Stewart Zachary Elijah, Steiner Quinn, Kliethermes Stephanie A, Wilson John, Lee Kenneth S
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA.
Eur Radiol. 2025 Jul 26. doi: 10.1007/s00330-025-11867-9.
To compare ultrasound and shear wave elastography (SWE) changes in the common extensor tendon over time after platelet-rich plasma (PRP) or corticosteroid (CS) treatment, and to assess for correlations between patient-reported outcomes (PROs) and US/SWE changes of the common extensor tendon.
A secondary analysis of a prospective double-blinded, randomized controlled trial comparing US and SWE changes after a single treatment of PRP or CS for the treatment of lateral epicondylosis was conducted. Subjects 18-65 years with recalcitrant lateral elbow pain were enrolled between 3/1/2017 and 4/1/2019 and randomized to a treatment group. US/SWE of the common extensor tendon was performed at baseline, 26 weeks, and 52 weeks, and PROs were also recorded. Treatment effects between groups were compared using linear mixed effects models.
Fifty elbows in 47 subjects (mean 48 years ± 8; 25 women) were randomized to two groups-PRP (N = 26) and CS (N = 24). Shear wave speed (SWS) increased with PRP more than with CS at both 26 weeks (2.02 m/s ± 0.61; p = 0.002) and 52 weeks (2.98 m/s ± 0.49; p < 0.01). At 26 weeks, no differences were detected between treatments by conventional US. At 52 weeks, echogenicity and hyperemia improved with PRP relative to CS (p < 0.05). Increased SWS correlated with improvement in all PROs (p < 0.05). For conventional US changes, the only correlation to PROs was that of echogenicity with pain (p = 0.04).
SWS increased more with PRP than CS at 26- and 52-week post-treatment for lateral epicondylosis, and increased SWS correlated with clinical improvement.
Question Can SWE detect healing changes in the common extensor tendon associated with clinical improvement of lateral epicondylitis in patients treated with PRP or CS injection? Findings Higher common extensor tendon SWSs were associated with clinical improvement and improved more in those treated with PRP than with CS. Clinical relevance statement SWE may be able to quantitatively detect treatment changes in tendons associated with clinical improvement.
比较富血小板血浆（PRP）或皮质类固醇（CS）治疗后，随着时间推移，伸肌总腱的超声和剪切波弹性成像（SWE）变化，并评估患者报告结局（PROs）与伸肌总腱的超声/SWE变化之间的相关性。
对一项前瞻性双盲随机对照试验进行二次分析，该试验比较了单次PRP或CS治疗外侧上髁炎后超声和SWE的变化。纳入2017年3月1日至2019年4月1日期间18 - 65岁、患有顽固性外侧肘部疼痛的受试者，并随机分为治疗组。在基线、26周和52周时对伸肌总腱进行超声/SWE检查，并记录PROs。使用线性混合效应模型比较组间治疗效果。
47名受试者（平均48岁±8岁；25名女性）的50个肘部被随机分为两组——PRP组（N = 26）和CS组（N = 24）。在26周（2.02 m/s±0.61；p = 0.002）和52周（2.98 m/s±0.49；p < 0.01）时，PRP组的剪切波速度（SWS）升高幅度均大于CS组。在26周时，常规超声检查未发现治疗组之间存在差异。在52周时，与CS组相比，PRP组的回声性和充血情况有所改善（p < 0.05）。SWS升高与所有PROs的改善相关（p < 0.05）。对于常规超声变化，与PROs唯一相关联的是回声性与疼痛的关联（p = 0.04）。
对于外侧上髁炎，治疗后26周和52周时，PRP组的SWS升高幅度大于CS组，且SWS升高与临床改善相关。
问题SWE能否检测出接受PRP或CS注射治疗的患者中，与外侧上髁炎临床改善相关的伸肌总腱愈合变化？研究结果伸肌总腱较高的SWS与临床改善相关，且PRP治疗组的改善程度大于CS治疗组。临床相关性声明SWE或许能够定量检测与临床改善相关的肌腱治疗变化。
