Ultrasound-guided Platelet-rich Plasma versus Autologous Whole-blood Injection in Chronic Lateral Epicondylitis: A Randomised Interventional Study

Abstract Background: Platelet-rich plasma (PRP) and autologous blood injection (ABI) have both been shown to stimulate repair in lateral epicondylitis (LE). Purpose: The purpose of this study was to determine the effectiveness of ultrasound-guided injection of PRP compared with autologous whole-blood injections in patients with chronic LE. Study Design: This was a hospital-based, randomised controlled (open-label) trial. Setting: Department of Physical Medicine and Rehabilitation, SMS Medical College and attached Hospitals, Jaipur, Rajasthan, India. Sample Size: The sample size was calculated to be a total of 50 subjects for each of the two groups at an α error of 0.05 and a power 80%, thus a total of 108 cases. Materials and Methods: One hundred and eight patients, after signing an informed consent, were assigned to either of the two study groups by randomisation software. For patients randomly assigned to either group, 1.5 ml of autologous whole blood or PRP was injected at the origin of wrist extensors by a peppering technique under ultrasound guidance into clefts of hypoechogenicity using aseptic techniques. Patients were evaluated using the Liverpool Elbow Score (LES) and Patient-rated Tennis Elbow Evaluation (PRTEE) score at day 0, after 1 month, and the final assessment was done after 3 months of intervention. Results: On the first follow-up after 1 month, both LES ( t = −2.954 with 48 degrees of freedom; P = 0.005) and PRTEE ( t = −2.025 with 48 degrees of freedom; P = 0.048) showed significantly more mean change in the PRP group than the ABI group. On the second follow-up at 3 months, there was no significant difference in mean change in the ABI and PRP groups in LES ( t = 0.178 with 48 degrees of freedom, P = 0.859) and PRTEE ( t = 1.655 with 48 degrees of freedom, P = 0.104); however, improvement was present in both the groups. Conclusion: Both PRP and autologous whole blood were effective in reducing the pain and increasing function in the patients affected by LE. In comparison to ABI, the proportion of patients whose symptoms improved was slightly higher in the PRP group, but statistically not significant. Autologous blood injection is easy and inexpensive to prepare and can be considered a viable treatment option for chronic LE if there are resource limitations.