Even Experts Cannot Agree on the Optimal Use of Platelet-rich Plasma in Lateral Elbow Tendinopathy: an International Delphi Study

Overview

Journal J Orthop Traumatol

Specialties Emergency Medicine
Orthopedics

Date 2021 Nov 26

PMID 34825302

Citations 3

Authors

Jonathan P Evans

Nicola Maffulli

Chris Smith

Adam Watts

Jose Valderas

Vicki Goodwin

Affiliations

Soon will be listed here.

Abstract

Background: Platelet-rich plasma (PRP) is widely used in the management of lateral elbow tendinopathy (LET) despite conflicting evidence on its effectiveness. With high levels of user experience, this study aimed to assess consensus amongst experts on its clinical use.

Methods: A three-round international Delphi study was conducted. Participants were invited through national society mailing lists and contact lists derived from a systematic search of the literature on PRP. In round one, a primary working group developed 40 statements on PRP preparation and clinical application. In rounds two and three, an international group of researchers on PRP and clinical users of the device scored their levels of agreement with the statements on a five-point scale. Consensus was defined as an interquartile range of ≤ 1.

Results: Consensus of agreement was only reached for 17/40 (42.5%) statements. For statements on PRP formulation, consensus of agreement was reached in 2/6 statements (33%). Only limited consensus on the contraindications, delivery strategy and delivery technique was achieved.

Conclusion: Experts reached very limited consensus on the use of PRP in LET. High levels of user experience have not resulted in a convergence of opinion on the technical components of PRP formulation and delivery, substantiating the need for further studies and improved trial reporting.

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References

Nourissat G, Ornetti P, Berenbaum F, Sellam J, Richette P, Chevalier X . Does platelet-rich plasma deserve a role in the treatment of tendinopathy?. Joint Bone Spine. 2015; 82(4):230-4. DOI: 10.1016/j.jbspin.2015.02.004. View

Powell C . The Delphi technique: myths and realities. J Adv Nurs. 2003; 41(4):376-82. DOI: 10.1046/j.1365-2648.2003.02537.x. View

Andia I, Latorre P, Gomez M, Burgos-Alonso N, Abate M, Maffulli N . Platelet-rich plasma in the conservative treatment of painful tendinopathy: a systematic review and meta-analysis of controlled studies. Br Med Bull. 2014; 110(1):99-115. DOI: 10.1093/bmb/ldu007. View

Creaney L, Wallace A, Curtis M, Connell D . Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med. 2011; 45(12):966-71. DOI: 10.1136/bjsm.2010.082503. View

DeLong J, Russell R, Mazzocca A . Platelet-rich plasma: the PAW classification system. Arthroscopy. 2012; 28(7):998-1009. DOI: 10.1016/j.arthro.2012.04.148. View

Krogh T, Bartels E, Ellingsen T, Stengaard-Pedersen K, Buchbinder R, Fredberg U . Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med. 2012; 41(6):1435-46. DOI: 10.1177/0363546512458237. View

Ahmad Z, Brooks R, Kang S, Weaver H, Nunney I, Tytherleigh-Strong G . The effect of platelet-rich plasma on clinical outcomes in lateral epicondylitis. Arthroscopy. 2013; 29(11):1851-62. DOI: 10.1016/j.arthro.2013.07.272. View

Moraes V, Lenza M, Tamaoki M, Faloppa F, Belloti J . Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev. 2014; (4):CD010071. PMC: 6464921. DOI: 10.1002/14651858.CD010071.pub3. View

Kaux J, Bouvard M, Lecut C, Oury C, Gothot A, Sanchez M . Reflections about the optimisation of the treatment of tendinopathies with PRP. Muscles Ligaments Tendons J. 2015; 5(1):1-4. PMC: 4396669. View

10.

Magalon J, Chateau A, Bertrand B, Louis M, Silvestre A, Giraudo L . DEPA classification: a proposal for standardising PRP use and a retrospective application of available devices. BMJ Open Sport Exerc Med. 2016; 2(1):e000060. PMC: 5117023. DOI: 10.1136/bmjsem-2015-000060. View

11.

Glanzmann M, Audige L . Platelet-rich plasma for chronic lateral epicondylitis: is one injection sufficient?. Arch Orthop Trauma Surg. 2015; 135(12):1637-45. DOI: 10.1007/s00402-015-2322-7. View

12.

ONeill S, Watson P, Barry S . A DELPHI STUDY OF RISK FACTORS FOR ACHILLES TENDINOPATHY- OPINIONS OF WORLD TENDON EXPERTS. Int J Sports Phys Ther. 2016; 11(5):684-697. PMC: 5046962. View

13.

Vos R, Windt J, Weir A . Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review. Br J Sports Med. 2014; 48(12):952-6. DOI: 10.1136/bjsports-2013-093281. View

14.

LaPrade R, Geeslin A, Murray I, Musahl V, Zlotnicki J, Petrigliano F . Biologic Treatments for Sports Injuries II Think Tank-Current Concepts, Future Research, and Barriers to Advancement, Part 1: Biologics Overview, Ligament Injury, Tendinopathy. Am J Sports Med. 2016; 44(12):3270-3283. DOI: 10.1177/0363546516634674. View

15.

Anitua E, Sanchez M, Zalduendo M, de la Fuente M, Prado R, Orive G . Fibroblastic response to treatment with different preparations rich in growth factors. Cell Prolif. 2009; 42(2):162-70. PMC: 6496288. DOI: 10.1111/j.1365-2184.2009.00583.x. View

16.

Long L, Briscoe S, Cooper C, Hyde C, Crathorne L . What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations. Health Technol Assess. 2015; 19(8):1-134. PMC: 4781358. DOI: 10.3310/hta19080. View

17.

Miller L, Parrish W, Roides B, Bhattacharyya S . Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: systematic review and meta-analysis of randomised injection-controlled trials. BMJ Open Sport Exerc Med. 2017; 3(1):e000237. PMC: 5687544. DOI: 10.1136/bmjsem-2017-000237. View

18.

Schnabel L, Mohammed H, Miller B, McDermott W, Jacobson M, Santangelo K . Platelet rich plasma (PRP) enhances anabolic gene expression patterns in flexor digitorum superficialis tendons. J Orthop Res. 2006; 25(2):230-40. DOI: 10.1002/jor.20278. View

19.

Murphy M, Black N, Lamping D, McKEE C, Sanderson C, Askham J . Consensus development methods, and their use in clinical guideline development. Health Technol Assess. 1998; 2(3):i-iv, 1-88. View

20.

Dohan Ehrenfest D, Andia I, Zumstein M, Zhang C, Pinto N, Bielecki T . Classification of platelet concentrates (Platelet-Rich Plasma-PRP, Platelet-Rich Fibrin-PRF) for topical and infiltrative use in orthopedic and sports medicine: current consensus, clinical implications and perspectives. Muscles Ligaments Tendons J. 2014; 4(1):3-9. PMC: 4049647. View