Tennis elbow and orthobiologics: what the evidence shows, and which patients the trials left out

For lateral epicondylitis — tennis elbow — the answer about platelet-rich plasma depends on two things that are easy to lose in a headline: when the outcome is measured, and who was allowed into the study. Measured against a placebo injection, pooled randomized data have not shown PRP or autologous blood to outperform a control [1][9]. Measured against corticosteroid injection at six months and beyond, pooled data run the other way and favor PRP on pain and function [12].

Both of those statements are accurate, and neither of them settles the question for an individual elbow. The trials behind them enrolled a narrow slice of patients: most set a floor or a ceiling on symptom duration, one pooled only patients with previously untreated disease, one excluded anyone who had received an injection in the preceding six months, and one excluded diabetes mellitus, hypothyroidism and rheumatoid arthritis by name [6][10][11][12].

This page does two things. It reports what each study found without softening it, and it states the eligibility and exclusion criteria of each study so you can judge how closely its population resembles yours.

What lateral epicondylitis is, and why the framing matters

A degenerative tendinopathy rather than a simple inflammation

Lateral epicondylitis is described in the orthopedic literature as “a degenerative rather than inflammatory tendinopathy” [2]. It affects 1% to 3% of the general population, mostly people over 40 years of age, with equal distribution between men and women [2], and a second review reports the same 1% to 3% population figure [3].

That framing matters because a therapy aimed at suppressing inflammation may be addressing something that is not the dominant process. It is one reason results differ so widely between injection types, and between trials of the same injection type.

The literature is not unanimous even on this point. A 2022 review in World Journal of Orthopedics describes lateral epicondylitis as a chronic aseptic inflammatory condition caused by repetitive microtrauma and overload, while also reporting imaging changes at the proximal muscle insertion [3]. When reviewers cannot agree on whether the underlying process is degenerative or inflammatory, disagreement about which injection should help is the expected consequence, not a surprise.

Confirming the pain generator before choosing an injection

Pain over the lateral elbow can arise from the common extensor origin, from the joint itself, or from the radial nerve as it passes the elbow. We confirm which structure is generating symptoms before an injection is discussed, because the target determines whether an orthobiologic is a sensible question at all.

Study populations vary in exactly the same way. Trials that enrolled patients differing in symptom duration, severity, and tissue involvement will not produce results that line up neatly, which is part of why the pooled estimates are so wide.

The time horizon changes the answer

Corticosteroid at 4 weeks, 26 weeks and 1 year

Lateral epicondylitis has an unusually informative literature on this point, and corticosteroid is the clearest illustration. In a 2 × 2 factorial randomized placebo-controlled trial of 165 adults with unilateral lateral epicondylalgia of more than six weeks’ duration, conducted at a university research center and 16 primary care settings in Brisbane, Australia, corticosteroid injection produced complete recovery or much improvement in 71% of patients at 4 weeks versus 10% with placebo injection (RR 7.32; 99% CI 2.1 to 25.5; P < .001) [10].

By 26 weeks the direction had reversed: 55% with corticosteroid versus 85% with placebo (RR 0.79; 99% CI 0.62 to 0.99; P < .001) [10]. At one year, 83% with corticosteroid versus 96% with placebo had recovered or much improved (RR 0.86; 99% CI 0.75 to 0.99; P = .01), and recurrence was 54% with corticosteroid versus 12% with placebo (RR 0.23; 99% CI 0.10 to 0.51; P < .001) [10].

The authors’ conclusion was that in patients with chronic unilateral lateral epicondylalgia, corticosteroid injection versus placebo injection resulted in worse clinical outcomes after one year [10]. A treatment can therefore be strikingly effective at four weeks and a net negative at fifty-two, in the same patients, in the same trial.

Why a review with six-month minimum follow-up reports the opposite of a four-week result

A 2022 systematic review and meta-analysis in JSES International restricted itself to randomized trials with a minimum follow-up of six months after the first intervention, in adults aged 18 years or older with lateral epicondylitis [1]. Within that window, seven trials with 416 patients compared corticosteroid injection with a control, and the control group had statistically superior pain (mean difference 0.70, 95% CI 0.22 to 1.18) and function (SMD −0.35, 95% CI −0.54 to −0.16) [1].

