Recalcitrant lateral epicondylitis: Early results of a new technique combining ultrasonographic percutaneous tenotomy with Platelet-Rich Plasma injection

AIM: We hypothesized in this prospective study that the addition of an injection of PRP to a percutaneous epicondylar tenotomy under ultrasound control would optimize the results with an early gain on pain, strength, and with a rapid return to professional activities at three months postoperative. BACKROUND: Surgical treatment of patients with recalcitrant epicondylitis remains difficult with suboptimals results. Recently, minimally invasive treatments such as percutaneous epicondylar tenotomy and PRP injections have been described. Few studies have examined the combination of the two techniques especially under ultrasound. METHODS: 261 patients with recalcitrant lateral epicondylitis were treated by percutaneous epicondylar tenotomy under ultrasound control, coupled with an injection of PRP. We analyzed prospectively the evolution of pain on the visual analogue scale (VAS-P), the functional scores: Quick DASH, PRTEE and MEPS, patient satisfaction (Self Evaluation Elbow), the grip strength and return to work. RESULTS: At 3 months follow up significants improvements were observed in all scores. VAS-P decreased by 3.4 points (SD 2.2; p <0.0001) QuickDash decreased by 32.9 points (SD 18.9, 56.1 to 23.1; p <0.0001) PRTEE droped by 14.8 points (SD 19.1, 49.8 to 26.4; p = 0.017) MEPS rose 19.4 points (SD 13.1, 67.4 to 86.9; p <0.0001) Grip strength gained 8.3 Kg (SD 10.7; p<0.0001) and increased by 26% (SD 0.60, 0,7 to 0.96; p <0.0001) compared to the opposite side. Improvement rate perceived by the patient (SEE) was 78.3% (SD 19.4). CONCLUSION: Treatment of recalcitrant epicondylitis by percutaneous tenotomy combined with PRP injection under ultrasound control provides rapid recovery on pain and force with a high satisfaction rate at 3 months postoperative.