Introduction: Emergent technologies, i.e., monopolar capacitive coupled
Radiofrequency (mcRF) and Platelet Rich Plasma (PRP) are now available to
treat conditions characterized by a failed Wound Healing Response. Both mcRF
and PRP positively influence the chemical/cellular inflammatory cascade to promote
healing. mcRF application results in temperature elevation at the targeted
structure up to 50℃ stimulating heat shock proteins, thus inciting the Wound
Healing Response. Ultrasound-guided PRP injections results in an inflammatory/reparative reaction through cytokinin
release. Methods: Sixty-eight patients who have failed previous conservative
treatment for tendinopathies and chronic ligament conditions of the elbow,
hip, knee and ankle/foot, were treated either with mcRF or PRP. Treatments
were delivered directly by the investigator, and patients were followed
prospectively for an average of 19.7 months (range 15 to 24 months). Results: Average
age for the mcRF cohort was 53 years (range 17 to 88). Average age for the PRP
group was 58 (range 19 to 90). The male to female ratio for both groups was
1/1. 33 of 42 patients treated with mcRF experienced marked improvement (78%),
while in the PRP group 19 of 26 patients experienced marked improvement (73%)
as self-assessed by study subjects. Discussion/Conclusion: Results of this
study are in agreement with reports on the use of both technologies; however, this is the first time that a
side-by-side comparison is established. PRP and mcRF represent a new approach
to musculoskeletal pathology; both modalities aim at inducing a biological
response and are considered at the frontier of regenerative therapeutics.
The high safety profile suggests that these, non-invasive (mcRF) and minimally invasive
(PRP), office-based alternatives for the management of musculoskeletal
conditions are valuable tools and should be used in accordance with a clear
understanding of the underlying pathology.
Cite this paper
Cronkey, J. and Villegas, D. (2013) Monopolar capacitive coupled Radiofrequency (mcRF) and ultrasound-guided Platelet Rich Plasma (PRP) give similar results in the treatment of enthesopathies: 18-Month follow-up. Health, 5, 72-77. doi: 10.4236/health.2013.56A2011.
 Hudak, P.L., Cole, D.C. and Haines, A.T. (1996) Understanding prognosis to improve rehabilitation: The example of lateral elbow pain. Archives of Physical Medicine and Rehabilitation, 77, 586-593.
 Bisset, L., Smidt, N., Van der Windt, D.A., et al. (2007) Conservative treatments for tennis elbow do subgroups of patients respond differently? Rheumatology, 46, 1601- 1605.
 Bjordal, J.M., Lopes-Martins, R., Joensen, J., et al. (2008) A systematic review with procedural assessments and metaanalysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord, 9, 75.
 Smidt, N., Assendelft, W.J., Arola, H., et al. (2003) Effectiveness of physiotherapy for lateral epicondylitis: A systematic review. Annals of Medicine, 35, 51-62.
 Kivi, P. (1983) The etiology and conservative treatment of humeral epicondylitis. Scandinavian Journal of Rehabilitation Medicine, 15, 37-41.
 Kay, N.R. (2003) Litigants’ epicondylitis. Journal of Hand Surgery, 28, 460-464.
 Faro, F. and Wolf, J.M. (2007) Lateral epicondylitis: Review and current concepts. Journal of Hand Surgery, 32, 1271-1279. doi:10.1016/j.jhsa.2007.07.019
 Nirschl, R.P. and Pettrone, F.A. (1979) Tennis elbow. The surgical treatment of lateral epicondylitis. The Journal of Bone & Joint Surgery, 61, 832-839.
 Weil, L.J.R., Glover, J.P. and Weil, L.S.S.R. (2008) A new minimally invasive technique for treating plantar fasciosis using bipolar radiofrequency: A prospective analysis. Foot & Ankle Specialist, 1, 13-18.
 Nirschl, R.P. (1995) Tennis elbow tendinosis: Pathoanatomy, nonsurgical and surgical management. In: Repetitive Motion Disorders of the Upper Extremity. American Academy of Orthopaedic Surgeons, Rosemont.
 Kraushaar, B.S. and Nirschl, R.P. (1999) Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. The Journal of Bone & Joint Surgery, 81, 259-278.
 Dunn, J.H., Kim, J.J., Davis, L. and Nirschl, R.P. (2008) Tento 14-year follow-up of the Nirschl surgical technique for lateral epicondylitis. The American Journal of Sports Medicine, 36, 261-266.
