Current treatments for lateral epicondylitis include: rest, behaviour modification and physiotherapy, anti-inflammatory medication - both steroidal and non-steroidal, and surgery. Current experimental therapies include muscle relaxants to reduce muscle tone and force on the epicondyle, laser therapy to stimulate collagen production, and blood based therapies including the injection of autologous blood and protein rich plasma. Cell Therapy Ltd (trading as Celixir) has developed a regenerative gel that combines isolated allogeneic platelet growth factors and a cellulose-derivative gel.
Lateral epicondylitis, also called "tennis elbow" is a common condition affecting 1 to 3% of the population; most commonly individuals aged 35 to 55 years. It is frequently self limiting but can lead to refractory symptoms in a minority of cases. Pain is localised to the lateral epicondyle of the elbow at the point of insertion of the common extensor tendon. Although associated with repetitive movement of the extensor muscles of the forearm, frequently no precipitating cause can be discerned. The term "epicondylitis" is a misnomer as histological investigations have revealed that there is only limited inflammation, and the term "epicondylosis" should be employed, due to the degenerative nature of the condition. The condition is divided in to 4 stages, though progression may not occur through all four. Firstly, there is acute inflammation that is quick to resolve. Secondly, prolonged injury results in an increase in fibroblasts, vascular hyperplasia, disorganised collagen disposition and degeneration of the tendon. Thirdly, further accumulation of structural alterations leads to partial or complete tendon rupture. Stage 4 exhibits the same features as 2 and 3 but with the addition of calcification. Current treatments for lateral epicondylitis include: rest, behaviour modification and physiotherapy, anti-inflammatory medication both steroidal and non-steroidal, and surgery. Current experimental therapies include muscle relaxants to reduce muscle tone and force on the epicondyle, laser therapy to stimulate collagen production, and blood based therapies including the injection of autologous blood and protein rich plasma. Trials of the latter two treatments give conflicting results due to variations in protocol and trial design. Cell Therapy Ltd has developed a regenerative gel, Tendoncel, that combines isolated platelet growth factors and cellulose-derivative gel. Tendoncel consists of a proprietary platelet lysate formulation that is easy to apply to the skin.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
30
Platelet lysate gel
Placebo control gel
Orthopaedic Clinic of Aristotle University of Thessaloniki, General Hospital of Papanikolaou
Thessaloniki, Greece
Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire
15 question questionnaire measuring pain and function. Total scores from 15 questions compared - pain and function combined. Scale: 10 to 100 (best to worst). Difference between test and control scores compared.
Time frame: Baseline
Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire
15 question questionnaire measuring pain and function. Total scores from 15 questions compared - pain and function combined. Scale: 10 to 100 (best to worst). Difference between test and control scores compared.
Time frame: Day 23 (end of treatment).
Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire
15 question questionnaire measuring pain and function. Total scores from 15 questions compared - pain and function combined. Scale: 10 to 100 (best to worst). Difference between test and control scores compared.
Time frame: 4 weeks follow up
Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire
15 question questionnaire measuring pain and function. Total scores from 15 questions compared - pain and function combined. Scale: 10 to 100 (best to worst). Difference between test and control scores compared.
Time frame: 6 weeks follow up.
Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire
15 question questionnaire measuring pain and function. Total scores from 15 questions compared - pain and function combined. Scale: 10 to 100 (best to worst). Difference between test and control scores compared.
Time frame: 3 months follow up.
Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire
15 question questionnaire measuring pain and function. Total scores from 15 questions compared - pain and function combined. Scale: 10 to 100 (best to worst). Difference between test and control scores compared.
Time frame: Mean of 47 weeks follow up.
Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire
30 question questionnaire measuring disabilities of the upper limb. Scale from 0 to 100 (best to worst). Difference between test and control scores compared.
Time frame: Baseline
Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire
30 question questionnaire measuring disabilities of the upper limb. Scale from 0 to 100 (best to worst). Difference between test and control scores compared.
Time frame: Day 23.
Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire
30 question questionnaire measuring disabilities of the upper limb. Scale from 0 to 100 (best to worst). Difference between test and control scores compared.
Time frame: 4 week follow up.
Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire
30 question questionnaire measuring disabilities of the upper limb. Scale from 0 to 100 (best to worst). Difference between test and control scores compared.
Time frame: 6 week follow up.
Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire
30 question questionnaire measuring disabilities of the upper limb. Scale from 0 to 100 (best to worst). Difference between test and control scores compared.
Time frame: 3 months follow up
Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire
30 question questionnaire measuring disabilities of the upper limb. Scale from 0 to 100 (best to worst). Difference between test and control scores compared.
Time frame: Mean of 47 weeks follow up.
Pain free grip strength
Measured using a dynamometer. Results compared between test and control elbows, and between study and contralateral elbow (internal control).
Time frame: Baseline
Pain free grip strength
Measured using a dynamometer. Results compared between test and control elbows, and between study and contralateral elbow (internal control).
Time frame: Day 23
Pain free grip strength
Measured using a dynamometer. Results compared between test and control elbows, and between study and contralateral elbow (internal control).
Time frame: Mean of 47 weeks follow up (final follow up).
Safety - Number of participants in each group with adverse events.
Measured by participant questionnaire. Comparison of the number of participants in each group with cutaneous events - "redness", "rash", "swelling" or changes at gel site. Classed as none, mild, moderate or severe. Plus any other event mentioned by the participants.
Time frame: Day 3 (1st treatment visit), day 7, day 14, day 21, day 23 (end of treatment). Follow ups: 4 weeks, 6 weeks, 3 months and mean of 47 weeks.
Safety: Immune response - blood IgE levels. Difference between test and control groups.
Measurement of blood IgE levels. Test and control averages compared. Normal is \<100IU/mL.
Time frame: Baseline
Safety: Immune response - blood IgE levels. Difference between test and control groups.
Measurement of blood IgE levels. Test and control averages compared. Normal is \<100IU/mL.
Time frame: Day 7
Safety: Immune response - blood IgE levels. Difference between test and control groups.
Measurement of blood IgE levels. Test and control averages compared. Normal is \<100IU/mL.
Time frame: Day 23
Safety: Immune response - blood IgE levels. Number of participants in each group with a normal baseline reading and a subsequently elevated reading.
Measurement of blood IgE levels. Comparison of the number of participants in each group, test and control, with a normal baseline reading of blood IgE and a subsequently elevated IgE reading. Normal is \<100IU/mL.
Time frame: Baseline, day 7 and day 23.
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