Pilot cohort study testing buffered PRP versus bupivacaine injection in 20 patients with chronic severe elbow epicondylar tendinosis. All had failed a mean of 15 months of nonoperative treatment and were actively considering surgery. Primary outcome was VAS pain score; secondary outcome was modified Mayo elbow score.
For the patient in your clinic with 15 months of elbow pain, failed PT, failed corticosteroid injections, and asking about surgery, this paper offers a data-backed alternative before you make a referral.
Before Mishra 2006, there was no in-vivo human evidence for autologous growth factor injection in tendinosis. Corticosteroid was standard practice despite known risks of subcutaneous atrophy and intratendinous structural damage with repeated use.
When you see a patient meeting these criteria (pain >3 months, VAS ≥60, failure of PT plus NSAIDs/bracing/steroid, no diabetes, RA, cervical radiculopathy, or pregnancy), a single buffered PRP injection is a reasonable next step before surgery.
Critical protocol detail: NSAIDs are prohibited after injection. Use acetaminophen or a short opioid course instead, since anti-inflammatory agents may blunt the platelet-mediated healing response.
This was a small unblinded pilot (n=20) with industry funding. The 93% satisfaction figure is compelling, but the loss of the control group after 8 weeks and the lack of blinding mean the effect size should be interpreted cautiously until larger controlled trials confirm it.
Pilot cohort study testing buffered PRP versus bupivacaine injection in 20 patients with chronic severe elbow epicondylar tendinosis. All had failed a mean of 15 months of nonoperative treatment and were actively considering surgery. Primary outcome was VAS pain score; secondary outcome was modified Mayo elbow score.
For the patient in your clinic with 15 months of elbow pain, failed PT, failed corticosteroid injections, and asking about surgery, this paper offers a data-backed alternative before you make a referral.
Before Mishra 2006, there was no in-vivo human evidence for autologous growth factor injection in tendinosis. Corticosteroid was standard practice despite known risks of subcutaneous atrophy and intratendinous structural damage with repeated use.
When you see a patient meeting these criteria (pain >3 months, VAS ≥60, failure of PT plus NSAIDs/bracing/steroid, no diabetes, RA, cervical radiculopathy, or pregnancy), a single buffered PRP injection is a reasonable next step before surgery.
Critical protocol detail: NSAIDs are prohibited after injection. Use acetaminophen or a short opioid course instead, since anti-inflammatory agents may blunt the platelet-mediated healing response.
This was a small unblinded pilot (n=20) with industry funding. The 93% satisfaction figure is compelling, but the loss of the control group after 8 weeks and the lack of blinding mean the effect size should be interpreted cautiously until larger controlled trials confirm it.