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Platelet Rich Plasma (PRP) injections for tennis elbow: What is the evidence?

Lateral epicondylitis (“tennis elbow”) is one of the most common conditions seen by orthopedists. It is estimated that 1-4% of the population suffers from tennis elbow. The peak incidence usually occurs between ages 30 and 50. Lateral epicondylitis is classified as an overuse injury to one of the main forearm extensor muscles. The muscle becomes weakened from overuse and microscopic tears develop in the tendon that attaches to the bone (lateral epicondyle). The end result is chronic pain and inflammation.

Treatment has traditionally included bracing, corticosteroid injections, use of non-steroidal anti-inflammatory medications, exercise, and surgery. Acupuncture, cold laser therapy, and extra corporeal shock wave therapy have also been utilized by some with mixed success.

Treatment of tennis elbow with PRP injections has gained popularity over the last ten years. Many studies are being conducted across the U.S… Within the current published medical literature, there are numerous studies comparing the use of PRP to other treatment modalities in the treatment of tennis elbow. Studies range from high quality, controlled clinical trials to single case reports. Of the studies published in the last five years, evidence for the use of PRP has been mixed, but has favored a positive outcome overall.

In the most recent of studies (Behera et al 2015), PRP was compared to bupivacaine for chronic tennis elbow. Bupivacaine is also known as Marcaine and is a local anesthetic. Twenty-Five patients were studied for up to 1 year following one injection of either PRP or bupivacaine. Those who received bupivacaine had better improvements in pain and functional scores than those treated with PRP. However, at 6 months and 1 year after injection, PRP was far superior to bupivacaine.

In a randomized control trial comparing PRP to an active control group by Mishra et al (2014), 230 patients were studied. A successful outcome was defined as a 25% or greater improvement on the visual analog pain scale. The results of the study showed that there were no differences between groups at 12 months, but at 24 months PRP was superior (83.9% vs. 68.3% in control group).

A doubled blinded, randomized control trial by Gosens et al (2011) comparing PRP versus corticosteroid injections in patients with chronic lateral epicondylitis has similar findings to Mishra et al. In this study, 150 patients were randomly divided into the two groups. Patients treated with PRP were significantly improved versus those who had received a corticosteroid injection after two years of follow-up. No complications were noted.

There are additional published studies looking at PRP use in treating lateral epicondylitis. Evaluating these studies can be challenging as the comparison group (“controls”) and outcome measures often vary considerably. Unfortunately, some studies also have methodological flaws which may invalidate the results.

PRP for tennis elbow does appear to be safe and has so far shown the potential to be effective for a subset of patients.