TDNet Discover

Background: Inflammatory soft tissue injuries include sprains, strains, tendonitis, and tears. They occur across various populations and can largely affect a person’s ability to function in their daily life. Patients who initially present with an inflammatory soft tissue injury are typically treated conservatively at first, involving rest, ice, compression, and elevation. The current guidelines mention use of corticosteroid injections for next line treatment;however, newer research suggests that they may not be the most efficacious treatment available. Platelet-rich plasma (PRP) injections are another option available to patients, yet not used nearly as frequently. PRP injections use a concentration of the patient’s own platelets in order to promote and accelerate healing. Objective: To determine if PRP or corticosteroid injections, produce better clinical outcomes for inflammatory soft tissue injuries. Methods: An evidence-based medicine literature review study design was completed by searching databases such as Google Scholar, PubMed, and Cochrane Library using search phrases like “PRP AND steroid AND systematic review”, “PRP AND steroid AND injury”, “PRP AND steroid”, “PRP AND corticosteroids AND joint”, and “PRP AND corticosteroids”. The following limits were used: human subjects, clinical studies, systematic reviews, metaanalyses, published in English, and a publication date within the last 10 years. Study population had to be a patient being treated for an inflammatory soft tissue injury, specifically elbow epicondylitis or plantar fasciitis. An induplicate search and review process was conducted to select included studies. A quality assessment, level of evidence, and data extraction were utilized to qualitatively analyze each included article. v Results: Three systematic reviews and meta-analyses were included in this review. The patient population was diagnosed with either epicondylitis or plantar fasciitis and had not been previously treated surgically or with injection. Outcomes were measured using validated scoring systems including AOFAS, VAS, and DASH scores. All three articles provided level 1 evidence and were rated “good” for quality. All studies suggest that PRP could provide better long-term outcomes (lower pain and increased function) for patients with inflammatory soft tissue injuries, such as plantar fasciitis and elbow epicondylitis. Due to limited data, it is too soon to recommend PRP for inclusion in clinical guidelines as an alternative or even replace corticosteroids as a treatment option. Conclusion: PRP injections appear to be a safe and beneficial option for the treatment of inflammatory soft tissue injuries, but it currently cannot be deemed as effective as corticosteroids or considered an alternative in the guidelines. Unfortunately scoring methods used in the included studies are subjective, which makes it difficult to truly compare intervention methods. If an objective means of scoring and studies with larger sample sizes could be utilized, then perhaps PRP could someday be featured in the guidelines.