Tennis Elbow: Study Finds Saline Injections As Good As PRP – Platelet Rich Plasma

Dr. Patrick Le Goux Rheumatologist Hôpitaux universitaires Paris Ouest France French Tennis Federation medical Interview with:
Dr. Patrick Le Goux
Rheumatologist Hôpitaux universitaires Paris Ouest France
French Tennis Federation medical staff

MedicalResearch: What are the main findings of the study?

Dr. Le Goux: The therapeutic effect of platelet-rich plasma (PRP) of two ultrasound guided PRP injections at 4 weeks interval compared to two saline injections (as placebo or treatment of reference) is similar on a visual analogic scale for epicondylitis of recent evolution (3 months duration maximum) in a prospective randomized double blind study with 12 months follow up. We have no intrinsic or inherent benefit of the PRP injections.

MedicalResearch: Were any of the findings unexpected?

Dr. Le Goux: Despite no confirmation of the own clinical effect of the platelet-rich plasma we could conclude that the similar favorable outcome of the injections in both groups of the study may be connected to the technique Ultrasound guided intra-tendinous injections which can stimulate the tendon repair process. The therapeutic effect may be linked to the mechanical or irritant effect of the injected substance and / or the  effect of the needling by intratendinous injection. This action may be called “prolotherapy”

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Le Goux: There is a gap between outcomes and findings of works in vitro (experimental studies ) which seem to attest the efficiency of growth factors containing PRP,  and the data of clinical randomized trials which conclude to a very conflicting evidence. In clinical practice there is a lack of homogeneity of different preparations of PRP and the platelet concentrate may not work for many reasons (balance of factors pro and anti-angiogenic with neutralization for therapeutic effect, unknown variables concerning the activation these growth factors, platelet count different according to the patients .

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Le Goux: First, we have to improve the preparation of PRP, to find techniques to isolate and activate the pro-angiogenic factors to work better in the healing process of the tendon.

Secondly, we also need to test the efficacy of prolotherapy with trial designed with injected and non -injected groups, or non intra-tendinous injected patients to attest to  the superiority of these techniques on the natural evolution of the tendinopathy.


European League Against Rheumatism Congress 2014
Le Goux P, Montalvan B, Leparc JM et al. Treatment Of Epicondylitis By Ultrasound-Guided Local Injections Of Autologous Conditioned Plasma (Acp®): A Double-Blind Placebo-Controlled Randomized Clinical Trial With 1-Year Follow-Up. EULAR 2014; Paris: Abstract OP0013