A Comparative Study of Platelet-Rich Plasma, Steroid Injection and Normal Saline as Placebo for the Treatment of Lateral Epicondylitis

Background Lateral elbow pain is common with a population prevalence of 1 %3 % and is seen more commonly in non-athletes than athletes. Non-operative methods are the mainstay of treatment being effective in more than 95 % of cases. However, there has been much debate about the best treatment modality for this condition. Platelet rich plasma (PRP) has shown promising results in many studies as compared to steroid injection& other modes of conservative management. The study was a comparative trial to validate the short term efficacy of single injection of platelet-rich plasma (PRP), 40mg methyl prednisolone (Depomedrol) and normal saline for lateral epicondylitis. Materials and Methods In this study, 90 patients with unilateral lateral epicondylitis were randomized into three groups, the PRP group (n=30), the Steroid group (n=30) and Placebo group (n=30) by selecting a sealed envelope. Patients were evaluated at weeks 2, 6, 12, 24 and 36 with visual analog scale (VAS) and facial pain scale (FPS). Patients suffering from elbow pain due to other problems or those who have previously received any form of injection were excluded from the study. KruskalWallis test was used for statistical analyses of FPS at all follow ups. Results Overall, 58 females and 32 males were included with 30 elbows in each group. the PRP group had equivocal relief compared to Depomedrol group at initial 2 and 6 week follow up and was better in both groups than saline group at these early follow ups. At 12, 24 and 36 weeks the PRP group better pain relief than 40 mg depomedrol (Pless than 0.05) group which in turn had had only moderate benefit compared to the saline injection (Pgreater than 0.05). Conclusion Over a short term period, PRP gives better pain relief than 40 mg depomedrol or normal saline in tennis elbow. Pain reduction benefit associated with steroid injection fades by the 24th week of follow-up but lasts longer with PRP injection.