The findings from a new study indicate that the use of platelet-rich plasma (PRP) is better for healing tennis elbow, when compared to the conventional corticosteroids. Platelet-rich plasma is still a controversial treatment for tendon injuries.
Tendon injuries take time to heal as the blood supply to this region is poor. Blood platelets attract growth factors which help to heal the injured tendons. Some of the studies have reported that PRP may be beneficial in the treatment of tennis elbow. But one of the studies showed that the findings of the other study may not be completely true.
Corticosteroids, on the other hand, are good in relieving pain but they do not promote healing and may lead to further breakdown of the tendon. In this study participants having lateral epicondylitis, a condition characterized by tennis elbow lasting longer than six months and pain ranking at least five on a 10-point scale were recruited. One group was assigned to PRP while the second group got corticosteroid injections. The findings of the study was presented at the annual meeting of the American Academy of Orthopaedic Surgeons.
For the study, injections were given directly into the affected tendon using a ‘peppering’ technique. In this technique the needle is passed through the skin and inserted several times into the tendon. The results showed that participants assigned to the corticosteroid injection group had much faster relief from pain. But after 26 weeks of treatment, participants in the PRP group reported lesser pain and more function when compared to the corticosteroid group. This improvement was consistent throughout the next year. By one year, participants in the PRP group had 64% improvement in pain and 84% improvement in disability. This was much better than 25% improvement in pain and 17% improvement in disability reported by the participants in the corticosteroid group.
Moreover only three patients out of the total 51 had a surgery for tennis elbow and only two went back to the corticosteroid treatment. Among the 49 patients in the corticosteroid group, six went for surgery, six went back to PRP treatment.
Generally 80% of the patients with lateral epicondylitis will be healed within a year but all of them may have complaints for more than six months. In the present study with PRP significant results were obtained only after 26 weeks of treatment. Kenneth Mautner, MD, of Emory University's sports medicine center reported that he gets a better result than what is reported in the study. According to him, the study would have been better had they used ultrasound scans before the treatment to show that there was really damage in the tendon. He adds that the success with PRP injections would have been better had they used ultrasound guidance for the injections.
One of the downsides of PRP is the cost. Since PRP treatment is not covered by insurance, many people go for corticosteroid injections even when the condition is severe. Mautner recommends PRP when the patient complains of pain for more than two months and ultrasound shows a degeneration of tendon.
It is not clear whether PRP works only for the tendons of the elbow. According to Mautner, it is useful in Achilles tendon also. But more research is needed in this area to confirm this.