Official Journal of the Italian Society of Orthopaedics and Traumatology
Table 2. List of statements categorised by consensus group – Consensus of: agreement, disagreement, neither agree nor disagree or consensus not reached
Statement category | |
|---|---|
Consensus of agreement (median score = 4 or 5) | |
PRP should only be considered in patients presenting with characteristic tennis elbow pain (lateral elbow pain exacerbated by wrist extension) | Patient selection |
PRP should only be considered in patients who are experiencing considerable intrusion into their activities of daily life | Patient selection |
PRP treatment can be considered in patients over the age of 18, with no upper age limit | Patient selection |
PRP treatment can be considered in patients with manual or sedentary occupations | Patient selection |
PRP treatment can be considered in both high demand (e.g., sports people) and low demand (e.g., office worker) patients | Patient selection |
PRP is contraindicated in patients with known thrombocytopenia (less than 150,000 platelets per microlitre of whole blood) | Contraindication |
A single spin cycle of 20 min or less is recommended | PRP formulation |
PRP activation, through the addition of additives prior to its administration, is not required | PRP formulation |
Once processed, PRP should be administered within 30 min | Administration technique |
Needle fenestration is recommended over a single injection technique | Administration technique |
Following the first administration of PRP, the patient should be reassessed to discern the need for repeated administration | Administration strategy |
Surgery is recommended for patients in whom PRP treatment is not effective | Administration strategy |
Immobilisation of the elbow following injection is not necessary | Post procedural care |
Light loads should be avoided for the first 48 h following injection | Post procedural care |
Acetaminophen (paracetamol) and weak opioid-based analgesia can be offered as required following PRP administration | Post procedural care |
Clinical assessment is recommended to assess the outcome of PRP administration | Outcome assessment |
A validated patient-reported outcome measure (PROM) (e.g., PRTEE, DASH, OES) should be collected in addition to clinical assessment | Outcome assessment |
Consensus of disagreement (median score = 1 or 2) | |
PRP is contraindicated in patients with a coagulopathy | Contraindications |
PRP is contraindicated in patients taking anticoagulant medication | Contraindications |
Consensus of ‘neither agree nor disagree’ (median score = 3) | |
The maximum recommended platelet concentration of injected PRP is 5 × baseline | PRP formulation |
The maximum recommended volume of PRP is 3 ml | PRP formulation |
The addition of an anticoagulant to the whole blood sample is recommended prior to PRP preparation | PRP formulation |
A 19 g is the recommended MAXIMUM size used to administer PRP | Administration technique |
Consensus not reached | |
PRP should only be considered following at least 3 months of conservative therapy | Patient selection |
PRP is contraindicated in patients with large wrist extensor tendon tears | Contraindication |
PRP is contraindicated in patients with a dependence on non-steroidal anti-inflammatory drugs (NSAIDs) | Contraindication |
PRP is contraindicated in patients who have received a steroid injection for treatment of their lateral epicondylar tendinopathy, within 3 months of the intended PRP treatment date | Contraindication |
The minimum recommended platelet concentration of injected PRP is 2 × baseline | PRP formulation |
The minimum recommended volume of PRP is 1 ml | PRP formulation |
Leukocyte deplete PRP is the recommended formulation | PRP formulation |
Local anaesthetic should be administered to the skin and subcutaneous tissue | Administration technique |
Local anaesthesia should not be administered to the tendon | Administration technique |
Ultrasound guidance should be utilised in all PRP injections for lateral epicondylar tendinopathy | Administration technique |
A maximum of 3 administrations is recommended for each episode of lateral epicondylar tendinopathy | Administration strategy |
If symptoms recur following a successful course of treatment, PRP injection can be reattempted | Administration strategy |
Heavy loads should be avoided for 6 weeks | Post procedural care |
Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided for 1 week prior to PRP administration | Post procedural care |
Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided for at least 2 weeks following injection | Post procedural care |
A visual analogue pain score (VAS) should be collected in addition to clinical assessment | Outcome assessment |
Resolution of tendinosis on US or MRI can be utilised to assess outcome | Outcome assessment |