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 a headline can hide. One is when the result is measured. The other is who was let into the study. First, compare it to a placebo shot. Pooled randomized data have not shown PRP or autologous blood (your own blood) beating a control [1][9]. Now compare it to a steroid shot at six months and beyond. There, pooled data run the other way. They favor PRP on pain and function [12].

Both of those statements are true, and neither settles the question for one person’s elbow. The trials behind them took in a narrow slice of patients. Most set a floor or a ceiling on how long symptoms had lasted. One pooled only patients who had never been treated. One left out anyone who had a shot in the past six months. And one left out 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 lists who each study let in and kept out, so you can judge how closely its patients look like you.

What is tennis elbow, and why does the framing matter?

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. Most are people over 40 years of age, split evenly between men and women [2]. A second review reports the same 1% to 3% population figure [3].

That matters because a therapy aimed at calming inflammation may be aiming at something that is not the main process. It is one reason results differ so much between types of shots, and between trials of the same shot.

The research does not even agree on this point. A 2022 review in World Journal of Orthopedics calls lateral epicondylitis a long-term, germ-free inflammatory condition. It says repeated tiny damage and overload cause it. It also reports imaging changes where the muscle attaches near the elbow [3]. Reviewers cannot agree on whether the process is wear or inflammation. So it is no surprise they disagree about which shot should help.

Confirming the pain generator before choosing an injection

Pain on the outer elbow has three possible sources. It can come from the tendon that attaches there, from the joint itself, or from the radial nerve as it passes by. We confirm which structure is causing symptoms before we talk about a shot. That is because the target decides whether an orthobiologic is even a sensible question.

Study groups vary in the same way. Trials that took in patients with different symptom lengths, severity, and tissue damage will not line up neatly. That is part of why the pooled estimates are so wide.

Is PRP better than a cortisone shot for tennis elbow?

Corticosteroid at 4 weeks, 26 weeks and 1 year

Tennis elbow research is unusually clear on this point, and steroid is the best example. One randomized placebo-controlled trial used a 2 × 2 factorial design. It took in 165 adults with pain in one elbow lasting more than six weeks. It ran at a university research center and 16 primary care settings in Brisbane, Australia. At 4 weeks, a steroid shot brought full recovery or much improvement in 71% of patients, versus 10% with a placebo shot (RR 7.32; 99% CI 2.1 to 25.5; P < .001) [10].

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

The authors concluded that in patients with long-term pain in one elbow, a steroid shot led to worse results after one year than a placebo shot [10]. So a treatment can work strikingly well at four weeks and be a net loss at fifty-two. Same patients, 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 looked only at randomized trials with at least six months of follow-up after the first treatment. The patients were adults aged 18 years or older with lateral epicondylitis [1]. In that window, seven trials with 416 patients compared a steroid shot with a control. The control group did significantly better on pain (mean difference 0.70, 95% CI 0.22 to 1.18). It also did significantly better on function (SMD −0.35, 95% CI −0.54 to −0.16) [1].

That result does not clash with the four-week finding above. It is the same curve read at a different point. Any article that says steroid gives stronger relief than an orthobiologic, without naming the time point, is reporting half a measurement.

Steroid is also described as having a short-term effect at the elbow. Repeat use is discouraged because of side effects after long-term use, such as a weaker tendon, and little long-term pain control [2]. That is why we do not present orthobiologics as the risky choice and steroid as the safe 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. Of those, 354 got PRP and 376 got steroid. The search ran from January 2000 to July 2022, and the mean follow-up was 6.94 months [12]. Steroid beat PRP on short-term pain, meaning under two months. The numbers: 9 studies; mean difference 0.93 on the visual analog scale, 95% CI 0.42 to 1.44; I² = 85%; P = .0003. It also beat PRP 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 order flipped. Long-term pain scores favored PRP (6 studies; MD −2.18, 95% CI −3.13 to −1.22; I² = 89%; P < .0001). So did long-term DASH (5 studies; MD −8.13, 95% CI −9.87 to −6.39; I² = 25%; P < .0001). So did 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 middle 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. First, the authors removed trials at high risk of bias. Then steroid’s short-term pain edge was no longer significant (MD 0.53, 95% CI −0.13 to 1.19; I² = 78%; P = .12). So the authors advise treating the short-term pain finding with caution [12]. Second, the results varied a lot from trial to trial throughout, reaching I² = 98% on the long-term Mayo score [12].

The third caution is ours, not the authors’. The comparison in that review is steroid. In the placebo-controlled data above, steroid did worse at one year than a placebo shot [10]. Beating something that loses to placebo at one year is a weak bar. It is not the same claim as beating placebo.

Is PRP for tennis elbow effective against a placebo?

PRP and autologous blood compared with controls

In the JSES International meta-analysis, two randomized studies compared PRP with controls in adults with tennis elbow. No differences were found in pain (mean difference: −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. They found 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 ranges are wide enough to include both a real benefit and real harm. Two trials with 64 patients cannot settle a question like this. The accurate reading is that PRP has not been shown to beat a control shot in this pooled set. It has not been shown to fail, either.

The review’s overall conclusion was that the best available evidence does not support four treatments for lateral epicondylitis. They are exercise-based physical therapy, steroid shots, PRP, and autologous blood [1]. Exercise-based therapy did no better than the shots in that review. 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 shots for outer elbow pain included 32 trials with 2,337 people [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). 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 were moderate-certainty evidence [9]. No medically important differences were seen at 6 and 12 months [9].