That result is not in conflict with the four-week finding above. It is the same curve read at a different point. Any article that reports corticosteroid as producing stronger relief than an orthobiologic without naming the timepoint is reporting half of a measurement.

Corticosteroid is separately described as exerting a short-term effect at the elbow, with repetitive use discouraged because of adverse effects after long-term use such as weakening of tendon, and minimal long-term pain-controlling outcome [2]. This is why orthobiologics are not presented here as the risky option and steroid as the conservative one.

PRP compared with corticosteroid across the same timeline

A 2024 systematic review and meta-analysis in The American Journal of Sports Medicine pooled 11 randomized controlled trials with 730 patients (354 treated with PRP, 376 with corticosteroid), searched from January 2000 to July 2022, with a mean follow-up of 6.94 months [12]. Corticosteroid outperformed PRP on short-term pain, defined as under two months (9 studies; mean difference 0.93 on the visual analog scale, 95% CI 0.42 to 1.44; I² = 85%; P = .0003) and on the short-term DASH disability score (6 studies; MD 10.23, 95% CI 9.08 to 11.39; I² = 67%; P < .0001) [12].

At six months and beyond the ordering reversed. Long-term visual analog scale pain favored PRP (6 studies; MD −2.18, 95% CI −3.13 to −1.22; I² = 89%; P < .0001), as did long-term DASH (5 studies; MD −8.13, 95% CI −9.87 to −6.39; I² = 25%; P < .0001) and the long-term Mayo Elbow Performance Score (3 studies; MD 16.53, 95% CI 1.52 to 31.53; I² = 98%; P = .03) [12]. In the intermediate window of two to six months there was no significant difference in pain (8 studies; MD −0.32, 95% CI −0.64 to 0.01; I² = 87%; P = .06) [12].

Two cautions belong with that result, and the review states both. When trials at high risk of bias were removed in sensitivity analysis, the short-term pain advantage for corticosteroid was no longer significant (MD 0.53, 95% CI −0.13 to 1.19; I² = 78%; P = .12), so the authors advise that the short-term pain conclusion be treated with caution [12]. And heterogeneity was high throughout, reaching I² = 98% on the long-term Mayo score [12].

The third caution is ours rather than the authors’: the comparator in that analysis is corticosteroid, which in the placebo-controlled data above produced worse one-year outcomes than a placebo injection [10]. Outperforming a comparator that itself underperforms placebo at one year is a weak benchmark, and it is not the same claim as outperforming placebo.

What the placebo-controlled evidence shows

PRP and autologous blood compared with controls

In the JSES International meta-analysis, two randomized studies compared PRP with controls in adults with lateral epicondylitis. No differences were found in pain (SD: −0.15, 95% CI −1.89 to 1.35) or function (SMD: 0.14, 95% CI −0.45 to 0.73) [1]. Three studies compared autologous blood with controls and observed no differences in pain (0.49, 95% CI −2.35 to 3.33) or function (−0.07, 95% CI −0.64 to 0.50) [1].

Those confidence intervals are wide enough to include both a meaningful benefit and a meaningful harm. Two trials contributing 64 patients cannot resolve a question of this kind; the accurate reading is that PRP has not been shown to beat a control injection in this pooled set, not that it has been shown not to.

The review’s overall conclusion was that the highest-quality available evidence does not support the use of exercise-based physiotherapy, corticosteroid injections, PRP, or autologous blood in the treatment of lateral epicondylitis [1]. Exercise-based physiotherapy fared no better than the injections in that analysis: five studies with 447 patients found no significant differences in pain (−0.07, 95% CI −0.56 to 0.41) or function (−0.08, 95% CI −0.46 to 0.30) versus no active treatment [1].

The Cochrane assessment, on a much larger sample

A 2021 Cochrane review of autologous blood and PRP injection for lateral elbow pain included 32 trials with 2,337 participants [9]. At three months, pain was 0.16 points better on a 0 to 10 scale than with placebo (95% CI 0.60 better to 0.29 worse; 8 studies, 523 participants) and function was 1.86 points better on a 0 to 100 scale (95% CI 4.97 better to 1.25 worse; 8 studies, 502 participants), both moderate-certainty evidence [9]. No clinically important differences were observed at 6 and 12 months [9].

