Platelets rich plasma for treatment of chronic plantar fasciitis.

BACKGROUND: Plantar fasciitis is a common cause of heel pain in adults. Many treatment options exist. Platelets rich plasma (PRP) is derived from autologous blood and contains high concentration of growth factors necessary for tissue healing. The use of PRP in the treatment of plantar fasciitis is a fairly recent and evolving concept. The purpose of our work was to study the effectiveness of PRP treatment for chronic plantar fasciitis. MATERIALS AND METHODS: Between February 2010 and June 2011, 25 patients with chronic plantar fasciitis with a mean age of 44 years were treated by PRP injection and included in this prospective study. All patients were assessed for the pain on Visual Analogue Scale (VAS) pre-injection and post-injection. Using ultrasound, the thickness of the plantar fascia was measured prior to the injection of PRP and at each visit of follow-up after injection. The mean follow-up was 10.3 months. RESULTS: Using a visual analog pain scale, the average pre-injection pain in patients of was 9.1 (range 8-10). Prior to injection, 72 % of patients had severe limitation of activities, and 28 % of patients had moderate limitation of activities. Average post-injection pain decreased to 1.6. Twenty-two patients (88 %) were completely satisfied, two patients (8 %) were satisfied with reservations, and one patient (4 %) was unsatisfied with using the visual analog scale. Fifteen patients (60 %) had no functional limitations post-injection and eight patients (32 %) had minimal functional limitations. Two patients (8 %) had moderate functional limitations post-injection. Twenty PRP injections. Ultrasonography, we noted significant changes not only in thickness but also in the signal intensity of the plantar fascia after PRP injection. None of our patients experienced any complications from PRP injection at the end of follow-up period. CONCLUSION: Injection of PRP is safe and doesn't affect the biomechanical function of the foot. Our successful early findings with injection of PRP indicate that this may become a very commonly used modality in treating this difficult condition.

Arthroscopic versus percutaneous release of common extensor origin for treatment of chronic tennis elbow.

BACKGROUND: Lateral epicondylitis is a common orthopedic problem. Rest, activity modification, and conservative therapies are generally efficacious in relieving symptoms in the majority of patients; however, a small percentage of people will experience refractory pain and require surgical intervention to alleviate their discomfort. Surgical release of the common extensor origin can be done through an open, percutaneous, or arthroscopic approach. PATIENTS AND METHODS: This prospective study includes 33 patients with chronic resistant lateral epicondylitis who had received conservative treatment including modification of activity and 2 injections of 80 mg of hydrocortisone, for more than 6 months, aiming to compare two different techniques of treatment. The first group included 14 patients with a mean age of 42 years treated by arthroscopic release of common extensor origin. The second group included 19 patients with a mean age of 48 years treated by percutaneous tenotomy. The mean follow up was 12 months for the arthroscopic group and 10 months for the percutaneous tenotomy group. RESULTS: The results were evaluated according to the Disabilities of the Arm, Shoulder and Hand (DASH) score and the visual analogue scale (VAS). In the first group (treated by arthroscopy), the average DASH score improved from 72 to 48 and the average VAS improved from 9.1 to 2. In the second group (treated by percutaneous tenotomy), the average DASH score improved from 70 to 50 and the average VAS improved from 9 to 2.1. Concerning patient satisfaction after surgery, in the first group 7 patients (50%) were pleased, 6 (42.85%) were satisfied and 1 case (7.14%) was not satisfied. In the second group, 7 patients (36.84%) were pleased, 10(52.63%) were satisfied and 2 cases (10.52%) were not satisfied. CONCLUSION: Both arthroscopic and percutaneous release of the common extensor origin can be effective in treatment of lateral epicondylitis. Arthroscopic treatment of lateral epicondylitis gives more favorable results than percutaneous tenotomy. Although technically more difficult than percutaneous tenotomy, arthroscopy has the advantage of visualization of the pathology and much better improvement of elbow functions.

Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis.

BACKGROUND: Planter fasciitis is a common cause of heel pain in adults. Many treatment options exist. Most of patients resolve with conservative management. Approximately 10% of patients develop persistent and often disabling symptoms. PATIENTS AND METHODS: This prospective study includes 37 patients with an established diagnosis of chronic plantar fasciitis, aiming to compare two different techniques of treatment. First group includes 17 patients with a mean age of 42 years treated by endoscopic plantar fasciotomy (EPF); the mean follow-up was 11 months. Second group includes 20 patients with a mean age of 45 years treated by extracorporeal shock Wave Therapy (ESWT); the mean follow-up was 7.6 months. RESULTS: In the first group (EPF), using the visual analog scale the average post-operative pain was improved from 9.1 to 1.6. Post-operatively, 58.8% had no limitation of functional activities, 35.3% had minimal limitation of activities and 5.9% had moderate limitation of activities. Concerning patient satisfaction, 82.3% of patients were completely satisfied, 11.8% of patients were satisfied with reservation and 5.9% of patients were unsatisfied. For the second group (ESWT), using the visual analog scale the average post-operative pain was improved from 9 to 2.1. Post-operatively, 50% had no functional limitation of activities, 35% had minimal limitation of activities, 10% had moderate limitation of activities, and 5% had severe limitation of activities. Concerning patient satisfaction, 75% of patients were completely satisfied and 25% were satisfied with reservation or unsatisfied. CONCLUSION: Because of better results with endoscopic release versus the benefits of no complications, no immobilization, and early resumption of full activities with ESWT, we conclude that ESWT is a reasonable earlier line of treatment of chronic plantar fasciitis before EPF.

Endoscopic plantar fasciotomy versus injection of platelet-rich plasma for resistant plantar fasciopathy.

BACKGROUND: Resistant plantar fasciopathy is a common orthopedic problem. AIM: Comparing two different methods of treatment. METHODS: Fifty patients with chronic resistant plantar fasciopathy were divided into two groups. The first included 23 patients treated by endoscopic release of plantar fascia (EPF) and the second included 27 patients treated by injection of platelet-rich plasma (PRP). RESULTS: In the EPF group, the average VAS improved from 8.28 to 2.35. The average AOFAS improved from 65 to 94. In the PRP group, average VAS improved from 8.22 to 2.9 and the average AOFAS improved from 66 to 92. CONCLUSION: Both methods gave comparable results at late follow-up.