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Leukocyte-rich PRP or Leukocyte-free PRP vs Placebo in the Treatment of Epicondylitis

Primary Purpose

Tennis Elbow

Status
Recruiting
Phase
Not Applicable
Locations
Italy
Study Type
Interventional
Intervention
Injection of autologous leukocyte rich platelet rich plasma (LR-PRP)
Injection of autologous leukocyte poor platelet rich plasma (LP-PRP)
Placebo (saline solution)
Sponsored by
Istituto Ortopedico Rizzoli
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Tennis Elbow focused on measuring Platelet rich plasma, Leukocyte-rich PRP, Leukocyte-poor PRP, PRP, PRP injection, Double-blind randomized controlled clinical trial

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Patients with epicondylitis of the elbow: Patients with clinical picture of epicondylitis; Duration of symptoms > 3 months Ultrasound picture of short or long radial extensor carpal tendinopathy; Age > 18 and < 65 Both sexes; Failure, defined as persistence of symptoms, of other conservative treatments for at least 3 months; Hemoglobin > 11 g/dl; Platelet count > 150,000 plt/mm3 (Recently performed CBC examination); Negative serological tests for HBsAg, HCV Ab, HIV-1-2 Ab No clinically significant electrocardiographic changes (Recently performed ECG); Ability and consent of the patient to actively participate in clinical follow-up; Signature of informed consent. Exclusion Criteria: Patients undergoing previous surgical treatment on the epicondylar tendons; Patients undergoing epicondylar infiltration in the previous 6 months; Inability of patients to actively participate in clinical follow-up; Incapacitated patients; Patients with states of immunodepression; Patients with fibromyalgia; Ongoing systemic inflammatory diseases (stabilized outcomes of such diseases are not considered absolute contraindications); Patients with uncontrolled thyroid metabolic disorders; Patients abusing alcoholic beverages, drugs or medications; Patients who have taken NSAIDs in the 3 days prior to blood collection; Patients with coagulation problems or with ongoing antiplatelet therapy that cannot be suspended for at least 3 days prior to blood draw; Patients with cardiovascular disease for whom a 300-mL blood draw would be contraindicated; Positive serological tests for HBsAg, HCV Ab, HIV-1-2 Ab Other current elbow diseases (osteoarthritis, prevalence of symptomatology due to epitrochleitis, stiff elbow, etc.)

Sites / Locations

  • Istituto Ortopedico RizzoliRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Placebo Comparator

Arm Label

Leukocyte-rich Platelet rich plasma (LR-PRP)

Leukocyte-poor Platelet rich plasma (LP-PRP)

Saline solution

Arm Description

This group of patients will be treated with single injection of autologous leukocyte rich platelet rich plasma.At the 6-month follow-up visit, the patient will be informed about the treatment received.

This group of patients will be treated withsSingle injection of autologous leukocyte poor platelet rich plasma.At the 6-month follow-up visit, the patient will be informed about the treatment received.

This group of patients will be treated with single intra-articular injection of saline solution (placebo). At the 6-month follow-up visit, patients will be informed about the treatment received. Patients of this group can cross-over to the treatment arm after 6 months following a dedicated randomization list.

Outcomes

Primary Outcome Measures

Patient-rated Tennis Elbow Evaluation (PRTEE)
PRTEE is a 15-item questionnaire designed to measure forearm pain and disability in patients with lateral epicondylitis (also known as "tennis elbow"). The PRTEE allows patients to rate their levels of tennis elbow pain and disability from 0 to 10, and consists of 2 subscales: 1) Pain subscale (0 = no pain, 10 = worst imaginable) item 2) Function subscale (0 = no difficulty, 10 = unable to do). The total score is the sum of the two subscales and has a range from 0 to 100.