The authors concluded that the data do not support the use of autologous blood or PRP injection for lateral elbow pain, that these injections probably provide little or no clinically important benefit for pain or function, and that with no evidence of benefit the costs and risks are not justified [9]. That is the largest and most rigorous synthesis available, and it is stated here in the authors’ own terms rather than softened.

Preparation is not standardized, and that is measurable

The same Cochrane review records that no standardized nomenclature or method of preparation has been adopted for autologous blood products, and documents variation across included trials in centrifugation method, platelet concentration, white blood cell content, and injection technique [9]. It also notes that most studies were at risk of selection, performance and detection bias, mainly from inadequate allocation concealment and lack of participant blinding [9].

This matters concretely. In the largest placebo-controlled trial in this area, the PRP was prepared with a double-syringe kit at 1500 rpm for five minutes, producing a platelet concentration reported as roughly twice that of the patient’s venous blood, delivered as a single injection by landmark technique rather than under imaging guidance [5]. A trial of one preparation, at one concentration, given once, without guidance, tests that protocol. It does not test every protocol that shares the name.

Long-term data, and where shock wave therapy sits

A 2023 meta-analysis restricted to randomized trials with follow-up of 12 months or longer, searching PubMed and Embase from inception to March 2023, found that extracorporeal shock wave therapy significantly relieved pain in patients with lateral epicondylitis compared with controls (SMD −0.19, 95% CI −0.36 to −0.02, P = 0.03), with no significant difference in long-term function (SMD 0.24, P = 0.07) [4].

In that same long-term analysis, PRP showed no significant difference from control in either pain (SMD −0.30, 95% CI −0.85 to 0.25) or function (SMD −0.08, 95% CI −0.78 to 0.62), and corticosteroid showed no significant long-term difference in pain (SMD 0.70, 95% CI −0.43 to 1.82) or function (SMD −0.02, 95% CI −0.36 to 0.31) [4]. The authors concluded that only extracorporeal shock wave therapy demonstrated long-term pain relief among the conservative options examined [4].

That is included to place orthobiologics honestly among the non-surgical options rather than to stack treatments. Our orthobiologics program is built around matching a biologic to a confirmed target, not around offering every biologic to every painful elbow.

Who these trials enrolled, and who they screened out

Randomized trials answer the question “does this work in the patients we allowed in?” They cannot answer “does this work in the patients we kept out?” The eligibility and exclusion criteria below are facts printed in the papers, and each one narrows the population the result describes.

Palacio 2016 excluded systemic disease by name

This Brazilian trial randomized 60 of 72 consecutively screened patients into three arms of 20: 3 mL of 0.5% neocaine, 3 mL of dexamethasone acetate, or 3 mL of platelet-rich plasma, with DASH and PRTEE questionnaires at baseline, 90 days and 180 days [6]. Inclusion was “a minimum age of 18 years and positive findings from two of the following clinical tests: Cozen, Mill, Gardner and Maudsley” [6].

The exclusion criteria are printed in full: “those who had undergone some form of previous treatment in the elbow region; those who presented other diseases in the upper limbs (such as posterior interosseous nerve syndrome and/or carpal tunnel syndrome): patients with systemic diseases (such as diabetes mellitus, hypothyroidism and/or rheumatoid arthritis); pregnant patients; and lastly, patients using contraceptive drugs” [6].

Overall, 81.7% of patients in that trial had some improvement in symptoms, and the authors concluded there was no evidence that one treatment was more effective than another on DASH and PRTEE [6]. The population in which that null result was observed contained no patients with diabetes, no patients with hypothyroidism, no patients with rheumatoid arthritis, and no patients who had been treated for the elbow before. Those are four of the most common characteristics among patients who reach a referral practice.

Linnanmäki 2020 excluded little, but recorded less

This trial screened 128 patients and randomized 119 to PRP (n = 40), autologous blood (n = 40) or saline (n = 39), recruited between March 2011 and January 2017 from a secondary care hospital, with follow-up visits at 4, 8, 12, 26 and 52 weeks [5]. Inclusion was adults with lateral elbow pain for more than three months who were dissatisfied with the results of initial nonoperative treatment [5].

