Platelet-rich plasma may be effective against elbow tendinosis, study suggests

At 8 weeks follow-up, plasma-treated patients reported an average 60% improvement in symptoms.

A single injection of platelet-rich plasma may effectively reduce pain associated with chronic elbow tendinosis, the results of a pilot study suggest.

"Ours is the first in vivo human investigation of this novel biologic treatment for chronic, severe elbow tendonitis in patients who have simply 'flunked out' of other treatments," Allan Mishra, MD, lead author, said in a press release announcing the study results. "Ninety-three percent of patients in our study did well, which is as good a result as patients who have tendon surgery," he said.

Mishra, an orthopedic surgeon at Menlo Medical Clinic, Stanford University Medical Center in Menlo Park, Calif., conducted the study with Terri Pavelko, PAC, PT, which included 20 patients with chronic, severe lateral epicondylitis who were considering surgery. All patients had persistent pain for a mean of 15 months, despite undergoing a standardized physical therapy protocol and other nonoperative treatments, such as NSAIDs, bracing or cortisone shots, according to the study, published in the American Journal of Sports Medicine.

Fifteen patients received a single percutaneous injection containing buffered platelet-rich plasma. These patients averaged 48 years of age and had a mean baseline Visual Analog Scale (VAS) pain score of 80.3. The remaining five patients received a 2 mL to 3 mL injection of bupivacaine with epinephrine and served as a control group. These patients averaged 42 years of age and had a mean baseline VAS pain score of 86 points.

Both groups began a 2-week standardized stretching program at 1 day post-injection and were allowed to return to normal sporting and recreational activities at 4 weeks follow-up.

The researchers found significantly better results among plasma-treated patients. At 4 weeks, these patients reported a mean 46% improvement in symptoms compared to a mean 17% improvement among control patients, according to the release.

At 8 weeks follow-up, plasma-treated patients reported an average 60% improvement compared to 16% among control patients (P=.001), according to the study.

Also at 8 weeks, three of the five control patients had either sought other treatment or exited the study, limiting further analysis to patients treated with platelet-rich plasma, the authors noted.

The researchers found that VAS pain scores had improved 81% over baseline at 6 months follow-up (P=.0001) and improved 93% at 2 years (P<.0001), according to the study.

At 2 years, 93% of patients reported "complete satisfaction" with their treatment and 7% reported being "partially satisfied." In addition, nearly all plasma-treated patients had returned to activities of daily living and over 90% had returned to work or sporting activities, according to the press release.

"The results of our pilot study indicate this therapy is as effective as surgery, with sustained and significant improvement over time, no side effects, and high patient acceptance," Mishra said.

For more information:
Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006;34:1774-1778.