bess ian kelly prize winner 2016
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B Morgan; I A Trail; AC Watts; D Nuttall; A Birch
Wrightington, Wigan and Leigh NHS Trust
www.wrightington.com
This study is supported by an unrestricted grant from Zimmer Biomet Biologics, supplier of Recover Mini-platelet PRP system
www.wrightington.com
www.wrightington.com
www.wrightington.com
www.wrightington.com
www.wrightington.com
To compare the clinical outcome of PRP versus open tennis elbow release for the treatment of recalcitrant tennis elbow
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Prospective RCT
Recalcitrant tennis elbow diagnosed based on: History of insidious onset lateral elbow pain 6 months minimum Previous steroid injection and physio Tenderness at ECRB origin Positive Mills or Maudsley’s sign
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100 screened with recalcitrant tennis elbow
83 randomised
81 in the study
17 not eligible
2 with only baseline data; Excluded from analysis
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Surgery Group n = 39
Open tennis elbow release under GA Several surgeons (3 consultants, 9 fellows)
PRP Group n = 43
PRP injection under local anaesthetic Biomet Recover Miniplatelet system Several surgeons (3 consultants, 9 fellows)
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Primary outcome: Change in PRTEE pain score from baseline to one year
Secondary outcomes: Change in PRTEE Function score Change in DASH score Additional intervention within 12 months
Data collected at baseline, 6, 12, 24 and 52 weeks
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Surgery PRP Total p-value
Number 38 43 81
Mean Age (Min – Max)
48 (34 – 61)
47 (32 - 62)
47 ( 32 – 62)
0.277
Male Gender (%)
58 58 58 >0.999
British white ethnicity (%)
95 98 96 >0.999
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Surgery PRP Total p-value
Number of injection (n) 2 3 3 0.314
Disease duration (months) 22 23 23 0.795
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Surgery PRP Total p-value
PRTEE pain (/50)
34 32 33 0.268
PRTEE Function (/50)
30 28 29 0.531
DASH (%) 45 47 46 0.621
DASH work (%) 31 21 26 0.181
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-30
-25
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0 Week 0 Week 6 Week 12 Week 24 Week 52
Surgery PRP
p = 0.009
At final follow-up (Week 52), PRTEE data available for 24 surgery and 25 PRP patients. Analysis based on Last Observed Carried Forward (LOCF). P-value ! Treatment Group*Time on Repeated Measures Analysis of Variance
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-25
-20
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0 Week 0 Week 6 Week 12 Week 24 Week 52
Surgery PRP
p = 0.19
At final follow-up (Week 52), PRTEE data available for 24 surgery and 25 PRP patients. Analysis based on Last Observed Carried Forward (LOCF). P-value ! Treatment Group*Time on Repeated Measures Analysis of Variance
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0 Week 0 Week 6 Week 12 Week 24 Week 52
Surgery PRP
p = 0.37
At final follow-up (Week 52), DASH total data available for 16 surgery and 16 PRP patients. Analysis based on Last Observed Carried Forward (LOCF). P-value ! Treatment Group*Time on Repeated Measures Analysis of Variance
www.wrightington.com
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0
5
Week 0 Week 6 Week 12 Week 24 Week 52
Surgery PRP
p = 0.76
At final follow-up (Week 52), DASH total data available for 16 surgery and 16 PRP patients. Analysis based on Last Observed Carried Forward (LOCF). P-value ! Treatment Group*Time on Repeated Measures Analysis of Variance
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1 surgical patient (3%) had a subsequent PRP injection
13 PRP patients (30%) had surgery within 12 months
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For relief of pain in recalcitrant tennis elbow, surgery has a superior outcome to PRP over a period of twelve months
Pain scores improve significantly after both PRP injection and surgery up to twelve months
70% of patients will not seek further intervention within twelve months of a PRP injection
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PRP injection may be of value as a second line treatment in tennis elbow patients
The majority of patients treated with PRP will avoid the need for surgical intervention
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