Tennis Elbow: PRP vs Steroid Injection. Peerbooms et al (2010)
Peerbooms JC, Sluimer J, Burijn DJ, Gosens T. Positive Effect of an Autologous Platelet Concentrate in Lateral Epicondylitis in a Double-Blind Randomized Controlled Trial: Platelet-Rich Plasma Versus Corticosteroid Injection With a 1-Year Follow-up Am J Sports Med 2010 38:255-262.
Dr. Reeves' Notes: This was a good-sized trial with 100 patients. PRP group better at 1 year outcome with a single injection with peppering technique than with corticosteroid injection in this blinded study. Note that there was no control group without injection and steroid may be a somewhat harmful treatment ultimately. Success was defined as a 25% reduction in pain or DASH score (explained below) at 1 year and was 73% with PRP versus 49% in the steroid group. Steroid injected patients felt better quicker but did not do as well on longer term followup.
The complete study on Tennis Elbow is available in PDF format here.
A copy of the abstract is below:
Background: Platelet-rich plasma (PRP) has shown to be a general stimulation for repair. Purpose: To determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis.
Study Design: Randomized controlled trial
Level of evidence: Patients: The trial was conducted in 2 teaching hospitals in the Netherlands. One hundred patients with chronic lateral epicondylitis were randomly assigned in the PRP group (n 5 51) or the corticosteroid group (n 5 49). A central computer system carried out randomization and allocation to the trial group. Patients were randomized to receive either a corticosteroid injection or an autologous platelet concentrate injection through a peppering technique. The primary analysis included visual analog scores and DASH Outcome Measure scores (DASH: Disabilities of the Arm, Shoulder, and Hand).
Results: Successful treatment was defined as more than a 25% reduction in visual analog score or DASH score without a reintervention after 1 year. The results showed that, according to the visual analog scores, 24 of the 49 patients (49%) in the corticosteroid group and 37 of the 51 patients (73%) in the PRP group were successful, which was significantly different (P\.001). Furthermore, according to the DASH scores, 25 of the 49 patients (51%) in the corticosteroid group and 37 of the 51 patients (73%) in the PRP group were successful, which was also significantly different (P 5 .005). The corticosteroid group was better initially and then declined, whereas the PRP group progressively improved.
Conclusion: Treatment of patients with chronic lateral epicondylitis with PRP reduces pain and significantly increases function, exceeding the effect of corticosteroid injection. Future decisions for application of the PRP for lateral epicondylitis should be confirmed by further follow-up from this trial and should take into account possible costs and harms as well as benefits.