The stated exclusion criteria were narrow: “other concomitant upper-limb symptoms and previous surgical treatment of the elbow” [5]. Of the nine patients not randomized, the reasons recorded were bilateral symptoms (2), other upper-limb problems (3) and systemic disease (1) [5]. Diabetes, obesity and metabolic disease are not listed as exclusion criteria in this paper, and it would be wrong to claim otherwise.

What the paper also does not do is describe the metabolic status of the patients who were enrolled. The reported baseline comparison covers age, duration of symptoms, duration of sick leave, visual analog scale pain scores, DASH scores and grip strength [5]. The result — no clinically important difference in pain at 52 weeks for PRP versus saline (mean difference −0.2, P = 0.75) or autologous blood versus saline (0.5, P = 0.40), with the authors recommending against their use unless future trials show benefit — therefore applies to a population whose metabolic characteristics were never measured [5]. That is a limitation on what can be inferred, not a criticism of the finding.

Wolf 2011 enrolled only symptoms shorter than six months

This prospective, randomized, controlled multicenter study enrolled patients with clinically diagnosed lateral epicondylitis of less than six months’ duration, randomized to 3 mL of saline and lidocaine, corticosteroid and lidocaine, or autologous blood and lidocaine, with outcomes at baseline, 2 weeks, 2 months and 6 months [7]. Of 34 subjects enrolled, 28 completed follow-up: 10 saline, 9 autologous blood, 9 steroid [7].

The finding was that autologous blood, corticosteroid and saline injection provided no advantage over placebo saline injections, with patients in each group improving over six months [7]. The duration ceiling is the point worth noting: patients whose symptoms had already run past six months — the group for whom an injection is usually actually being considered — were not eligible. With nine patients per arm, this trial also cannot detect a difference of the size that would matter clinically.

Schöffl 2017 does not report its criteria in the available record

This prospective, double-blind, randomized controlled trial enrolled 50 patients with lateral epicondylitis, 25 receiving one round of autologous conditioned plasma and 25 receiving 0.9% sodium chloride placebo, re-evaluated at four weeks and six months; 36 of 50 qualified for re-evaluation, 18 per group [8]. The results suggested a therapeutic effect in both groups with no evidence of a therapeutically significant difference between them [8].

We could not read the full inclusion and exclusion criteria of this trial from the publicly available record, and we are not going to guess at them. What is verifiable is that 28% of enrolled patients did not reach re-evaluation, and that with 18 patients per group the trial is small.

Coombes 2013 excluded recent injection and inflammatory disorders

The corticosteroid trial described earlier has a fully published protocol, and its eligibility criteria are specific [11]. Inclusion required unilateral elbow pain for longer than six weeks, pain of at least 30 mm on a 100 mm visual analog scale, pain over the lateral humeral epicondyle provoked by at least two of gripping, palpation, stretching of forearm extensor muscles and resisted wrist or middle finger extension, reduced pain-free grip force, age between 18 and 70 years, an acceptable understanding of written and spoken English, and willingness to comply with treatment and follow-up [11].

Exclusions were: injection within the preceding 6 months; a course of exercise-based physiotherapy within the preceding 3 months; concomitant neck or other arm pain that had prevented usual work or recreation or needed treatment in the last 6 months; evidence of other primary sources of lateral elbow pain; history of fractures within the preceding 10 years, elbow surgery, malignancy, inflammatory or arthritic disorder; any medical condition which may contraindicate injection or exercise prescription; and pregnancy or breastfeeding [11]. The published trial report lists the same core exclusions [10].

Read that list against a typical referral population. A patient who has already had a steroid injection is excluded. A patient with an inflammatory or arthritic disorder is excluded. A patient with neck pain contributing to arm symptoms is excluded. A patient over 70 is excluded. The 96% one-year recovery rate in the placebo arm is a real number, and it describes that filtered population.

Xu 2024 pooled only previously untreated patients

The eligibility criteria of the 2024 PRP-versus-corticosteroid meta-analysis are printed plainly: studies were included if the study was an RCT; the focus was on participants 18 years of age or older “with previously untreated LE”; the intervention group received PRP and the comparator group received corticosteroid; the article was in English; and the study was published after January 2000 [12]. Studies were excluded if they were letters, editorials, reviews, case reports or basic science studies, if function or pain outcomes were unreported, or if data were incomplete [12].

