Platelet Rich Plasma (PRP)
External humeral epicondylitis is a common clinical disease characterized by pain on the lateral side of the elbow. It is insidious and easy to recur, which can cause forearm pain and wrist strength decline, and seriously affect the daily life and work of patients. There are various treatment methods for lateral epicondylitis of humerus, with different effects. There is no standard treatment method at present. Platelet rich plasma (PRP) has a good effect on bone and tendon repair, and has been widely used to treat external humeral epicondylitis.
According to the intensity of voting approval rate, it is divided into three grades:
100% is fully agreed (Level I)
90%~99% are strong consensus (Level II)
70%~89% are unanimous (Level III)
PRP Concept and Application Ingredient Requirements
(1) Concept: PRP is a plasma derivative. Its platelet concentration is higher than the baseline. It contains a large number of growth factors and cytokines, which can effectively promote tissue repair and healing.
(2) Requirements for applied ingredients:
① The platelet concentration of PRP in the treatment of external humeral epicondylitis is recommended to be (1000~1500) × 109/L (3-5 times of baseline concentration);
② Prefer to use PRP rich in white blood cells;
③ Activator activation of PRP is not recommended.
(Recommended intensity: Level I; literature evidence level: A1)
Quality Control of PRP Preparation Technology
(1) Personnel qualification requirements: The preparation and use of PRP should be carried out by medical personnel with the qualifications of licensed doctors, licensed nurses and other relevant medical personnel, and should be carried out after strict aseptic operation training and PRP preparation training.
(2) Equipment: PRP shall be prepared by using the preparation system of approved Class III medical devices.
(3) Operating environment: PRP treatment is an invasive operation, and its preparation and use are recommended to be carried out in a special treatment room or operating room that meets the requirements of sensory control.
(Recommended intensity: Level I; literature evidence level: Level E)
Indications and Contraindications of PRP
(1) Indications:
① PRP treatment has no clear requirements for the type of work of the population, and it can be considered to be carried out in patients with high demand (such as sports crowd) and low demand (such as office workers, family workers, etc.);
② Pregnant and lactating patients can use PRP cautiously when physical therapy is ineffective;
③ PRP should be considered when the non operative treatment of humeral epicondylitis is ineffective for more than 3 months;
④ After PRP treatment is effective, patients with relapses can consider using it again;
⑤ PRP can be used 3 months after steroid injection;
⑥ PRP can be used to treat extensor tendon disease and partial tendon tear.
(2) Absolute contraindications: ① thrombocytopenia; ② Malignant tumor or infection.
(3) Relative contraindications: ① patients with abnormal blood coagulation and taking anticoagulant drugs; ② Anemia, hemoglobin<100 g/L.
(Recommended intensity: Level II; literature evidence level: A1)
PRP Injection Therapy
When PRP injection is used to treat lateral epicondylitis of humerus, it is recommended to use ultrasound guidance. It is recommended to inject 1~3 ml of PRP at and around the injury site. A single injection is sufficient, generally no more than 3 times, and the injection interval is 2~4 weeks.
(Recommended intensity: Level I; literature evidence level: A1)
Application of PRP in Operation
Use PRP immediately after clearing or suturing the lesion during surgery; The dosage forms used include PRP or combined with platelet rich gel (PRF); PRP can be injected into the tendon bone junction, the tendon focus area at multiple points, and PRF can be used to fill the tendon defect area and cover the tendon surface. The dosage is 1-5ml. It is not recommended to inject PRP into the joint cavity.
(Recommended intensity: Level II; literature evidence level: Level E)
PRP Related Issues
(1) Pain management: After PRP treatment of external humeral epicondylitis, acetaminophen (paracetamol) and weak opioids can be considered to reduce the pain of patients.
(2) Countermeasures for adverse reactions: severe pain, hematoma, infection, joint stiffness and other conditions after PRP treatment should be actively dealt with, and effective treatment plans should be formulated after improving laboratory and imaging examination and evaluation.
(3) Physician patient communication and health education: Before and after PRP treatment, fully carry out doctor-patient communication and health education, and sign an informed consent form.
(4) Rehabilitation plan: no fixation is required after PRP injection treatment, and activities causing pain should be avoided within 48 hours after treatment. Elbow flexion and extension can be performed 48 hours later. After surgery combined with PRP, postoperative rehabilitation program should be given priority to.
(Recommended intensity: Level I; literature evidence level: Level E)
References: Chin J Trauma, August 2022, Vol. 38, No. 8, Chinese Journal of Trauma, August 2022
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Post time: Nov-28-2022