title: Do blood growth factors offer additional benefit in refractory lateral epicondylitis? A prospective, randomized pilot trial of dry needling as a stand-alone procedure versus dry needling and autologous conditioned plasma.
abstract: OBJECTIVE
  To evaluate whether autologous conditioned plasma offers any therapeutic advantage over ultrasound-guided dry needling as a stand-alone procedure in the treatment of refractory lateral epicondylitis.
  
  
  METHODS
  Prospective, randomized pilot study of 28 patients (11 men, 17 women, mean age, 49.1  years) with refractory lateral epicondylitis (mean symptom duration, 19.1 months) who underwent either dry needling (n = 13) or dry needling combined with autologous conditioned plasma (ACP) injection (n = 15). Each patient received two separate injections (0 weeks and 1 month) and analysis of visual analogue pain scores (VAS) and Nirschl scores were performed pre-procedure, at 2 months and final evaluation at 6 months. Successful treatment was defined as more than a 25 % reduction in pain scores without re-intervention. Data was analyzed using the Mann-Whitney test and local research ethics committee approval was obtained.
  
  
  RESULTS
  At 2 months, the mean VAS improvement was 0.85 (12.3 %) in the dry needling group compared to 2.19 (27.1 %) in the ACP group (p = 0.76) and there was a 5.83-point and 20.3-point Nirschl score improvement respectively (p = 0.72). At the final follow-up of 6 months, the mean VAS improvement was 2.37 (34 %) in the dry needling group compared to 3.92 (48.5 %) in the ACP group (p = 0.74) and there was a 22.5-point and 40-point Nirschl score improvement, respectively (p = 0.82).
  
  
  CONCLUSIONS
  There is a trend to greater clinical improvement in the short term for patients treated with additional ACP, however no significant difference between the two treatment groups was demonstrated at each follow-up interval. A larger, multicenter, randomized controlled trial is required to corroborate the results of this pilot study.
authors.affiliation: West Middlesex University Hospital NHS Trust, Twickenham Road, Isleworth, Middlesex, TW76AF, UK, gregors45@gmail.com.
authors.forename: Gregor
authors.initials: G
authors.lastname: Stenhouse
authors.forename: Paul
authors.initials: P
authors.lastname: Sookur
authors.forename: Martin
authors.initials: M
authors.lastname: Watson
mesh_terms: D015670:Acupuncture Therapy / Q000295:instrumentation / Q000379:methods*; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D016913:Blood Component Transfusion / Q000379:methods*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004867:Equipment Design; D005260:Female; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013716:Tennis Elbow / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D036341:Intercellular Signaling Peptides and Proteins
references.citation: Br J Sports Med. 2011 Sep;45(12):966-71
references.pmid: 21406450
references.citation: Skeletal Radiol. 2013 Jan;42(1):91-7
references.pmid: 23001116
references.citation: Int Orthop. 2008 Oct;32(5):671-7
references.pmid: 17551726
references.citation: BMJ. 2006 Nov 4;333(7575):939
references.pmid: 17012266
references.citation: Arch Phys Med Rehabil. 1996 Jun;77(6):586-93
references.pmid: 8831477
references.citation: Am J Sports Med. 2011 Oct;39(10):2130-4
references.pmid: 21813443
references.citation: Clin J Pain. 2005 Jul-Aug;21(4):330-4
references.pmid: 15951651
references.citation: J Bone Joint Surg Br. 2009 Aug;91(8):987-96
references.pmid: 19651823
references.citation: J Bone Joint Surg Am. 1973 Sep;55(6):1183-7
references.pmid: 4585946
references.citation: Br J Sports Med. 2007 Aug;41(8):518-21; discussion 522
references.pmid: 17387140
references.citation: Am J Sports Med. 2011 Jun;39(6):1200-8
references.pmid: 21422467
references.citation: Skeletal Radiol. 2006 Jun;35(6):371-7
references.pmid: 16552606
references.citation: J Craniomaxillofac Surg. 2002 Apr;30(2):97-102
references.pmid: 12069512
references.citation: J Bone Joint Surg Am. 1979 Sep;61(6A):832-9
references.pmid: 479229
references.citation: Br J Gen Pract. 1996 Apr;46(405):209-16
references.pmid: 8703521
references.citation: Lancet. 2002 Feb 23;359(9307):657-62
references.pmid: 11879861
references.citation: J Ultrasound Med. 2008 Aug;27(8):1137-44
references.pmid: 18645071
references.citation: BMJ Clin Evid. 2011 Jun 27;2011:
references.pmid: 21708051
references.citation: J Oral Maxillofac Surg. 2004 Apr;62(4):489-96
references.pmid: 15085519
references.citation: Scand J Rheumatol. 1974;3(3):145-53
references.pmid: 4428194
references.citation: Clin Sports Med. 1992 Oct;11(4):851-70
references.pmid: 1423702
references.citation: Am J Sports Med. 2010 Feb;38(2):255-62
references.pmid: 20448192
references.citation: Am J Sports Med. 2009 Nov;37(11):2259-72
references.pmid: 19875361
references.citation: Am J Sports Med. 2013 Mar;41(3):625-35
references.pmid: 23328738
references.citation: Cochrane Database Syst Rev. 2011 Mar 16;(3):CD003525
references.pmid: 21412883
references.citation: Br J Sports Med. 2014 Jun;48(12):957-65
references.pmid: 23335238
references.citation: J Bone Joint Surg Am. 1999 Feb;81(2):259-78
references.pmid: 10073590