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Scientific literature review: PRP (Platelet Rich Plasma) for the treatment of tennis and golfer's elbow

In the last few years there have been several good quality publications demonstrating the effectiveness of PRP in the treatment of tennis and golfer's elbow. This includes some randomised controlled trials of good quality and some systematic literature reviews. Although some publications suffer from poor methodology, there is an overall strong body of evidence to support the use of PRP in the treatment of tennis elbow. Golfer's elbow is a much rarer condition and it is no surprise that there is a paucity of good quality publications investigating the use of PRP. Our experience at the Orthobiologics Clinic of using PRP for patients with lateral and medial condylitis has been a very positive one and mirrors the good results demonstrated in the various research trials.

The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: A systematic review

Walid Ben-Nafa and Wendy Munro (2018)

The authors of this paper undertook a systematic review of 732 publications and identified 5 randomised trials comparing the effectiveness of corticosteroid injections with PRP injections for the treatment of tennis elbow (lateral condylitis). Their findings were:

  • Steroid injections provide rapid pain relief, but the effect wears off after 6-8 weeks
  • PRP injections lead a slower improvement in symptoms, but the effect lasts much longer
  • Steroid injections resulted in thinning of the tendons

The authors concluded that corticosteroid injections provide rapid therapeutic effect in the short-term with recurrence of symptoms afterwards, compared to the relatively slower but longer term beneficial effect of platelet-rich plasma.

Platelet rich plasma versus steroid on lateral epicondylitis: meta-analysis of randomized clinical trials

Bobin Mi, Guohui Liu, Wu Zhou, Huijuan Lv, Yi Liu, Qipeng Wu & Jing Liu (2017)

The authors identified 8 randomised controlled trials with 511 patients. Their findings were:

  • The was no significant difference in pain relief in the short term 4-6 weeks) and intermediate term (12 weeks) between the two treatments
  • Steroid injections resulted in better function in the short term (4-8 weeks)
  • PRP resulted in superior pain relief in the long term (6-12 months)
  • PRP treatment led to better functional outcomes in the intermediate term (3 months) and long term (6-12 months)

The authors concluded that treatment of patients with LE by steroid could slightly relieve pain and significantly improve function of elbow in the short-term (2 to 4 weeks, 6 to 8 weeks). PRP appears to be more effective in relieving pain and improving function in the intermediate-term (12 weeks) and long-term (6 months and one year). Considering the long-term effectiveness of PRP, we recommend PRP as the preferred option for LE.

Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis

Alisara Arirachakaran, Amnat Sukthuayat, Thaworn Sisayanarane, Sorawut Laoratanavoraphong, Wichan Kanchanatawan, Jatupon Kongtharvonskul (2016)

Another systematic review and meta-analysis providing Level 1 evidence (the highest level of evidence in scientific research). 10 publications were reviewed and analysed.
The authors concluded: This network meta-analysis provided additional information that PRP injection can improve pain and lower the risk of complications, whereas AB injection can improve pain, disabilities scores and pressure pain threshold but has a higher risk of complications.

The use of biologics for the elbow: a critical analysis review

Jason L. Dragoo, MDa, *,1 , Molly C. Meadows, MDb,1 (2019)

This working group from the USA undertook a major review of the various orthobiologics preparations and their use in the treatment of elbow conditions. As far as the use of PRP is concerned they came up with the following recommendations:

  • The application of platelet-rich plasma has superior results to corticosteroids for long-term pain relief in lateral epicondylitis (Grade A: Good evidence (Level I studies with consistent findings) for or against recommending intervention.)
  • First-line use of platelet-rich plasma in lateral epicondylitis can be recommended on the basis of the current literature (Grade B: Fair evidence (Level II or III studies with consistent findings) for or against recommending intervention.)
  • The use of platelet-rich plasma has been shown to reduce pain secondary to tendinopathies about the elbow (Grade B: Fair evidence (Level II or III studies with consistent findings) for or against recommending intervention.)

Autologous platelet-rich plasma versus corticosteroid in the management of elbow epicondylitis: A randomized study

Varshney A, Maheshwari R, Juyal A, Agrawal A, Hayer P. (2017)

The authors studied the use of PRP in the treatment of both lateral and medial epicondylitis. Although the results demonstrate superior results in the PRP group compared to the steroid group, the authors didn't stratify the results into lateral vs. medial epicondylitis. This is one of the very few randomised trials looking into the use of PRP in the treatment of both tennis and golfer's elbow. While the results are promising, there is still a need for further good quality research to determine the effect of PRP in the treatment of medial epicondylitis (golfer's elbow).

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