“Previously untreated” is the operative phrase. The long-term advantage for PRP in that analysis was measured in patients approaching their first treatment, not in patients arriving after a failed injection, a failed course of therapy, or several years of symptoms.

What the pooled populations describe

The Cochrane review characterizes its 2,337 participants by age, sex and symptom duration: mean ages ranged from 36 to 53 years across trials, 56% were female in the 22 studies reporting sex, symptom duration ranged from 1 to 22 months in the 13 studies reporting it, and individual trials ranged from 25 to 230 participants [9]. Participants with lateral elbow pain due to acute traumatic injury were excluded [9].

Those are the population descriptors available. A patient of 68 with type 2 diabetes, five years of symptoms and two prior steroid injections is outside the reported range on age, outside it on duration, and outside the eligibility criteria of several of the individual trials entirely.

The metabolic terrain question, stated honestly

What is established about diabetes and tendon

A 2016 systematic review with meta-analysis in the British Journal of Sports Medicine examined 31 case-control and cross-sectional studies. Tendinopathy was more prevalent in people with diabetes (17 studies, OR 3.67, 95% CI 2.71 to 4.97); diabetes was more prevalent in people with tendinopathy (5 studies, OR 1.28, 95% CI 1.10 to 1.49); people with both diabetes and tendinopathy had a longer duration of diabetes than people with diabetes alone (6 studies, mean difference 5.26 years, 95% CI 4.15 to 6.36); and people with diabetes had thicker tendons than controls (9 studies, SMD 0.79, 95% CI 0.47 to 1.12) [13].

That is an association across tendinopathy generally, drawn from observational designs. It establishes that diabetic tendon differs structurally and epidemiologically from non-diabetic tendon. It does not establish how diabetic tendon responds to an injection, because that question has not been put to a randomized trial in this condition.

What is contested in lateral epicondylitis specifically

Here the evidence genuinely conflicts, and pretending otherwise would be dishonest. A case-control study of 4,998 patients with lateral epicondylitis individually matched to 4,998 controls by age, sex and general practice, drawn from a United Kingdom primary care database, found on multivariate analysis that rotator cuff pathology (OR 4.95), De Quervain’s disease (OR 2.48), carpal tunnel syndrome (OR 1.50), oral corticosteroid therapy (OR 1.68) and previous smoking history (OR 1.20) were associated with lateral epicondylitis — and that diabetes mellitus, current smoking, trigger finger, rheumatoid arthritis, alcohol intake and obesity were not [14].

A 2022 review reports the opposite on body mass, listing age, body mass index above 25 and low social support in men as significant risk factors [3]. The same review reports that over 50% of patients say elbow pain still persists after 12 months [3], which sits awkwardly beside the 70% to 90% figure quoted below and reflects a different question being asked.

The honest summary: whether metabolic dysfunction raises the risk of developing tennis elbow is unsettled. That is a separate question from whether metabolic dysfunction changes the tissue’s capacity to repair once tendinopathy is present, and it is a further separate question from whether it changes the response to an injection. Only the first of those three has been studied at scale in this condition.

What this does and does not license

A null result in a selected population does not establish failure in the patients who were screened out. It also does not establish success in them. What it establishes is that the question has not been asked.

We do not tell patients that PRP works better in metabolic disease. There is no evidence for that claim, and stating it would be the mirror image of the error this page is trying to avoid. What we do say is that the trials most often cited to close the question excluded, or did not measure, the metabolic characteristics that plausibly govern tendon repair — so the strength of the negative conclusion in those patients is weaker than the headline suggests.

What single-modality trials cannot test

Every trial discussed above tested one injection, usually once, in isolation. That is the correct design for isolating a single variable, and it is the wrong design for describing sequenced or combined care.

None of these trials tested an orthobiologic delivered after the metabolic contributors were addressed. None tested an orthobiologic paired with a structured, supervised loading program as a single protocol with a shared endpoint. None tested repeat dosing guided by interval response. None compared preparations head to head at defined platelet concentrations and leukocyte content, which the Cochrane review identifies as unstandardized across the literature [9].

Follow-up is the other structural limit. The JSES International review notes that most included studies had an end point of 12 months, so there is a lack of data on the long-term durability of all nonsurgical options [1]. Durability past a year is unmeasured for essentially everything in this field.

