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24-03-2013 | Sports medicine | Article

New hope for athletes with elbow problems


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medwireNews: Two studies presented at the American Academy of Orthopedic Surgeons Annual Meeting in Chicago, USA discussed effective treatments developed for use in athletes with elbow tendon or ligament injury.

The first study, presented by Allan Mishra (Menlo Medical Clinic, California, USA), assessed injection of platelet-rich plasma (PRP) versus sham injection (control) at the site of injury for 230 patients with chronic tennis elbow or lateral epicondylar tendinopathy.

Injection with PRP (n=116), which was prepared using venous blood and a centrifuge at the clinic, improved 24 week pain scores by 71% compared with 56% in the control group. Similarly, 29% of PRP patients had elbow tenderness at 24 weeks compared with 54% of controls.

Mishra and team say that there were no significant complications and that the technique holds promise for treatment of this chronic condition.

David Altchek (Hospital for Special Surgery, New York, USA) presented the second study that looked at use of the docking technique for treatment of ulnar collateral ligament (UCL) insufficiency in 46 adolescent overhead athletes (40 baseball players, three gymnasts, three javelin throwers) aged 17 years on average.

The docking technique is a less invasive form of UCL repair that allows fewer holes to be drilled in the humerus and the ulnar nerve to remain undisturbed, unlike earlier surgical techniques such as Tommy John surgery that require detachment of muscles and movement of the nerve.

At their most recent follow-up appointment, 89% (n=41) of the patients had excellent results using the Conway scale to judge surgical outcome. Of the other five cases, one had a good, two a fair, and two poor results using the same scale.

The two poor outcome patients also had capitellar osteochondritis dissecans (OCD) lesions, note the authors, who add that one of the fair outcome patients was a revision surgery case.

Altchek commented that surgery is mainly considered for aspiring or professional athletes, as a return to normal everyday motion after UCL injury is usually possible without surgery.

"We carefully evaluate each patient to determine his or her goals and to see which treatment option would be best, and patient expectations are critical," he said in a press statement.

"We generally start with a conservative strategy of rest, anti-inflammatory medication and physical therapy. If those treatments fail and a young athlete wants to get back to his or her previous level of competition, surgery is considered."

By Helen Albert, Senior medwireNews Reporter

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