Narendralavhale presentation KING GOERGE

PRP IN OSTEOARTHRITIS

1. Title of Study: Functional outcome in Lateral Epicondylitis treated by local injection of Platelet Rich Plasma. Department : orthopedics Name of PG student: Narendra Babarao Lavhale Year of Admission: 2023 Name of PG Guide: Dr.Dnyanesh Patil sir Names of other guiding faculty members : Dr.Deepak Agrawal

2. Aim of Study : To determine the effectiveness of platelet rich plasma injection in the treatment of patients with lateral epicondylitis

3. Objectives: 1. To assess the functional outcome of the patients treated with Platelet rich plasma 2. To evaluate the efficacy of Platelet rich plasma in treatment of lateral epicondylitis

4. Background/ Introduction: Lateral epicondylitis is one of the most commonly reported non-traumatic musculoskeletal disorders in the upper extremity. First defined in 1873 by Runge.1 Also known as Tennis Elbow. Most commonly affected muscle is the extensor carpi radialis brevis. The prevalence rates of Lateral Epicondylitis in the general population range from 1-3% and commonly seen in patients ranging from 30-55 years old. The dominant arm is more frequently involved Chief complaints : Lateral elbow pain on doing mild daily activities like shaking hands, turning door knobs or grasping objects for a moderate length of time It occurs due normal tendon microtrauma and failure in subsequent repair. This condition is usually diagnosed clinically. HR-USG has been used nowadays in confirming the diagnosis of Lateral epicondylitis. Historically injection of choice fo LE has been corticosteroid injection Recently biological agents like Platelet rich plasma and Autologous blood are used PRP helps in healing by release of • Platelet derived growth factor • Transforming growth factor • Vascular endothelial growth factor • Insulin like growth factor.2 PRP is relatively safe when compared to corticosteroids .

5. Review of Literature : 1. Kemp JA, Olson MA, Tao MA and Burcal CJ 1 did a study on Platelet-Rich Plasma versus Corticosteroid Injection for the Treatment of Lateral Epicondylitis: A Systematic Review of Systematic Reviews which showed that PRP is a superior longterm treatment option for LE when compared to CS, while CS has been proven to create a short-term decrease in pain. 2. Qiaolong Xu, Jianyang Chen, LI Cheng3 did a study on Comparison of platelet rich plasma and corticosteroids in the management of lateral epicondylitis: A meta-analysis of randomized controlled trials which showed Local PRP injections was associated with superior outcomes for reducing pain and improving elbow joint function compared with local corticosteroids treatment for LE at a follow-up of 6 months. 3. Alisara Arirachakaran , Amnat Sukthuayat , Thaworn Sisayanarane , Sorawut Laoratanavoraphong , Wichan Kanchanatawan and Jatupon Kongtharvonskul5 did a study on Platelet Rich Plasma versus Autologous blood versus Steroid Injection in Lateral Epicondylitis: Systamatic review and network meta-analysis showed that PRP injection can improve pain and lower the risk of complications, whereas AB injection can improve pain, disabilities scores and pressure pain threshold but has a higher risk of complications. 4. Xiao Chen, BA, Ian A. Jones, BA, Caron Park, PhD and C4. Thomas Vangsness Jr did a study on The efficacy of Platelet Rich Plasma on Tendon and Ligament Healing showed that PRP may reduce pain associated with lateral epicondylitis and rotator cuff injury. .

6. 5. Seyed Ahmad Raeissadat , Leyla Sedighipour , Seyed Mansoor Rayegani , Mohammad Hasan Bahrami , Masume Bayat and Rosa Rahimi6 did a study on Effect of Platelet Rich Plasma versus Autologous Whole Blood on pain and function improvement in Tennis Elbow: A Randamized clinical trial which showed PRP and autologous whole blood injections are both effective methods to treat chronic lateral epicondylitis. However, at 8-week followup , PRP treatment seems to be a more effective treatment with more persistent efficacy than autologous blood in relieving pain and improving function. 6. . Jordyn A Kemp, MA, ATC, Megan A Olson, MA, ATC, Matthew A Tao, MD, Christopher J Burcal , PhD, ATC7 did a study on Platelet Rich Plasma versus Corticosteroid Injection for the Treatment of Lateral Epicondylitis: A systematic review of Systematic reviews showed PRP injections appear to be a more effective long-term treatment option than CS injections for those with LE who did not respond to conservative management. 7. Brian C Halpem , Salma Chaudhury and Scott A Rodeo 9did a study on the role of Platelet rich plasma in inducing musculoskeletal tissue healing which showed the rationale for the use of PRP to improve tissue healing is strong, but the efficacy for many musculoskeletal applications remains unproven. PRP has been shown to be a safe treatment. A number of questions regarding PRP remain unanswered, including the optimal concentration of platelets, what cell types should be present, the ideal frequency of application, or the optimal rehabilitation regimen for tissue repair and return to full function.

7. Methodology: Type of Study: prospective study Place of Study: Outdoor and indoor patient wards Study Duration and period: 2yrs from the approval

8. Minimum Sample size:40 Sampling Method : The minimum sample size formula based on rate of percentage is n= Za2P(1-P) d2 where P is the percentage of recovery and d is the percentage likely difference in P. Za is linked with the level of significance. For 5% level of the significance Za=1.96 . With P = 88% and d = 10% of P = 8.8%, the sample size is 52. Taking into consideration the likely loss in the follow up , the sample size will be increased to 70 Calculation of sample size:

9. Data collection/Measurements: obtaining the written consent, detailed case history, clinical examination of the patient will be recorded on a detailed proforma. Patient will undergo the following tests- - Cozen’s test -Mills test -Maudsley’s test Patient will undergo the above mentioned steps before the procedure, Follow up post procedure includes: 2 weeks post-procedure 6 weeks post-procedure, 3 months post-procedure and 6 months post procedure and their outcomes will be analyzed Written informed Consent: After

10. INCLUSION CRITERIA Patients in the age group of 25 – 55 years of either sex presenting with typical lateral epicondylitis features of either elbow after being clinically diagnosed as suffering from Lateral epicondylitis EXCLUSION CRITERIA Patients suffering from elbow pain due to: Rheumatoid arthritis Osteochondritis dissecans Crystal arthropathies like Gout Radial tunnel syndrome Cervical lesions and shoulder

11. Data processing: Collection: Data Entry: Plan for data analysis: Statistics calculations planned: Tests of significance (if Any) :

12. Results anticipated: Platelet rich plasma injection studies have shown good long term recovery in patients and better patient satisfaction compared to other studies.

13. Limitations of this study:

14. How your research study will be useful for academic purposes/ patient care/ welfare of community? Lateral epicondylitis is a common condition seen mostly in working age group causing discomfort. Studies with Platelet rich plasma injection have shown a good long term recovery showing positive results.

15. Case Record Form/ Questionaire / Interview schedule/ Data collection sheet: Show in Microsft word file. and Please provide 3 printed copies. Written informed consent form: Show in Microsoft word file. and Please provide 3 printed copies.