In the JournalsPerspective

Combined soft tissue repair matrix, PRP injection may improve lateral epicondylitis

Injection of a soft tissue repair matrix combined with platelet-rich plasma may significantly improve clinical outcomes among patients with lateral epicondylitis, according to published results.

Researchers assessed grip strength, functional disability and changes in sonographic tendon appearance for up to 6 months in 40 patients with lateral epicondylitis who received a Vergenix Soft Tissue Repair Matrix (CollPlant Ltd.) injection combined with autologous PRP.

Results showed no systemic or local severe adverse events among patients. Researchers noted improved mean patient-rated tennis elbow evaluation scores, as well as a 59% reduction from baseline at 6 months. At final follow-up, the SF-12 questionnaire improved from a mean score of 30.7 to 37.7, according to results. Researchers found an increase in grip strength from 28.8 kg at baseline to 36.8 kg at 6 months, as well as improvements in sonographic tendon appearance among 68% of patients.

Despite predictions of a long-lasting effect of treatment that are limited by the relatively short follow-up period, the researchers noted other studies have reported only short-term pain relief with injection treatments for lateral epicondylitis.

“Furthermore, the short-term benefits, or possibly the accelerating effort, of injectable treatments in terms of disability, lost productivity and quality of life cannot be ruled out,” the authors wrote. – by Casey Tingle

Disclosures: The authors report no relevant financial disclosures.

Injection of a soft tissue repair matrix combined with platelet-rich plasma may significantly improve clinical outcomes among patients with lateral epicondylitis, according to published results.

Researchers assessed grip strength, functional disability and changes in sonographic tendon appearance for up to 6 months in 40 patients with lateral epicondylitis who received a Vergenix Soft Tissue Repair Matrix (CollPlant Ltd.) injection combined with autologous PRP.

Results showed no systemic or local severe adverse events among patients. Researchers noted improved mean patient-rated tennis elbow evaluation scores, as well as a 59% reduction from baseline at 6 months. At final follow-up, the SF-12 questionnaire improved from a mean score of 30.7 to 37.7, according to results. Researchers found an increase in grip strength from 28.8 kg at baseline to 36.8 kg at 6 months, as well as improvements in sonographic tendon appearance among 68% of patients.

Despite predictions of a long-lasting effect of treatment that are limited by the relatively short follow-up period, the researchers noted other studies have reported only short-term pain relief with injection treatments for lateral epicondylitis.

“Furthermore, the short-term benefits, or possibly the accelerating effort, of injectable treatments in terms of disability, lost productivity and quality of life cannot be ruled out,” the authors wrote. – by Casey Tingle

Disclosures: The authors report no relevant financial disclosures.

    Perspective

    This pilot study by Farkash and colleagues introduces novel treatment options for tendinopathies that should be investigated further. As the authors mentioned in their paper, PRP injections have only shown modest effect in treating tennis elbow, with some authors now considering the anti-inflammatory properties of PRP more relevant than its healing effect. Also, histopathological studies show tennis elbow tendons undergo a disorganized attempt at healing and with the animal models showing a healing effect with collagen use alone, it may be the collagen matrix that helps organize the healing tendon fibers. Finally, with acute tennis elbow, one needs to consider the healing effect of time, as more than 80% of patients get better over 12 months with a watch-and-wait approach only.

    As such, if the authors could extend their study to include a collagen-only arm and a placebo-injection arm, their results would go a long way to helping understand the pathology and treatment of tennis elbow and tendinopathies in general.

     

    • Martin Kroslak, MBBS, MSpMed, MSurg
    • St. George Hospital Clinical School
      University of New South Wales
      Sydney

    Disclosures: Kroslak reports no relevant financial disclosures.

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