (+6.1 kg, 95% CI, 4.9 to 7.3; P < .0001) were observed across the full study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group versus 5 of 48 tenotomy patients (10%); P = 0.05. No complications occurred in any patients and no patients expressed dissatisfaction with their treatment course.
Conclusion: PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength and function demonstrated at average follow-up of greater than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short-to-midterm.
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