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Platelet-Rich Plasma Versus Autologous Whole Blood for the Treatment of Chronic Lateral Elbow Epicondylitis A Randomized Controlled Clinical Trial

Christos Thanasas,*y MD, George Papadimitriou,z MD, Charalambos Charalambidis,z MD, Ilias Paraskevopoulos,z MD, and Athanasios Papanikolaou,z MD, PhD AJSM PreView, published on August 2, 2011 as doi:10.1177/0363546511417113

Background: Chronic lateral elbow epicondylitis is a tendinosis with angiofibrolastic degeneration of the wrist extensors’ origin.
Healing of this lesion is reported with the use of autologous blood as well as with platelet-rich plasma (PRP).
Purpose: A comparative study of these 2 treatments was conducted in an effort to investigate the possible advantages of PRP.
Study Design: Randomized controlled trial; Level of evidence, 1.
Methods: Twenty-eight patients were divided equally into 2 groups, after blocked randomization. Group A was treated with a single
injection of 3 mL of autologous blood and group B with 3 mL of PRP under ultrasound guidance. A standardized program of
eccentric muscle strengthening was followed by all patients in both groups. Evaluation using a pain visual analog scale (VAS) and
Liverpool elbow score was performed at 6 weeks, 3 months, and 6 months.
Results: The VAS score improvement was larger in group B at every follow-up interval but the difference was statistically significant
only at 6 weeks, when mean improvement was 3.8 points (95% confidence interval [CI], 3.1-4.5) in group B (61.47%
improvement) and 2.5 points (95% CI, 1.9-3.1) in group A (41.6% improvement) (P\.05). No statistically significant difference
was noted between groups regarding Liverpool elbow score.
Conclusion: Regarding pain reduction, PRP treatment seems to be an effective treatment for chronic lateral elbow epicondylitis
and superior to autologous blood in the short term. Defining details of indications, best PRP concentration, number
and time of injections, as well as rehabilitation protocol might increase the method’s effectiveness. Additionally, the possibility
of cost reduction of the method might justify the use of PRP over autologous whole blood for chronic or refractory tennis
elbow.
Keywords: lateral elbow epicondylitis; platelet-rich plasma; autologous whole blood; pain; function