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

Abstract

Lateral epicondylitis is a common source of elbow pain. Though it is often a self-limited condition, refractory lateral epicondylitis can lead to problems with activities of daily living and sometimes requires sick leave from work. Therefore prompt treatment is essential. Histopathologic studies have suggested that lateral epicondylitis is a tendinopathy, associated with apoptosis and autophagy, rather than a tendonitis associated with inflammation. Although corticosteroids have been used for short-term treatment, recent studies have suggested that they are not helpful and may even be harmful and delay healing in the treatment of lateral epicondylitis. Researchers have recently begun to investigate the use of biologics as potential treatment options for lateral epicondylitis. Autologous blood preparations including platelet rich plasma (PRP) and autologous whole blood injections (ABIs) have been proposed in order to deliver growth factors and other nutrients to the diseased tendon. Stem cell therapies have also been suggested as a method of improving tendon healing. This review discusses the current evidence for the use of PRP, ABI, and stem cell therapies for treatment of lateral epicondylitis. We also review the evidence for nonbiologic treatments including corticosteroids, prolotherapy, botulinum toxin A, and nitric oxide.

Healing of rotator cuff tendons using botulinum toxin A and immobilization in a rat model

“…Recent literature has focused on the biology as the cause of tenopathy and tendon re-tear rather than the stiffness of the repair construct or other mechanical theories [ 27 , 28 ]. Botox has been used clinically for chronic tendinopathies, including lateral epicondylitis [ 29 , 30 ]. Multiple mechanisms have been proposed, including reversible paralysis of the common extensor to allow microtrauma to heal versus modulation of local pain receptors.…”

Therapeutic Intervention in Musculoskeletal Radiology: Current Practice and Future Directions

“…Autologous blood principally contains red blood cells, and the theoretical mechanism of its use in tendinopathy is founded on enhanced collagen regeneration and stimulating a cellular response that enhances blood flow to tissues. [119][120][121][122][123] The technique showed some promise in symptom relief in medial epicondylitis, 122 lateral epicondylitis, 120,121,123 and patellar tendinosis. 124 However, a randomized controlled trial in its use in lateral epicondylitis showed no benefit over corticosteroid or placebo saline injections, despite improved outcomes in each group over a 6-month period.…”

Ultrasound-Guided Percutaneous Tenotomy

“…22 Other percutaneous tendon injections to treat tendinopathy include the injection of autologous whole blood and platelet-rich plasma (PRP), used to introduce growth factors to promote healing. [24][25][26][27][28][29][30] Still other types of injections include autologous tenocytes, 31 botulinum toxin, 32,33 polidocanol, 29,34 and hyaluronic acid. 32 The use of stem cells is being investigated in animal models.…”