Comparing PRP, Saline and Steroid injection
Am J Sports Med. 2013 Jan 17.
Treatment of Lateral Epicondylitis With Platelet-Rich Plasma, Glucocorticoid, or Saline: A Randomized, Double-Blind, Placebo-Controlled Trial.
Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T.
Diagnostic Centre, Region Hospital Silkeborg, Silkeborg, Denmark.
BACKGROUND:Lateral epicondylitis (LE) is a common musculoskeletal disorder for which an effective treatment strategy remains unknown.
PURPOSE:To examine whether a single injection of platelet-rich plasma (PRP) is more effective than placebo (saline) or glucocorticoid in reducing pain in adults with LE after 3 months. STUDY DESIGN:Randomized controlled trial; Level of evidence, 1.
METHODS:A total of 60 patients with chronic LE were randomized (1:1:1) to receive either a blinded injection of PRP, saline, or glucocorticoid. The primary end point was a change in pain using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire at 3 months. Secondary outcomes were ultrasonographic changes in tendon thickness and color Doppler activity.
RESULTS:Pain reduction at 3 months (primary end point) was observed in all 3 groups, with no statistically significant difference between the groups; mean differences were the following: glucocorticoid versus saline: -3.8 (95% CI, -9.9 to 2.4); PRP versus saline: -2.7 (95% CI, -8.8 to 3.5); and glucocorticoid versus PRP: -1.1 (95% CI, -7.2 to 5.0). At 1 month, however, glucocorticoid reduced pain more effectively than did both saline and PRP; mean differences were the following: glucocorticoid versus saline: -8.1 (95% CI, -14.3 to -1.9); and glucocorticoid versus PRP: -9.3 (95% CI, -15.4 to -3.2). Among the secondary outcomes, at 3 months, glucocorticoid was more effective than PRP and saline in reducing color Doppler activity and tendon thickness. For color Doppler activity, mean differences were the following: glucocorticoid versus PRP: -2.6 (95% CI, -3.1 to -2.2); and glucocorticoid versus saline: -2.0 (95% CI, -2.5 to -1.6). For tendon thickness, mean differences were the following: glucocorticoid versus PRP: -0.5 (95% CI, -0.8 to -0.2); and glucocorticoid versus saline: -0.8 (95% CI, -1.2 to -0.5).
CONCLUSION:Neither injection of PRP nor glucocorticoid was superior to saline with regard to pain reduction in LE at the primary end point at 3 months. However, injection of glucocorticoid had a short-term pain-reducing effect at 1 month in contrast to the other therapies. Injection of glucocorticoid in LE reduces both color Doppler activity and tendon thickness compared with PRP and saline.
My Comment: As a common finding with other papers, the pain and functional benefit of steriod is greatest in the short term (1-3 months), however as this paper points out there was no difference in pain reduction outcome regardless of what substance is injected. Shame they didn't have a real control which would have been No injected material. However other papers have indicated that the result would have been similar, it is not the substance injected rather the tissue trauma provoking a healing response.
Another recent paper looking at a 12 month followup of steroid +/- physio and placebo injection +/- physio showed that the steroid group was worse off at 12 months and the best group was the placebo injection plus physio at 12 months. The placebo was saline.