Orthobiologics for the Treatment of Tennis Elbow
Lateral epicondylitis (LE) is a common, painful condition which can produce marked disability in the upper limb. Both orthobiologic and non-orthobiologic modalities aim to rapidly restore function and ameliorate pain. There are many conventional treatments for LE such as NSAIDs, physiotherapy, extracorporeal shockwave therapy, and corticosteroid (CS) injections, but these therapies are often ineffective. The best available evidence indicates that orthobiologic therapies for LE, including injections of platelet-rich plasma (PRP), autologous tenocyte injections, point of care isolation from mixed tissue-derived cells from bone marrow or fat, and autologous conditioned serum all seem to be safe with minimal side effects. The RCTs comparing PRP to CS have demonstrated superior and longer-term efficacy associated with PRP administration. There are unanswered questions on PRP, such as the best composition of the injectate (platelet concentration, leukocyte content, and the need for activation). Additional research needs to be conducted on other orthobiologic therapies to determine their usefulness in the treatment of LE. Future studies should further highlight safety and adverse events, cost-effectiveness, long-term efficacy, indications, patient selection, standardization of cell harvest and processing procedures, quantitative characterization of the final product injected, and quality management. These efforts are essential to establish and optimize clear clinical indications and benefits for orthobiologic injection therapies.
