A Prospective Randomized Double Blinded Controlled Trial of Non-Operative Management of TFCC Injuries
- Conditions
- Wrist InjuriesPRP
- Interventions
- Procedure: Platelet-rich plasma (PRP)
- Registration Number
- NCT03830775
- Lead Sponsor
- William Beaumont Army Medical Center
- Brief Summary
Platelet-rich Plasma (PRP) is formed when a patient's blood sample is concentrated by a commercially available centrifuge. The sample then contains a high concentration of growth factors and has been used for numerous indications in a number of joints. This process has not yet been proven for non-operative management of the Triangular FibroCartilage Complex (TFCC), which is a very commonly injured soft tissue structure in the wrist. This study seeks to determine the efficacy of PRP for TFCC injuries.
- Detailed Description
Platelet-rich Plasma (PRP) therapy has recently been indicated in the treatment of joint pain, arthritis, tendonitis, and to augment surgical treatment has become increasingly common (Hsu) PRP is obtained from obtaining an autologous blood sample, which is then condensed in a small commercial centrifuge to isolate a concentrated sample of platelets and growth factors. This sample contains high concentrations of Platelet-derived growth factors (PDGF), transforming growth factors β (TGFβ), insulin-like growth factor-1 (IGF1), and vascular endothelial growth factor-1 (VEGF) all of which aid in healing of soft tissues. (Padilla) The blood sample is autologous, the concentration is prepared in the clinic, and the complications of the injection are no greater than any other injection given in the clinic. (Hsu) In addition to being safe, PRP is efficacious. PRP has been well-studied including 10 prospective randomized controlled trials proving the effectiveness of PRP for knee osteoarthritis alone. (Dai) Strong evidence has also been reported in support of PRP use for bone healing (Bibbo, Tsai) tendinopathy (Mishra, Peerbooms) cartilage healing (Mei-Dan), and for augmentation of both ligament reconstruction (Fallouh) and repair (Mazzocca). Furthermore, the use of PRP has been shown to be a more cost effective treatment as compared to traditional methods in both chronic wound management and tendonitis (Gosens, Dougherty) PRP has not been studied in the wrist. Ulnar-sided wrist pain, most commonly involving the Triangular fibrocartilage complex (TFCC) is both difficult to diagnosis and treat,(Kleinmann, Fulcher, Graham) The TFCC is a meniscal homologue which acts to stabilize the wrist and to dissipate compressive forces. Tears within this soft tissue structure are painful and heal slowly. (Palmer, Palmer). Immobilization, steroid injections, or surgical treatment are the mainstays of treatment. However, PRP has not been studied as a treatment modality.
The purpose of this analysis is to study the efficacy of PRP injection in the treatment of a TFCC tear.
The null hypothesis is that there is no difference between injection into the wrist of PRP and saline (placebo).
The investigators hypothesize that PRP will reduce pain as compared to placebo.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 42
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Experimental - PRP injection Platelet-rich plasma (PRP) 2cc of PRP is injected into the ulnocarpal joint control - Saline injection Platelet-rich plasma (PRP) 2cc of 0.9% sterile saline is injected into the ulnocarpal joint
- Primary Outcome Measures
Name Time Method Disability of the Army Shoulder Hand (DASH) 12 months post injection SCALE: 0-100 (0 being a good result and 100 being complete disability)
- Secondary Outcome Measures
Name Time Method Michigan Hand Outcome Questionnaire (MHOQ Pre-injection, 2 weeks, 3 months SCALE: 0-100 (with 100 being a great result and 0 being considerable pain and dysfunction)
Single Assessment Numerical Evaluation (SANE) Pre-injection, 2 weeks, 3 months, 6 months, 12 months SCALE: 0-100 (with 100 being a great result and 0 being considerable pain and dysfunction)
Mayo Wrist Score (Mayo) Pre-injection, 2 weeks, 3 months, 6 months, 12 months SCALE: 0-100 (with 100 being a great result and 0 being considerable pain and dysfunction)
Pain Anxiety Symptom Scale (PASS) Pre-injection, 2 weeks, 3 months SCALE: 0-100 (100 meaning a patient has a high level of anxiety, pain, apprehension; while a lower scale indicates a patient has no concerns or anxiety about pain. The average is about 38 and the standard deviation is 20)
Trial Locations
- Locations (1)
Lola Norton
🇺🇸El Paso, Texas, United States