PRP Versus Corticosteroid In Lateral Elbow Tendinopathy: 1-Year Trial Results

A randomized controlled trial in adults with chronic lateral elbow tendinopathy compared a single ultrasound-guided leukocyte-rich platelet-rich plasma (PRP) injection with a corticosteroid injection, tracking patient-reported outcomes through 52 weeks. Investigators reported greater early improvement with corticosteroid at 4 and 8 weeks. At 26 and 52 weeks, mean PRTEE scores favored PRP but did not reach conventional statistical significance (P=.07 and P=.10), while QuickDASH scores favored PRP at both time points (P=.05). Across visits, the pattern described early benefit with corticosteroid and later separation favoring PRP on some measures.

The study was a prospective, double-blinded, randomized two-arm trial with ultrasound guidance for each injection. It included 48 participants involving 50 elbows, with assignment concealed in sequentially numbered, opaque, sealed envelopes. Participants and assessors remained blinded, syringes were covered with opaque adhesive tape, and the corticosteroid group underwent sham phlebotomy to maintain masking. These procedures were intended to keep the treatment comparison masked throughout follow-up.

In the PRP arm, the protocol used a leukocyte-rich platelet rich plasma injection prepared with the PEAK Platelet Rich Plasma system. A 3-mL intratendinous injection was administered under ultrasound guidance, along with five fenestrating passes in a fan-shaped pattern at the common extensor origin. The comparator was a 3-mL corticosteroid mixture containing 1 mL triamcinolone 40 mg/mL and 2 mL lidocaine 1%. The groups differed primarily by injectate, while the ultrasound-guided technique—including five fenestrating passes—was standardized across arms.

Patient-reported outcomes were recorded at baseline and at 4, 8, 12, 16, 26, and 52 weeks after treatment, with PRTEE and QuickDASH as primary measures of elbow-related pain, function, and disability. Researchers also assessed grip strength, visual analog scale pain scores, and treatment satisfaction. They observed lower average VAS scores over time in the PRP group, while grip strength differences at specific follow-up visits were not significant. In combination, the outcomes distinguished early versus later experience across the follow-up schedule.

The authors concluded that corticosteroid was linked to faster initial symptom improvement, whereas PRP showed more favorable results by 6 and 12 months. They noted limitations, including reliance on patient-centered questionnaires, variation in PRP products across practice settings, and incomplete capture of remote prior corticosteroid exposure. Investigators also reported lower average pain scores with PRP across the study period, even when individual time points were less distinct. They framed the comparison as one in which relative benefit differed by follow-up interval.

Key Takeaways

• Corticosteroid was associated with greater short-term improvement; later outcomes were mixed, with mean PRTEE scores favoring PRP at 26 and 52 weeks without conventional statistical significance (P=.07 and P=.10) and QuickDASH scores favoring PRP at both time points (P=.05).
• The study used a randomized, double-blind, ultrasound-guided design with sham phlebotomy and opaque syringe masking.
• The authors described the comparison as time-dependent, with different patterns emerging early versus later in follow-up.