bess ian kelly prize winner 2016

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


 To compare the clinical outcome of PRP versus open tennis elbow release for the treatment of recalcitrant tennis elbow


 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


100 screened with recalcitrant tennis elbow

83 randomised

81 in the study

17 not eligible

2 with only baseline data; Excluded from analysis


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)


 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


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



Number of injection (n) 2 3 3 0.314

Disease duration (months) 22 23 23 0.795



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


-30

-25

-20

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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


-25

-20

-15

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-5


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


-35

-30

-25

-20

-15

-10

-5


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


-25

-20

-15

-10

-5

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


 1 surgical patient (3%) had a subsequent PRP injection

 13 PRP patients (30%) had surgery within 12 months


 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


 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

bess ian kelly prize winner 2016

Health & Medicine