In this video, we are going to talk about PRP, or platelet-rich plasma – what it is, why it might work, and what injuries PRP might be especially useful for lateral epicondylitis – better known as tennis elbow.

Please understand, in this video, I am not giving you medical advice. This is meant for general information and educational purposes only.

What is platelet-rich plasma?

PRP, also known as platelet-rich plasma, is a concentration of platelets that comes from your whole blood. It is centrifuged to obtain a ready-to-use product.

PRP works by releasing cytokines and growth factors, like platelet derived growth factor, platelet derived endothelial growth factor, transforming growth factor β1, insulin-like growth factor 1, fibroblast growth factor 2, and vascular endothelial growth factor A.

These growth factors enhance healing by stimulating cell proliferation, migration, and differentiation. They also modulate the immune system, inflammation, and angiogenesis, or the development of new blood vessels in the damaged tissue.

Nurse drawing patient's blood to make platelet-rich plasma

Biologic mediators in PRP and how they help healing

Those growth factors are essential for the three phases of healing of injured tendons and ligaments: inflammation, proliferation, and remodeling. In theory, PRP allows for the patient’s own blood to provide a high concentration of growth factors to promote healing in sites that have limited healing capacity due to blood supply. PRP can create a matrix that serves as scaffold for sustained release of growth factors that help bring in healing cells and new blood vessels that help deliver nutrients to improve healing.

What is tennis elbow?

To understand why PRP might be helpful for lateral epicondylitis, we have to understand what tennis elbow is. Tennis elbow is a condition causing pain on the lateral side of the elbow. Similar to medial epicondylitis – or golfer’s elbow – this condition often develops over time, usually with little or no previous trauma. A small area of degeneration in one of the extensor tendons develops just off the bony prominence on the lateral side of the elbow. It causes the pain on the outside of the elbow. Usually, orthopedic surgeons try nonsurgical treatments like a counterforce strap, activity modification, rest, and physical therapy to resolve the problem without surgery.

Let’s see what recent scientific literature tells us about how effective PRP is for tennis elbow.

Illustration of tennis elbow injury

PRP for lateral epicondylitis (tennis elbow)

For years, orthopedic surgeons have used cortisone shots to treat tennis elbow, but research has shown those injections can actually be detrimental to healing of the tendon.

In a systematic review of PRP vs. steroids, PRP provided slower relief but longer lasting benefits compared to corticosteroids. Clinical improvement lasted up to 2 years for PRP. There were also no side effects of PRP, unlike that of steroid shots.

Generally with lateral epicondylitis, PRP is no better in the days or first few weeks after injection compared to cortisone shots, but from 6 months on, PRP is much more effective than steroids.

Caution about the research

There are many different methods of preparation, and different final products: PRP, leukocyte-rich PRP, platelet-rich fibrin, platelet gel, and more. All these platelet products have varying concentrations of blood cells, plasma, or fibrinogen. Therefore, they have different concentrations of growth factors and bioactive molecules, meaning they could have different efficacy for knee osteoarthritis.

The exact composition of PRP is not reported in many of the available studies. There are difference between leukocyte-rich and leukocyte-poor PRP and much more. Plus, humans have different numbers of platelets in our blood, so studies comparing PRP will lead different results.

Plus, other than the leukocyte content, research studies differ in terms  volume of blood harvested, use of anticoagulant, number and speed of centrifugations, the final volume of PRP obtained, the overall number of platelets, their integrity and activation method, and more. All of these factors that could influence the properties of the final PRP product and how well it helps patients with osteoarthritis.

Doctor injecting PRP for tennis elbow

Is PRP covered by insurance?

Most insurance companies still consider PRP experimental and will not cover these treatments. And again, I’m not giving you medical advice. This information about platelet-rich plasma is intended for informational and educational purposes only.

Conclusion

Based on these recent studies, platelet-rich plasma offers a benefit that, although not significant at the early follow-ups (1 to 2 months), greatly exceeds the benefits over time, compared to the improvement offered by cortisone shots at 12 months, without an increased risk of adverse events, weakening the tendon, or any of the other risks of steroids. It certainly appears to be a reasonable option for patients with lateral epicondylitis trying to avoid surgery.

Links to studies in the comments

If you would like to read the studies I mentioned in the video, here are links to them:

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If you have a tendon or ligament injury and you want to see someone who truly knows about bone and joint injuries in athletes and active people, I’d be happy to help. I’m a double-board certified orthopedic surgeon and sports medicine specialist. I’d love to talk to you about all your options to recover from injury, not just surgery, cortisone shots, and physical therapy. Go to the Contact page to make an appointment to see me.

I’m Dr. David Geier. Thank you for watching, and I look forward to helping you feel and perform Better Than Ever.