 Meknas, K., Odden-Miland, A., Mercer, J.B., Castillejo, M. and Johansen, O. (2008) Radiofrequency microtenotomy: A promising method for treatment of recalcitrant lateral epicondylitis. The American Journal of Sports Medicine, 36, 1960-1965. doi:10.1177/0363546508318045
 Almekinders, L.C. and Temple, J.D. (1998) Etiology, diagnosis, and treatment of tendonitis: An analysis of the literature. Medicine & Science in Sports & Exercise, 30, 1183-1190. doi:10.1097/00005768-199808000-00001
 Schmidt-Rohlfing, B., Graf, J., Schneider, U. and Niethard, F.U. (1992) The blood supply of the Achilles tendon. International Orthopaedics, 16, 29-31.
 Yepes, H., Tang, M., Morris, S.F. and Stanish, W.D. (2008) Relationship between hypovascular zones and patterns of ruptures of the quadriceps tendon. The Journal of Bone & Joint Surgery, 90, 2135-2141. doi:10.2106/JBJS.G.01200
 Almekinders, L.C., Baynes, A.J. and Bracey, L.W. (1995) An in vitro investigation into the effects of repetitive motion and nonsteroidal antiinflammatory medication on human tendon fibroblasts. The American Journal of Sports Medicine, 23, 119-123.
 Smidt, N., Assendelft, W.J., van der Windt, D.A., Hay, E.M., Buchbinder, R. and Bouter, L.M. (2002) Corticosteroid injections for lateral epicondylitis: A systematic review. Pain, 96, 23-40.
 Fisher, P. (2004) Role of steroids in tendon rupture or disintegration known for decades. Archives of Internal Medicine, 164, 678. doi:10.1001/archinte.164.6.678-a
 Newnham, D.M., Douglas, J.G., Legge, J.S. and Friend, J.A. (1991) Achilles tendon rupture: An underrated complication of corticosteroid treatment. Thorax, 46, 853-854. doi:10.1136/thx.46.11.853
 Buchbinder, R., Green, S., White, M., Barnsley, L., Smidt, N. and Assendelft, W.J. (2002) Shock wave therapy for lateral elbow pain. Cochrane Database of Systematic Reviews, 1, CD003524.
 Buchbinder, R., Green, S.E., Youd, J.M., Assendelft, W.J., Barnsley, L. and Smidt, N. (2005) Shock wave therapy for lateral elbow pain. Cochrane Database of Systematic Reviews, 4, CD003524.
 Buchbinder, R., Green, S.E., Youd, J.M., Assendelft, W.J., Barnsley, L. and Smidt, N. (2006) Systematic review of the efficacy and safety of shock wave therapy for lateral elbow pain. The Journal of Rheumatology, 33, 1351-1363.
 Staples, M.P., Forbes, A., Ptasznik, R., Gordon, J. and Buchbinder, R. (2008) A randomized controlled trial of extracorporeal shock wave therapy for lateral epicondylitis (tennis elbow). The Journal of Rheumatology, 35, 2038-2046.
 Keizer, S.B., Rutten, H.P., Pilot, P., Morre, H.H., van Os, J.J. and Verburg, A.D. (2002) Botulinum toxin injection versus surgical treatment for tennis elbow: A randomized pilot study. Clinical Orthopaedics and Related Research, 401, 125-131. doi:10.1097/00003086-200208000-00015
 Morre, H.H., Keizer, S.B. and van Os, J.J. (1997) Treatment of chronic tennis elbow with botulinum toxin. Lancet, 349, 1746. doi:10.1016/S0140-6736(05)62958-3
 Placzek, R., Drescher, W., Deuretzbacher, G., Hempfing, A. and Meiss, A.L. (2007) Treatment of chronic radial epicondylitis with botulinum toxin A. A double-blind, placebo-controlled, randomized multicenter study. The Journal of Bone & Joint Surgery, 89, 255-260.
 McShane, J.M., Nazarian, L.N. and Harwood, M.I. (2006) Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow. Journal of Ultrasound in Medicine, 25, 1281-1289.
 Whipple, T. and Steinmann, S. (2012) Mechanism of action of non-invasive monopolar radiofrequency: Technology review. Open Journal of Orthopedics, 3, 23-28.
 Whipple, T. and Villegas, D. (2010) Thermal and electric energy fields by noninvasive monopolar capacitive-coupled radiofrequency: Temperatures achieved and histological outcomes in tendons and ligaments. PM&R, 2, 599-606.
 England, L., Egbert, B. and Pope, K. (2005) Wound healing in an animal model following thermage treatment. Wound Repair and Regeneration, 13, A28-A48.
 England, L.J., Egbert, B.M. and Pope, K. (2005) Dermal wound healing in an animal model following monopolar radiofrequency treatment. Wound Healing Society Meeting, Chicago.
