Dilay Eken GEDİK, Gülseren Dost SÜRÜCÜ, Mehmet KARABİBER, Adem YILDIRIM

LATERAL EPİKONDİLİT TEDAVİSİNDE OTOLOG KAN ENJEKSİYONUNUN ETKİNLİĞİ: RANDOMİZE KLİNİK ÇALIŞMA

Amaç: Bu çalışma, lateral epikondilit (LE) tedavisinde otolog kan enjeksiyonunun kısa ve uzundönem etkinliğini araştırmak amacıyla yapıldı.Gereç ve yöntem: LE tanısı konan 70 hasta, kontrol (35 hasta, Grup 1) ve enjeksiyon (35 hasta,Grup 2) gruplarına randomize edildi. Her iki gruba 4 hafta süre ile lateral epikondil bandajı veev egzersiz programı, Grup 2’deki hastalara ise ek olarak lateral epikondil çevresindeki enduyarlı noktaya otolog kan enjeksiyonu (2 ml venöz kan 1 ml %2 prilokain ile karıştırılarak)uygulandı. Tüm hastalar kör bir araştırıcı tarafından başlangıçta, 4. haftada (primer sonlanımnoktası), 3 ve 6. ayda algometrik duyarlılık, ağrısız el kavrama gücü, “Hasta Bazlı LateralEpikondilit Değerlendirme Testi” ve “Tedaviye Yanıt Skoru” kullanılarak değerlendirildi. Dörthafta sonunda 1. gruptan bandaj ve ev egzersiz programına “orta” ya da “kötü” yanıt verenhastalara (21 hasta, Grup 3) devam eden tedaviye ek olarak otolog kan enjeksiyonu yapıldı. Buhastalar enjeksiyon sonrası 1, 3 ve 6. ayda yeniden değerlendirildi.Bulgular: Grup 1 ve 2’de tüm parametrelerde 4. haftada anlamlı düzelme görüldü.Parametrelerin yüzdesel değişimi açısından gruplar karşılaştırıldığında, Grup 2’de görülendüzelmeler anlamlı derecede daha fazla idi. Ek olarak tüm gruplarda (primer sonlanımnoktasından sonra Grup 1’de kalan 13 hastada, Grup 2’de bulunan 32 hastada ve Grup 3’tebulunan 21 hastada) 3 ve 6. ayda anlamlı iyileşmelerin sürdüğü gözlendi. Sonuç: Bu çalışma, otolog kan enjeksiyonunun LE’li hastalarda etkili olduğunu ve bu etkinin6. ayda da devam ettiğini göstermiştir. Bu nedenle, göreceli olarak daha az yan etkiye sahipolan otolog kan enjeksiyonu, LE için uzun süreli tedavi seçenekleri arasında yer alabilir

Anahtar Kelimeler:

Lateral epikondilit, otolog kan enjeksiyonu, uzun dönem sonuçlar

Effectiveness of autologous blood injection in the treatment of lateral epicondylitis: randomized clinical study

Objective: The aim of this study was to investigate the short and long-term effectiveness ofautologous blood injection in the treatment of lateral epicondylitis (LE).Materials-Methods: Seventy patients diagnosed as LE were randomized as control (Group 1,n=35) and injection (Group 2, n=35) groups. In control group, epicondyle bandage and homeexercise program was applied for 4 weeks. In injection group, autologous blood was injectedinto the most tender spot around the lateral epicondyle in addition to bandage and home exerciseprogram. All patients were evaluated by a blinded investigator at baseline, 4 weeks (primaryendpoint), 3 and 6 months. The outcome measurements were algometric sensitivity, pain-freegrip strength, Patient-rated Tennis Elbow Evaluation Questionnaire, and response to treatmentscore. At the end of 4 weeks (primary endpoint), we also applied autologous blood injection topatients who had "moderate" or "poor" response to treatment in Group 1 (21/34 patients, definedas Group 3).Results: At primary endpoint, all above-mentioned parameters improved significantly in Group1 and Group 2. Improvements in Group 2 were more significant when percentage rate of changeswere compared between groups. Moreover, significant improvements continued at 3 and 6months in all groups (13 patients who remained in Group 1 after the primary endpoint; 32patients in Group 2 and 21 patients in Group 3). Conclusion: This study showed that, autologous blood injection is effective in patients with LEand this effectiveness has continued at 6 months. Therefore, autologous blood injection, whichhas relatively less side effects, might be included among long-term treatment options for LE