The baseline every option has to beat

Within one year of treatment, 70% to 90% of patients with lateral epicondylitis show a clinical course of spontaneous resolution or a response to conservative management [2]. That baseline is the single most important number in this literature, and it explains a great deal of the null results above.

When a control group recovers that reliably, any injection has a very high bar to clear before it can demonstrate added benefit, and a trial needs to be large to detect a difference at all. It also means that time, load management and a structured strengthening program are not a delaying tactic; they are the treatment with the best supporting evidence in an unselected population.

When escalation is discussed

Persistent debilitating pain lasting more than six months despite nonoperative therapy is described in the literature as the point at which patients become candidates for surgical treatment [2]. Regen.MD does provide surgery when conservative measures have genuinely been exhausted, and Dr. Gurpreet Singh Padda, MD, MBA, MHP is a surgeon — but surgery follows exhausted conservative care rather than leading it.

Between those two poles sits the decision most patients are actually facing: whether a time-bound trial of an orthobiologic injection, paired with a rehabilitation program, is a reasonable next step for them specifically.

How this evidence is used in a Clinical Evaluation

We start by confirming the diagnosis and identifying which structure is generating pain, then review what conservative care has already been completed and for how long. Only then does an orthobiologic become a question worth asking, and it is framed as a monitored trial with defined endpoints and a defined stopping point, not a promised outcome.

The evidence above is presented to patients as it reads. Placebo-controlled data have not shown a benefit for PRP or autologous blood over a control injection [1][9]. Comparative data favor PRP over corticosteroid past six months, in previously untreated patients, against a comparator with worse one-year outcomes than placebo [10][12]. Where a patient’s own characteristics fall outside the populations studied, we say that rather than borrowing a conclusion that was never measured in them.

Our terrain-first approach also examines the metabolic conditions a tendon is being asked to heal in, because tissue attempting repair in a hostile environment behaves differently regardless of what is injected into it — a mechanism supported by observational tendon data [13] and not yet tested by a randomized trial in this condition.

“My ethos is to treat all of my patients as I would my own family, with the goal of giving them back their quality of life.” — Dr. Gurpreet Singh Padda, MD, MBA, MHP

Frequently asked questions

Key takeaways

• The answer depends on when you measure. Corticosteroid produced recovery or much improvement in 71% of patients at 4 weeks versus 10% with placebo, then 83% versus 96% at one year with 54% versus 12% recurrence, in the same randomized trial.
• In pooled placebo-controlled data in adults with lateral epicondylitis, PRP and autologous blood showed no difference from controls for pain or function, and a 32-trial Cochrane review concluded they probably provide little or no clinically important benefit.
• Against corticosteroid rather than placebo, pooled data favor PRP at six months and beyond on pain, DASH and Mayo Elbow Performance Score — but only in previously untreated patients, with high heterogeneity, and against a comparator that itself does worse than placebo at one year.
• The trials excluded a great deal. One excluded diabetes mellitus, hypothyroidism and rheumatoid arthritis by name; one excluded injection within the preceding six months, inflammatory or arthritic disorder, and age over 70; one enrolled only symptoms shorter than six months; one pooled only previously untreated patients.
• A null result in a selected population does not establish failure in the patients who were screened out — and it does not establish success in them either. It establishes that the question was not asked.
• Within one year, 70% to 90% of patients with lateral epicondylitis resolve spontaneously or respond to conservative management, which is a very high bar for any injection to beat and a reason to complete conservative care first.

Medically reviewed by Gurpreet Singh Padda, MD, MBA, MHP — Board Certified in Anesthesiology, Pain Medicine, Interventional Pain Management, Addiction Medicine, and Obesity Medicine. Last reviewed August 2026.

This article is educational and is not a substitute for evaluation, diagnosis, or treatment by a physician. Individual results vary, and not every patient is a candidate for the therapies described. Do not start, stop, or change any treatment without consulting your physician. Orthobiologic therapies are not FDA-approved for this indication and are provided as part of physician-directed care.

