Hyaluronic acid injection for chronic tennis elbow may relieve pain, improve function
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SAN DIEGO — Results presented at the American Academy of Orthopaedic Surgeons Annual Meeting showed hyaluronic acid injection may effectively relieve pain and improve function in patients with chronic tennis elbow.
Gershon Zinger, MD, MS, and colleagues randomly assigned patients with chronic tennis elbow to receive either an injection of hyaluronic acid or saline. Researchers collected VAS pain scores, patient-rated tennis elbow evaluation and QuickDASH scores at 3, 6 and 12 months after injection.
“The biggest problem with the research was the follow-up for the saline group,” Zinger, of Shaare Zedek Medical Center and faculty of medicine at Hebrew University of Jerusalem in Israel, told Healio Orthopedics. Zinger said fewer patients in the group came at each follow-up visit and that by 12 months, only 40% of patients were left in that group. “We decided we could not use it as a comparator. It was just completely unreliable.”
Zinger noted patients who received hyaluronic acid injections experienced significant improvements in VAS pain scores, patient-rated tennis elbow evaluation and QuickDASH scores.
“Each patient on their own also improved,” Zinger said. “Of the 18 patients enrolled, one was lost before his first evaluation and the other 17 were followed for the full year. All 17 did well. In other words, there was not one failure, which I did not expect.”
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In this prospective clinical trial, Gershon Zinger, MD, MS, and colleagues compared hyaluronic acid and saline (control) injection for the treatment of chronic lateral epicondylitis in 31 patients. Patients randomized and blinded to treatment received a series of three injections (Intragel or saline), 2 weeks apart, using a fanning technique. Although the hyaluronic acid treatment group demonstrated sustained improvements in VAS pain scores at 3, 6 and 12 months, there was a greater than 40% dropout rate of the saline control group at 6 and 12 months, precluding suitable comparison of outcomes between groups.
While the use of hyaluronic acid injections for the treatment of knee osteoarthritis is well known, its use for treating tendinopathy has received less attention. In animal studies, peritendinous hyaluronic acid injection has been shown to aid in tendon healing by enhancing anti-inflammatory activity, cell proliferation and collagen deposition while reducing adhesion formation. In addition to treatment of lateral epicondylitis, hyaluronic acid injections have been studied for use in patellar, rotator cuff and Achilles tendinopathies. While hyaluronic acid injections appear to be safe, it remains unclear whether these are superior to placebo or other treatments, including physical therapy and steroid injection. Large-scale randomized controlled trials are needed to establish the clinical efficacy of hyaluronic acid injections for chronic tendinopathies.
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Zinger G, et al. Paper 705. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. Aug. 31 - Sept. 3, 2021; San Diego.
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