Secondary Outcome Measures

Patient-rated Tennis Elbow Evaluation (PRTEE)
PRTEE is a 15-item questionnaire designed to measure forearm pain and disability in patients with lateral epicondylitis (also known as "tennis elbow"). The PRTEE allows patients to rate their levels of tennis elbow pain and disability from 0 to 10, and consists of 2 subscales: 1) Pain subscale (0 = no pain, 10 = worst imaginable) item 2) Function subscale (0 = no difficulty, 10 = unable to do). The total score is the sum of the two subscales and has a range from 0 to 100.
Disability of the arm, shoulder and hand score (DASH)
The Disabilities of the Arm, Shoulder and Hand (DASH) Score is a 30-item self-reported questionnaire in which the response options are presented as 5-point Likert scales. Scores range from 0 (no disability) to 100 (most severe disability). This score was designed be useful in patients with any musculoskeletal disorder of the upper limb.
Tegner Activity Level Scale
Tegner Activity Level Scale is a questionnaire to find out the patient's level of physical activity.All patients will indicate the type of sporting activity performed and its frequency. The Tegner activity scale is a one-item score that graded activity based on work and sports activities on a scale of 0 to 10. Zero represents disability and 10 represents a competitive level of sport.
Oxford Elbow Score (OES)
Oxford Elbow score is a questionnaire consisting of 12 questions (related to pain, function, and socio-psychological aspects) specifically designed and developed to evaluate the outcomes of elbow surgery. The Oxford Elbow score has 12 items (questions) with 5 response options each. Each item response is scored as 0 to 4, with 0 representing greater severity. Underlying the 12 items are 3 domains (subscales): elbow pain, elbow function and social-psychological effects. Scores for each domain are calculated as the sum of each individual item score within that domain. This gives a score range of 0-16 for each domain and 0-48 overall, with 0 indicating the worst elbow score and 48 as a 'normal' elbow score
Visual Analogue Scale (VAS)
Visual analog scale consisting of a straight line segment (10 cm length), the ends of which correspond to "no pain" (0) and "the strongest pain imaginable" (10).
EuroQol Visual Analogue Scale (EQ-VAS)
EQ-VAS is a visual analog scale that has a range of scores from 0 (worst imaginable health condition) to 100 (best imaginable health condition).
EQ-5D (EuroQoL) Current Health Assessment
The generic health-related quality of life instrument-EQ-5D-allows both a description of health status along 5 dimensions and the evaluation of health or the estimation of a health summary score: the EQ-5D score on a scale where 0 is death and 1 is full health. EQ-5D is useful to evaluate the quality life of the patients. The EQ-5D respondents classify their own health status into 5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression with 3 levels of severity (no problems, moderate problems, or severe problems).
Pain detect
The Pain Detect-Questionnaire is a reliable screening tool for neuropathic pain with high sensitivity, specificity, and positive predictive accuracy. In this scale, the score ranges from 0 to 38 (range 0-12 neuropathic component of pain unlikely, range 13-18 neuropathic component of pain probably present, range 19-38 neuropathic component of pain present).
Patient Acceptable Symptom State (PASS)
A tool to assess patient satisfaction in consideration of their current degree of pain, function, and daily activity. Patients can express if their state of health will be satisfying, answering "yes" or "no.
Final treatment opinion
The patient should indicate satisfaction and relative degree with treatment at the end of the clinical trial (24 months follow-up). All patients will be able to indicate their health condition by choosing from this answers; "Full recovery", "much better", "somewhat better", "no change", "a little worse", "much worse".
Effectiveness of the blinding procedure
The patient should indicate, after the infiltrative procedure, the type of treatment they think they received.
Expectations of treatment efficacy
The patient should indicate at baseline what benefits they expect from the treatment

Full Information

First Posted
September 10, 2023
Last Updated
September 15, 2023
Sponsor
Istituto Ortopedico Rizzoli
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1. Study Identification

Unique Protocol Identification Number
NCT06040203
Brief Title
Leukocyte-rich PRP or Leukocyte-free PRP vs Placebo in the Treatment of Epicondylitis
Official Title
Leukocyte-rich PRP or Leukocyte-free PRP vs Placebo in the Treatment of Epicondylitis: a Randomized Controlled Clinical Trial
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
March 23, 2023 (Actual)
Primary Completion Date
March 2027 (Anticipated)
Study Completion Date
March 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Istituto Ortopedico Rizzoli