Sources

1. Lapner P, Alfonso A, Hebert-Davies J, Pollock JW, Marsh J, King GJW. “Nonoperative treatment of lateral epicondylitis: a systematic review and meta-analysis.” JSES International, 2022;6(2):321–330. https://pmc.ncbi.nlm.nih.gov/articles/PMC8888180/
2. Kim GM, Yoo SJ, Choi S, Park YG. “Current Trends for Treating Lateral Epicondylitis.” Clinics in Shoulder and Elbow, 2019;22(4):227–234. https://pmc.ncbi.nlm.nih.gov/articles/PMC7714311/
3. Karabinov V, Georgiev GP. “Lateral epicondylitis: New trends and challenges in treatment.” World Journal of Orthopedics, 2022;13(4):354–364. https://pmc.ncbi.nlm.nih.gov/articles/PMC9048498/
4. Chen Q, Shen P, Zhang B, Chen Y, Zheng C. “Long-term effectiveness of conservative management for lateral epicondylitis: a meta-analysis.” Journal of Plastic Surgery and Hand Surgery, 2023;58:67–73. https://doi.org/10.2340/jphs.v58.12333
5. Linnanmäki L, Kanto K, Karjalainen T, Leppänen OV, Lehtinen J. “Platelet-rich Plasma or Autologous Blood Do Not Reduce Pain or Improve Function in Patients with Lateral Epicondylitis: A Randomized Controlled Trial.” Clinical Orthopaedics and Related Research, 2020;478(8):1892–1900. https://pmc.ncbi.nlm.nih.gov/articles/PMC7371073/
6. Palacio EP, Schiavetti RR, Kanematsu M, Ikeda TM, Mizobuchi RR, Galbiatti JA. “Effects of platelet-rich plasma on lateral epicondylitis of the elbow: prospective randomized controlled trial.” Revista Brasileira de Ortopedia, 2016;51(1):90–95. https://pmc.ncbi.nlm.nih.gov/articles/PMC4767828/
7. Wolf JM, Ozer K, Scott F, Gordon MJV, Williams AE. “Comparison of autologous blood, corticosteroid, and saline injection in the treatment of lateral epicondylitis: a prospective, randomized, controlled multicenter study.” The Journal of Hand Surgery (American), 2011;36(8):1269–1272. https://doi.org/10.1016/j.jhsa.2011.05.014
8. Schöffl V, Willauschus W, Sauer F, Küpper T, Schöffl I, Lutter C, Gelse K, Dickschas J. “Autologous Conditioned Plasma Versus Placebo Injection Therapy in Lateral Epicondylitis of the Elbow: A Double Blind, Randomized Study.” Sportverletzung Sportschaden, 2017;31(1):31–36. https://doi.org/10.1055/s-0043-101042
9. Karjalainen TV, Silagy M, O’Bryan E, Johnston RV, Cyril S, Buchbinder R. “Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain.” Cochrane Database of Systematic Reviews, 2021;9:CD010951. https://pmc.ncbi.nlm.nih.gov/articles/PMC8481072/
10. Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. “Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial.” JAMA, 2013;309(5):461–469. https://doi.org/10.1001/jama.2013.129
11. Coombes BK, Bisset L, Connelly LB, Brooks P, Vicenzino B. “Optimising corticosteroid injection for lateral epicondylalgia with the addition of physiotherapy: a protocol for a randomised control trial with placebo comparison.” BMC Musculoskeletal Disorders, 2009;10:76. https://pmc.ncbi.nlm.nih.gov/articles/PMC2707364/
12. Xu Y, Li T, Wang L, Yao L, Li J, Tang X. “Platelet-Rich Plasma Has Better Results for Long-term Functional Improvement and Pain Relief for Lateral Epicondylitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.” The American Journal of Sports Medicine, 2024;52(10):2646–2656. https://doi.org/10.1177/03635465231213087
13. Ranger TA, Wong AMY, Cook JL, Gaida JE. “Is there an association between tendinopathy and diabetes mellitus? A systematic review with meta-analysis.” British Journal of Sports Medicine, 2016;50(16):982–989. https://doi.org/10.1136/bjsports-2015-094735
14. Titchener AG, Fakis A, Tambe AA, Smith C, Hubbard RB, Clark DI. “Risk factors in lateral epicondylitis (tennis elbow): a case-control study.” The Journal of Hand Surgery (European Volume), 2013;38(2):159–164. https://doi.org/10.1177/1753193412442464