Keywords:

Lateral epicondylitis, autologous blood injection, long-term results,

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Stasinopoulos D, Johnson MI. 'Lateral elbow tendinopathy' is the most appropriate diagnostic term for the condition commonly referred-to as lateral epicondylitis. Med Hypotheses 2006;67:1400-2.
Struijs PAA, Smidt N, Arola H et al. Orthotic devices for tennis elbow: a systematic review. Br J Gen Pract 2001;51:924-9.
Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am 1999;81:259-78.
Whaley AL, Baker CL. Lateral epicondylitis. Clin Sports Med 2004;23:677-91.
De Vos RJ, Van Veldhoven PLJ, Moen MH, Weir A, Tol JL, Maffullli N. Autologous growth factor injections in chronic tendinopathy: a systematic review. British Medical Bulletin 2010;95:63-77.
Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg Am 2003;28:272-8.
Connell DA, Ali KE, Ahmad M et al. Ultrasound-guided autologous blood injection for tennis elbow. Skeletal Radiol 2006;35:371-7.
Ul Gani N, Butt M, Dhar SA et al. Autologous blood injection in the treatment of refractory tennis elbow. Internet J Orthop Surg 2007;5(1).
Ozturan KE, Yucel I, Cakici H, Guven M, Sungur I. Autologous blood and corticosteroid injection and extracorporeal shock wave therapy in the treatment of lateral epicondylitis. Orthopedics 2010;33:84-91.
Kazemi M, Azma K, Tavana B, Rezaiee Moghaddam F, Panahi A. Autologous blood versus corticosteroid local injection in the short-term treatment of lateral elbow tendinopathy: a randomized clinical trial of efficacy. Am J Physical Medicine and Rehabilitation 2010;89:660-7.
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;15.
Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet rich plasma. Am J Sports Med 2006;34:1774-8.
Dojode C.M. A randomised control trial to evaluate the efficacy of autologous blood injection versus local corticosteroid injection for treatment of lateral epicondylitis. Bone Joint Res 2012;1:192-7.
Jindal N, Gaury Y, Banshiwal RC, Lamoria R, Bachhal V. Comparison of short term results of single injection of autologous blood and steroid injection in tennis elbow: a prospective study. Journal of Orthopaedic Surgery and Research 2013;8:10.
Arik HO, Kose O, Guler F, Deniz G, Egerci OF, Ucar M. Injection of aotologous blood versus corticosteroid for lateral epicondylitis: a randomised controlled study. Journal of Orthopaedic Surgery 2014;22(3):333-7.
Raeissadat SA, Rayegani SM, Hassanabadi H, Rahimi R, Sedighipour L, Rostami K. Is Platelet-rich plasma superior to whole blood in the management of chronic tennis elbow: one year randomized clinical trial. BMC Sports Science, Medicine, and Rehabilitation 2014;6:12.
Rabago D, Best T, Zgierska A, Zeisig E, Ryan M, Crane D. A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet rich plasma. Br J Sports Med 2009;43:471-81.
Overend TJ, Wuori JL, Kramer JF, MacDermid JC. Reliability of a patient-rated forearm evaluation questionnare for patients with lateral epicondylitis. J Hand Ther 1999;12:31-7.
Altan L, Ercan I, Konur S. Reliability and validity of Turkish version of the patient rated tennis elbow evaluation. Rheumatol Int 2010;30:1049-54.
Verhaar JAN, Walenkamp GHIM, Kester A, van Mameren H, van der Lindan T. Lateral extensor release for tennis elbow: A prospective long term follow-up study. J Bone Joint Surg 1993;75A:1034-1043.
James SL, Ali K, Pocock C, et al. Ultrasound guided dry needling and autologous blood injection for patellar tendinosis. Br J Sports Med 2007;41:518-21.
Taylor MA, Norman TL, Clovis NB, Blaha JD. The response of rabbit patellar tendons after autologous blood injection. Med Sci Sports Exerc 2002;34:70-3.
Suresh SP, Ali KE, Jones H et al. Medial epicondylitis: is ultrasound guided autologous blood injection an effective treatment? Br J Sports Med 2006;40:935-9.