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The EPIC-PRP study is a double-blind randomized controlled clinical trial with 1:1:1 allocation.The objective of the study is to evaluate by means of a randomized controlled, double-blind clinical trial the clinical outcomes of echo-guided injection of PRP with or without leukocytes compared with echo-guided injection of saline for minimally invasive treatment of patients with epicondylitis resistant to conservative therapy. It will be the aim of the study to evaluate the efficacy and safety of the injection procedures by revealing the improvement and incidence of adverse events following treatment
Detailed Description
Patients with elbow epicondylitis will be included in a double-blind, randomized controlled trial, in which one group of patients will be treated with an echo-guided injection of LP-PRP (low leukocyte PRP), one group of patients will be treated with an echo-guided injection of LR-PRP (high leukocyte PRP), and another group of patients will be treated with an echo-guided injection of saline.All enrolled patients undergo sampling of a venous whole blood bag of approximately 300 cc from which Fresh Autologous PRP (PRP-A) will subsequently be obtained. According to randomization, a "leukodepletion" filter will be used to remove leukocytes in order to obtain LP-PRP. Instead, an aliquot of PRP will be cryopreserved and made available for the patient for a possible second PRP infiltration if there is no benefit after 6 months after the first infiltration.The patient will then be placed on the randomization list and will, therefore, be assigned to one of the three treatment groups (leukocyte-rich PRP, leukocyte-poor PRP, or saline solution). In the case of patients in the saline injection group, PRP will be prepared with or without leukocytes according to a dedicated randomization list, for possible treatment after 6 months if necessary.The patient will subsequently undergo 1 echo-guided infiltration, according to randomization.Patients will be clinically evaluated before the infiltration procedure and at 1-3-6-12 months after treatment by medical personnel. Questionnaires will be administered for clinical evaluations before treatment and at the above-mentioned clinical checkups during follow-up. Any adverse events to treatment will also be evaluated during follow-up visits. The duration and extent of swelling and pain following infiltration will be reported, and any drug therapies given by the patient will be recorded

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Tennis Elbow
Keywords
Platelet rich plasma, Leukocyte-rich PRP, Leukocyte-poor PRP, PRP, PRP injection, Double-blind randomized controlled clinical trial

