Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial.

Thanasas C, Papadimitriou G, Charalambidis C, Paraskevopoulos I, Papanikolaou A.
Am J Sports Med. 2011 Oct;39(10):2130-4. Epub 2011 Aug 2.

Over the past few months SMR has reviewed multiple articles regarding platelet-rich plasma (PRP) and its efficacy (see related posts below).  These articles have shown varying degrees of success depending on where and how the PRP treatment has been administered.  One area of the body that has shown positive responses to PRP intervention is the elbow, and more specifically the muscles and tendons at the lateral epicondyle.  While previous articles have compared PRP efficacy to cortico-steroid injection for lateral epicondylitis, Thanasas et al. has moved the discussion in a different direction.  In this article the authors investigate and compare the efficacy of two biologic treatments for lateral epicondylitis, PRP and autologous whole blood. For this study, 28 subjects suffering from lateral epicondylitis were recruited and alternately placed into one of 2 groups; Group A: the whole blood treatment group (n=14) or Group B: the PRP treatment group (n=14).  All subjects met the following inclusion criteria: clinically diagnosed lateral epicondylitis, no history of trauma, duration > 3 months, no previous injection of any kind, no history of rheumatic disorder or posterior interosseous nerve entrapment.  There was no considerable difference between the groups regarding age, gender, occupation or hand dominance.  All subjects completed visual analog scales for pain and Liverpool scores pre-intervention as well during each subsequent follow-up session.  The Liverpool score tracks elbow ROM, ulnar nerve function, and daily activities; thus it was deemed to be the most appropriate for the purposes of this study.  Group A was treated by injecting 3mL of autologous whole blood to the injury site and using a peppering technique (single skin insertion, multiple peripheral deep tissue insertions).  Group B was injected with 3mL of PRP utilizing the same injection technique.  During follow-up neither group was prescribed cortisone injection nor oral non-steroidals to manage discomfort.  All subjects were instructed to avoid heavy labor for the next week.  One week after the treatment both groups were prescribed a standardized exercise program focusing on stretching and eccentric strengthening of the affected musculature.  This program was performed by the individual 2x’s/day for 5 weeks.  All subjects were then reevaluated at 6 weeks, 3 months and 6 months post-injection, and completed the VAS and Liverpool scores.  During follow-up, the PRP group had decreased pain at every follow-up evaluation according to their VAS scores.  However, pain was only statistically significant at the 6 week time point. 

The results of this study are interesting for a few reasons.  First, there was no statistical significance difference in pain at any follow-up period except for 6 weeks.  This result demonstrates that both treatments were effective for treating the condition.  By comparing PRP to autologous whole blood, though, there seems that there may be a case for utilizing PRP and its concentrated growth factors within the lateral epicondylitis injury/treatment paradigm.  It is possible that PRP might be more effective at mediating the inflammatory process, thus resulting in better VAS scores early in the follow-up process.   Another item to note, there was no statistical significance between the two groups when comparing the Liverpool scores.  This could be a result from the Liverpool score’s structure.  While ADL’s are a crucial component to the score, tracking ulnar nerve function and ROM, which are minimally affected by the condition, may have counterbalanced and eliminated the ADL scores.  What are your thoughts on PRP and whole-blood therapy as possible treatment solutions for your patients?  As sports medicine clinicians, we are always looking for an edge to get our clients back to their respective sports as quickly and as safely as possible.  PRP for lateral epicondylitis appears to give us a viable option based upon the 6 week follow-up stats from this article.  However, the treatment outcomes weren’t much different in the long run between the two groups.  Taking cost into consideration, do you believe that there might be a place for whole-blood therapy if the patient’s out-of-pocket expense for PRP might prove to be too great?   Based upon this study’s finding, when conferring with your physician, would you be more willing to suggest autologous whole blood or PRP?

Written by:  Mark Rice
Reviewed by:  Stephen Thomas

Related Posts:

Thanasas C, Papadimitriou G, Charalambidis C, Paraskevopoulos I, & Papanikolaou A (2011). Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. The American Journal of Sports Medicine, 39 (10), 2130-4 PMID: 21813443