BioMed Research International / 2015 / Article / Tab 1

Review Article

New Developments in the Use of Biologics and Other Modalities in the Management of Lateral Epicondylitis

Table 1

Summary of studies of biologics for lateral epicondylitis.

AuthorType of studyLevel of evidenceNumber of participantsPrimary outcome measuresResults

Edwards and Calandruccio [26]Case seriesIV28 patients were injected with 2 mL of autologous blood under ECRB; 19/28 patients received 1 injection; 7/28 patients received 2 injections; 2/28 patients received 3 injections0–10 patient ratings of pain; patient rating according to Nirschl staging (0–7)79% of all patients with complete resolution of pain at average of 9.5 months of follow-up; reduction in pain score from mean of 7.8 to 2.3 at last follow-up; reduction in Nirschl staging from mean of 6.5 to 2.0 at last follow-up

Mishra and Pavelko [40]CohortII15 treated with PRP; 5 treated with bupivacaine VAS for pain60% improvement in VAS with PRP versus 16% improvement in controls at eight weeks (); PRP group had 93% reduction in pain at final follow-up compared to baseline ()

Connell et al. [51]Case seriesIV12 treated with injection of collagen-producing tenocyte-like cells derived from autologous skin fibroblastsPRTEESignificant improvement in PRTEE scores at 6 weeks, 3 months, and 6 months compared to baseline; significant improvement in tendon structure noted on ultrasound

Peerbooms et al. [42]RCTI51 treated with PRP; 49 treated with corticosteroidSuccessful outcome: >25% reduction in VAS or DASH score without reintervention 73% successful outcome in PRP group versus 49% successful outcome in corticosteroid group based on VAS () at 1 year; 73% successful outcome in PRP group versus 51% successful outcome in corticosteroid group based on DASH score () at 1 year

Creaney et al. [27]RCTI70 treated with PRP; 60 treated with ABIImprovement in PRTEE score >25 points at final follow-upNo significant difference in success rates between PRP and ABI groups at 6 months ()

Gosens et al. [43]RCTI51 treated with PRP; 49 treated with corticosteroidSuccessful outcome: >25% reduction in VAS or DASH score without reintervention 77% successful outcome in PRP group versus 43% successful outcome in corticosteroid group based on VAS at 2 years (); 73% successful outcome in PRP group versus 39% successful outcome in corticosteroid group based on DASH score at 2 years ()

Wolf et al. [28]RCTII9 treated with ABI and lidocaine; 9 treated with steroid and lidocaine; 10 treated with saline and lidocaineDASH scores: PRFE pain and function scores; VAS scoreNo significance in DASH scores, PRFE pain scores, and VAS scores between the three groups at 2 months or 6 months of follow-up; PRFE function score significantly better for saline compared to PRP group at 6 months

Thanasas et al. [45]RCTI14 treated with PRP; 14 treated with ABIVAS for pain; Liverpool elbow scorePRP group had significantly greater improvement in VAS for pain at 6 weeks compared to ABI group (); no significant difference in VAS for pain at 3 months and 6 months; no significant differences in Liverpool elbow score at all time points

Krogh et al. [44]RCTI20 treated with PRP; 20 treated with glucocorticoid; 20 treated with isotonic salinePain reduction at 3 months based on PRTEE pain scoreNo significant difference in pain reduction between PRP group, glucocorticoid group, and saline group at primary endpoint of 3 months ()

Wang et al. [18]Case seriesIV16 treated with injection of autologous tenocytes derived from patellar tendon cellsVAS, Quick-DASH, grip strength, and grade of tendinopathy at common extensor origin on MRISignificant improvement at 1, 3, 6, and 12 months in mean VAS, Quick-DASH scores, and grip strength; significant improvement in grade of tendinopathy on MRI at 12 months

Mishra et al. [41]RCTII116 treated with PRP; 114 treated bupivacaineSuccessful outcome: improvement of >25% in VAS with resisted wrist extension; patient-reported elbow tendernessNo significant difference in successful outcomes or percentage reporting elbow tenderness at 12 weeks; success rate of 83.9% in PRP group versus 68.3% in control group at 24 weeks (); significant elbow tenderness reported in 29.1% of PRP group versus 54.0% of control group at 24 weeks ()

Raeissadat et al. [46]RCTI33 treated with PRP;
31 treated with ABI
VAS, pressure pain threshold, modified Mayo clinic performance index Significant improvement in both groups in all pain variables compared to baseline at 4 weeks, 8 weeks, 6 months, and 12 months; no significant differences between ABI and PRP groups at any follow-up point

ABI = autologous blood injection; PRP = platelet rich plasma;
DASH = Disabilities of the Arm, Shoulder, and Hand;
PRFE = Patient-Rated Forearm Evaluation;
PRTEE = Patient-Rated Tennis Elbow Evaluation;
RCT = randomized controlled trial;
VAS = visual analog scale.
Note: trials of Peerbooms et al. [42] and Gosens et al. [43] include the same patient cohort with different time points of follow-up.