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Model Description
This is a double-blind randomized controlled clinical trial with 1:1:1 allocation
Masking
ParticipantOutcomes Assessor
Masking Description
They will be "blinded" patients, health professionals who will assess clinical and functional outcomes (outcome assessors), and professionals who will analyze the data.
Allocation
Randomized
Enrollment
240 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Leukocyte-rich Platelet rich plasma (LR-PRP)
Arm Type
Experimental
Arm Description
This group of patients will be treated with single injection of autologous leukocyte rich platelet rich plasma.At the 6-month follow-up visit, the patient will be informed about the treatment received.
Arm Title
Leukocyte-poor Platelet rich plasma (LP-PRP)
Arm Type
Experimental
Arm Description
This group of patients will be treated withsSingle injection of autologous leukocyte poor platelet rich plasma.At the 6-month follow-up visit, the patient will be informed about the treatment received.
Arm Title
Saline solution
Arm Type
Placebo Comparator
Arm Description
This group of patients will be treated with single intra-articular injection of saline solution (placebo). At the 6-month follow-up visit, patients will be informed about the treatment received. Patients of this group can cross-over to the treatment arm after 6 months following a dedicated randomization list.
Intervention Type
Biological
Intervention Name(s)
Injection of autologous leukocyte rich platelet rich plasma (LR-PRP)
Intervention Description
Patients will be treated with a single eco-guided injection of Autologous LR-PRP in the elbow affected by epicondylitis.
Intervention Type
Biological
Intervention Name(s)
Injection of autologous leukocyte poor platelet rich plasma (LP-PRP)
Intervention Description
Patients will be treated with a single eco-guided injection of Autologous LP-PRP in the elbow affected by epicondylitis.
Intervention Type
Drug
Intervention Name(s)
Placebo (saline solution)
Intervention Description
Patients will be treated with a single injections of saline solution in the elbow affected by epicondylitis.
Primary Outcome Measure Information:
Title
Patient-rated Tennis Elbow Evaluation (PRTEE)
Description
PRTEE is a 15-item questionnaire designed to measure forearm pain and disability in patients with lateral epicondylitis (also known as "tennis elbow"). The PRTEE allows patients to rate their levels of tennis elbow pain and disability from 0 to 10, and consists of 2 subscales: 1) Pain subscale (0 = no pain, 10 = worst imaginable) item 2) Function subscale (0 = no difficulty, 10 = unable to do). The total score is the sum of the two subscales and has a range from 0 to 100.
Time Frame
6 months follow-up
Secondary Outcome Measure Information:
Title
Patient-rated Tennis Elbow Evaluation (PRTEE)
Description
PRTEE is a 15-item questionnaire designed to measure forearm pain and disability in patients with lateral epicondylitis (also known as "tennis elbow"). The PRTEE allows patients to rate their levels of tennis elbow pain and disability from 0 to 10, and consists of 2 subscales: 1) Pain subscale (0 = no pain, 10 = worst imaginable) item 2) Function subscale (0 = no difficulty, 10 = unable to do). The total score is the sum of the two subscales and has a range from 0 to 100.
Time Frame
baseline, 1 month, 3 months and 12 months follow-up
Title
Disability of the arm, shoulder and hand score (DASH)
Description
The Disabilities of the Arm, Shoulder and Hand (DASH) Score is a 30-item self-reported questionnaire in which the response options are presented as 5-point Likert scales. Scores range from 0 (no disability) to 100 (most severe disability). This score was designed be useful in patients with any musculoskeletal disorder of the upper limb.
Time Frame
baseline, 1 month, 3 months, 6 months and 12 months follow-up
Title
Tegner Activity Level Scale
Description
Tegner Activity Level Scale is a questionnaire to find out the patient's level of physical activity.All patients will indicate the type of sporting activity performed and its frequency. The Tegner activity scale is a one-item score that graded activity based on work and sports activities on a scale of 0 to 10. Zero represents disability and 10 represents a competitive level of sport.
Time Frame
baseline, 1 month, 3 months, 6 and 12 months follow-up
Title
Oxford Elbow Score (OES)
Description
Oxford Elbow score is a questionnaire consisting of 12 questions (related to pain, function, and socio-psychological aspects) specifically designed and developed to evaluate the outcomes of elbow surgery. The Oxford Elbow score has 12 items (questions) with 5 response options each. Each item response is scored as 0 to 4, with 0 representing greater severity. Underlying the 12 items are 3 domains (subscales): elbow pain, elbow function and social-psychological effects. Scores for each domain are calculated as the sum of each individual item score within that domain. This gives a score range of 0-16 for each domain and 0-48 overall, with 0 indicating the worst elbow score and 48 as a 'normal' elbow score
Time Frame
baseline, 1 month, 3 months, 6 and 12 months follow-up
Title
Visual Analogue Scale (VAS)
Description
Visual analog scale consisting of a straight line segment (10 cm length), the ends of which correspond to "no pain" (0) and "the strongest pain imaginable" (10).
Time Frame
baseline, 1 month, 3 months, 6 and 12 months follow-up
Title
EuroQol Visual Analogue Scale (EQ-VAS)
Description
EQ-VAS is a visual analog scale that has a range of scores from 0 (worst imaginable health condition) to 100 (best imaginable health condition).
Time Frame
baseline, 1 month, 3 months, 6 and 12 months follow-up
Title
EQ-5D (EuroQoL) Current Health Assessment
Description
The generic health-related quality of life instrument-EQ-5D-allows both a description of health status along 5 dimensions and the evaluation of health or the estimation of a health summary score: the EQ-5D score on a scale where 0 is death and 1 is full health. EQ-5D is useful to evaluate the quality life of the patients. The EQ-5D respondents classify their own health status into 5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression with 3 levels of severity (no problems, moderate problems, or severe problems).
Time Frame
baseline, 1 month, 3 months, 6 and 12 months follow-up
Title
Pain detect
Description
The Pain Detect-Questionnaire is a reliable screening tool for neuropathic pain with high sensitivity, specificity, and positive predictive accuracy. In this scale, the score ranges from 0 to 38 (range 0-12 neuropathic component of pain unlikely, range 13-18 neuropathic component of pain probably present, range 19-38 neuropathic component of pain present).
Time Frame
baseline
Title
Patient Acceptable Symptom State (PASS)
Description
A tool to assess patient satisfaction in consideration of their current degree of pain, function, and daily activity. Patients can express if their state of health will be satisfying, answering "yes" or "no.
Time Frame
baseline, 1 month, 3 months, 6 and 12 months follow-up
Title
Final treatment opinion
Description
The patient should indicate satisfaction and relative degree with treatment at the end of the clinical trial (24 months follow-up). All patients will be able to indicate their health condition by choosing from this answers; "Full recovery", "much better", "somewhat better", "no change", "a little worse", "much worse".
Time Frame
1 month, 3 months, 6 and 12 months follow-up
Title
Effectiveness of the blinding procedure
Description
The patient should indicate, after the infiltrative procedure, the type of treatment they think they received.
Time Frame
baseline
Title
Expectations of treatment efficacy
Description
The patient should indicate at baseline what benefits they expect from the treatment
Time Frame
baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with epicondylitis of the elbow: Patients with clinical picture of epicondylitis; Duration of symptoms > 3 months Ultrasound picture of short or long radial extensor carpal tendinopathy; Age > 18 and < 65 Both sexes; Failure, defined as persistence of symptoms, of other conservative treatments for at least 3 months; Hemoglobin > 11 g/dl; Platelet count > 150,000 plt/mm3 (Recently performed CBC examination); Negative serological tests for HBsAg, HCV Ab, HIV-1-2 Ab No clinically significant electrocardiographic changes (Recently performed ECG); Ability and consent of the patient to actively participate in clinical follow-up; Signature of informed consent. Exclusion Criteria: Patients undergoing previous surgical treatment on the epicondylar tendons; Patients undergoing epicondylar infiltration in the previous 6 months; Inability of patients to actively participate in clinical follow-up; Incapacitated patients; Patients with states of immunodepression; Patients with fibromyalgia; Ongoing systemic inflammatory diseases (stabilized outcomes of such diseases are not considered absolute contraindications); Patients with uncontrolled thyroid metabolic disorders; Patients abusing alcoholic beverages, drugs or medications; Patients who have taken NSAIDs in the 3 days prior to blood collection; Patients with coagulation problems or with ongoing antiplatelet therapy that cannot be suspended for at least 3 days prior to blood draw; Patients with cardiovascular disease for whom a 300-mL blood draw would be contraindicated; Positive serological tests for HBsAg, HCV Ab, HIV-1-2 Ab Other current elbow diseases (osteoarthritis, prevalence of symptomatology due to epitrochleitis, stiff elbow, etc.)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Enrico Guerra, MD
Phone
0516366567
Email
enrico.guerra@ior.it
First Name & Middle Initial & Last Name or Official Title & Degree
Roberta Licciardi, MSc
Phone
6366567
Ext
051
Email
roberta.licciardi@ior.it
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Enrico Guerra, MD
Organizational Affiliation
Istituto Ortopedico Rizzoli - SC Chirurgia della spalla e del gomito
Official's Role
Principal Investigator
Facility Information:
Facility Name
Istituto Ortopedico Rizzoli
City
Bologna
ZIP/Postal Code
40136
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Enrico Guerra, MD
Phone
6366567
Email
enrico.guerra@ior.it
First Name & Middle Initial & Last Name & Degree
Roberta Licciardi, MSc
Phone
6366567
Ext
051
Email
roberta.licciardi@ior.it

