Lateral epicondylitis, also known as “tennis elbow,” is the swelling and tearing of the extensor tendons in the forearm. It's generally caused by trauma to the elbow or by repetitive motion of the tendons.
Since 2006, surgeons have been using platelet-rich plasma (PRP) injections to manage this condition with promising results. But several questions regarding the following remain unanswered:
Of all these questions, whether to use LR- or LP-PRP for lateral epicondylitis is perhaps the most fiercely debated.
A recently-published meta-analysis sought to answer this question. In this article, we'll review their findings.
In knee osteoarthritis treatment, both LP-PRP and LR-PRP have been used with similar, positive clinical outcomes . But some studies suggest that LR-PRP produces more adverse side effects, including short-term pain and swelling. Still, the consensus is that they're equally effective.
Many PRP users agree on the use of LR-PRP for tendinopathies. Most of the randomized clinical trials involving PRP in lateral epicondylitis treatment have used LR-PRP . This may have been due to the simple fact that early studies used LR-PRP with success. But due to the concern over the negative effects of leukocytes, the use of LP-PRP for tendinopathies has been increasing in recent years.
Leukocytes in PRP secrete inflammatory cytokines and matrix metalloproteinases (MMPs). Together, they create an exaggerated inflammatory response that could harm the tissue being injected. The leukocytes also increase collagen 3 more than collagen 1, indicating the presence of scar tissue, fibrosis, and poor mechanical strength .
On the other hand, studies have shown that LP-PRP increases collagen 1, resulting in a collagen 1/collage 3 ratio that actually promotes healing.
The current meta-analysis included a search for studies on the efficacy and safety of LP-PRP and LR-PRP in lateral epicondylitis.
Studies were included in the analysis if they met the following criteria:
Studies that were unrandomized, prospective, and retrospective in design were excluded. Those that evaluated mixed interventions in treatment groups were also excluded.
The initial search returned 2,358 articles. After further screening, the researchers identified 26 randomized clinical trials with 2,034 patients. Of these, 17 of the 26 trials used LR-PRP while the rest used LP-PRP in their treatment arms.
Only one study compared LR-PRP and LP-PRP for lateral epicondylitis. The authors of the study concluded both were effective .
The investigators reviewed all available studies to discover the effect of leukocyte presence in PRP on the outcome of lateral epicondylitis treatment.
Their analysis revealed that both LR-PRP and LP-PRP treatment groups showed significant improvements in pain and functional scores. Patients who received either LR-PRP or LP-PRP did not experience more adverse events compared to the control group. And despite the negative effects of leukocytes in PRP observed in various studies, the clinical outcomes were similar for both types of PRP.
The authors acknowledged several limitations of their study. One major limitation was that there was only one study directly comparing LP-PRP to LR-PRP. Therefore, they couldn't establish the superiority of one over the other. Their findings can only confirm that both types are clinically beneficial .
Patients with lateral epicondylitis now have a better treatment option — PRP. Numerous studies have shown that PRP injections are non-invasive, safe, and effective. Regardless of the leukocyte content, PRP can improve the outcomes for your patients.
Got questions? We've got answers. Call us today at 844-377-7787 (DR- PRP-US).