 Whiiple, T. and Villegas, D. (2011) Bioactive radiofrequency effects on ligament and tendon injuries. In: Mahmut Nedim Doral, M., Reha, N., Tandogan, M., Gideon Mann, M. and Rene Verdonk, M., Eds., Sports Injuries— Prevention, Diagnosis, Treatment and Rehabilitation. 1st Edition, Springer-Verlag, Berlin, 1193-1200.
 Hayashi, A. (2008) Getting athletes back in the game: A global view. AAOS Now, 2, 1-6.
 Werner, S. and Grose, R. (2003) Regulation of wound healing by growth factors and cytokines. Physiological Reviews, 83, 835-870.
 Mishra, A. and Pavelko, T. (2006) Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. The American Journal of Sports Medicine, 34, 1774-1778.
 Weber, T. and Kabelka, B. (2012) Non-invasive monopolar capacitive-coupled radiofrequency (mcRF) for the treatment of elbow lateral tendinopathies: 1-year followup. PM&R, 4, 176-181. doi:10.1016/j.pmrj.2011.11.003
 Foster, T.E., Puskas, B.L., Mandelbaum, B.R., Gerhardt, M.B. and Rodeo, S.A. (2009) Platelet-rich plasma: From basic science to clinical applications. American Journal of Sports Medicine, 37, 2259-2272.
 Whipple, T.L. (2009) From mini-invasive to non-invasive treatment using monopolar radiofrequency: The next orthopaedic frontier. Orthopedic Clinics of North America, 40, 531-535. doi:10.1016/j.ocl.2009.06.006
 Cronkey, J. and LaPorta, G. (2012) Rating systems for evaluation of functional ankle instability: Prospective evaluation in a cohort of patients treated with mcRF. Foot and Ankle Specialist, 5, 293-299.
 de Vos, R.J., Weir, A., van Schie, H.T., et al. (2010) Platelet-rich plasma injection for chronic Achilles tendinopathy: A randomized controlled trial. Journal of the American Medical Association, 303, 144-149.
 Hall, M.P., Band, P.A., Meislin, R.J., Jazrawi, L.M. and Cardone, D.A. (2009) Platelet-rich plasma: Current concepts and application in sports medicine. Journal of the American Academy of Orthopaedic Surgeons, 17, 602- 608.
 Hildebrand, K.A., Woo, S.L., Smith, D.W., et al. (1998) The effects of platelet-derived growth factor-BB on healing of the rabbit medial collateral ligament. An in vivo study. The American Journal of Sports Medicine, 26, 549- 554.
 Allain, J.C., Le Lous, M., Bazin, S., Bailey, A.J. and Delaunay, A. (1978) Isometric tension developed during heating of collagenous tissues. Relationships with collagen cross-linking. Biochimica et Biophysica Acta (BBA)- Protein Structure, 533, 147-155.
 Allain, J.C., Le Lous, M., Cohen, S., Bazin, S. and Maroteaux, P. (1980) Isometric tensions developed during the hydrothermal swelling of rat skin. Connective Tissue Research, 7, 127-133. doi:10.3109/03008208009152104
 Arnoczky, S.P. and Aksan, A. (2000) Thermal modification of connective tissues: Basic science considerations and clinical implications. Journal of the American Academy of Orthopaedic Surgeons, 8, 305-313.
 Ochiai, N., Tasto, J.P., Ohtori, S., Takahashi, N., Moriya, H. and Amiel, D. (2007) Nerve regeneration after radiofrequency application. The American Journal of Sports Medicine, 35, 1940-1944.
 Takahashi, N., Tasto, J.P., Ritter, M., et al. (2007) Pain relief through an antinociceptive effect after radiofrequency application. The American Journal of Sports Medicine, 35, 805-810. doi:10.1177/0363546506297085
 Wright, N.T. and Humphrey, J.D. (2002) Denaturation of collagen via heating: An irreversible rate process. Annual Review of Biomedical Engineering, 4, 109-128.
 Letcher, F.S. and Goldring, S. (1968) The effect of radiofrequency current and heat on peripheral nerve action potential in the cat. Journal of Neurosurgery, 29, 42-47.
 Grellner, W., Georg, T. and Wilske, J. (2000) Quantitative analysis of proinflammatory cytokines (IL-1beta, IL-6, TNF-alpha) in human skin wounds. Forensic Science International, 113, 251-264.
 Grose, R., Werner, S., Kessler, D., et al. (2002) A role for endogenous glucocorticoids in wound repair. EMBO Reports, 3, 575-582. doi:10.1093/embo-reports/kvf119
 Hubner, G., Brauchle, M., Smola, H., Madlener, M., Fassler, R. and Werner, S. (1996) Differential regulation of pro-inflammatory cytokines during wound healing in normal and glucocorticoid-treated mice. Cytokine, 8, 548- 556. doi:10.1006/cyto.1996.0074