12. IPD Sharing Statement

Citations:
PubMed Identifier
33330224
Citation
Kim GM, Yoo SJ, Choi S, Park YG. Current Trends for Treating Lateral Epicondylitis. Clin Shoulder Elb. 2019 Dec 1;22(4):227-234. doi: 10.5397/cise.2019.22.4.227. eCollection 2019 Dec.
Results Reference
background
PubMed Identifier
19836974
Citation
Chen J, Wang A, Xu J, Zheng M. In chronic lateral epicondylitis, apoptosis and autophagic cell death occur in the extensor carpi radialis brevis tendon. J Shoulder Elbow Surg. 2010 Apr;19(3):355-62. doi: 10.1016/j.jse.2009.07.064.
Results Reference
background
PubMed Identifier
24292930
Citation
Hsu WK, Mishra A, Rodeo SR, Fu F, Terry MA, Randelli P, Canale ST, Kelly FB. Platelet-rich plasma in orthopaedic applications: evidence-based recommendations for treatment. J Am Acad Orthop Surg. 2013 Dec;21(12):739-48. doi: 10.5435/JAAOS-21-12-739.
Results Reference
background
PubMed Identifier
29268037
Citation
Chen X, Jones IA, Park C, Vangsness CT Jr. The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment. Am J Sports Med. 2018 Jul;46(8):2020-2032. doi: 10.1177/0363546517743746. Epub 2017 Dec 21.
Results Reference
background
PubMed Identifier
26955228
Citation
Karaduman M, Okkaoglu MC, Sesen H, Taskesen A, Ozdemir M, Altay M. Platelet-rich plasma versus open surgical release in chronic tennis elbow: A retrospective comparative study. J Orthop. 2016 Jan 22;13(1):10-4. doi: 10.1016/j.jor.2015.12.005. eCollection 2016 Mar.
Results Reference
background

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Leukocyte-rich PRP or Leukocyte-free PRP vs Placebo in the Treatment of Epicondylitis

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