The authors concluded that the data do not support autologous blood or PRP shots for outer elbow pain. They said these shots probably give little or no meaningful benefit for pain or function. With no evidence of benefit, they said, the costs and risks are not justified [9]. That is the largest and most careful review available. We state it here in the authors’ own terms, not softened.

Preparation is not standardized, and that is measurable

The same Cochrane review notes that no standard name or preparation method has been adopted for these blood products. It shows the trials varied in how blood was spun, platelet count, white blood cell content, and injection method [9]. It also notes most studies were at risk of bias in who got which treatment, how it was given, and how results were judged. The main reasons were poor hiding of group assignment and patients knowing their treatment [9].

This matters in a real way. Take the largest placebo-controlled trial in this area. The PRP was made with a double-syringe kit at 1500 rpm for five minutes. That gave a platelet count about twice that of the patient’s own blood. It was given as a single shot, placed by feel, not under imaging [5]. A trial of one preparation, at one strength, given once, without guidance, tests that one method. It does not test every method that shares the name.

Long-term data, and where shock wave therapy sits

A 2023 meta-analysis looked only at randomized trials with follow-up of 12 months or longer. It searched PubMed and Embase from the start of each database to March 2023. It found that shock wave therapy clearly eased pain in tennis elbow compared with controls (SMD −0.19, 95% CI −0.36 to −0.02, P = 0.03). There was no significant difference in long-term function (SMD 0.24, P = 0.07) [4].

In that same long-term review, PRP showed no significant difference from control in pain (SMD −0.30, 95% CI −0.85 to 0.25) or function (SMD −0.08, 95% CI −0.78 to 0.62). Steroid 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 shock wave therapy showed long-term pain relief among the non-surgical options they studied [4].

We include that to place orthobiologics honestly among the non-surgical options, not to pile on treatments. Our orthobiologics program is built around matching a biologic to a confirmed target. It is not built 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 entry rules below are printed in the papers. Each one narrows the group the result describes.

Palacio 2016 excluded systemic disease by name

This Brazilian trial randomly split 60 of 72 patients screened in a row into three groups of 20. They got 3 mL of 0.5% neocaine, 3 mL of dexamethasone acetate, or 3 mL of platelet-rich plasma. DASH and PRTEE questionnaires were done 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. The authors concluded there was no evidence that one treatment beat another on DASH and PRTEE [6]. But look at who was in it. There were no patients with diabetes, hypothyroidism, or rheumatoid arthritis. There were no patients who had been treated for the elbow before. Those are four of the most common traits among patients who reach a referral practice.

Linnanmäki 2020 excluded little, but recorded less

This trial screened 128 patients and randomly assigned 119 to PRP (n = 40), autologous blood (n = 40) or saline (n = 39). They were recruited between March 2011 and January 2017 from a secondary care hospital. Follow-up visits came at 4, 8, 12, 26 and 52 weeks [5]. It took adults with outer elbow pain for more than three months who were unhappy with their first non-surgical treatment [5].

The stated exclusion criteria were narrow: “other concomitant upper-limb symptoms and previous surgical treatment of the elbow” [5]. Nine patients were not randomized. The reasons recorded were pain in both elbows (2), other arm problems (3) and whole-body disease (1) [5]. Diabetes, obesity and metabolic disease are not listed as exclusions in this paper. It would be wrong to claim otherwise.

What the paper also does not do is describe the metabolic health of the patients it enrolled. Its baseline comparison covers age, how long symptoms lasted, time off work, pain scores, DASH scores and grip strength [5]. The result was no meaningful difference in pain at 52 weeks for PRP versus saline (mean difference −0.2, P = 0.75). It was the same for autologous blood versus saline (0.5, P = 0.40). The authors recommended against both unless future trials show benefit. That result applies to a group whose metabolic traits were never measured [5]. That limits what we can conclude. It is not a criticism of the finding.

Wolf 2011 enrolled only symptoms shorter than six months

This was a forward-looking, randomized, controlled study at several centers. It took patients diagnosed with tennis elbow lasting less than six months. They were randomly given 3 mL of saline and lidocaine, steroid and lidocaine, or autologous blood and lidocaine. Results were checked at baseline, 2 weeks, 2 months and 6 months [7]. Of 34 people enrolled, 28 finished follow-up: 10 saline, 9 autologous blood, 9 steroid [7].

The finding was that autologous blood, steroid and saline shots gave no edge over placebo saline. Patients in every group improved over six months [7]. The time limit is the key point. Patients whose symptoms had already lasted past six months could not join. Yet that is the group for whom a shot is usually being considered. With nine patients per group, this trial also cannot detect a difference big enough to matter.

Schöffl 2017 does not report its criteria in the available record

This forward-looking, double-blind, randomized controlled trial took 50 tennis elbow patients. 25 got one round of autologous conditioned plasma, and 25 got 0.9% sodium chloride placebo. They were checked again at four weeks and six months. 36 of 50 qualified for the recheck, 18 per group [8]. The results suggested both groups improved, with no meaningful difference between them [8].

We could not read this trial’s full entry rules from the public record, and we will not guess at them. What we can confirm is that 28% of enrolled patients did not reach the recheck. With 18 patients per group, the trial is small.

Coombes 2013 excluded recent injection and inflammatory disorders

The steroid trial described earlier has a fully published plan, and its entry rules are specific [11]. Patients needed pain in one elbow for longer than six weeks. Pain had to be at least 30 mm on a 100 mm pain scale. Pain over the outer elbow bone had to be set off by at least two of four things. Those were gripping, pressing, stretching the forearm muscles, and pushing against wrist or middle finger lifting. Grip strength without pain had to be reduced. Age had to be between 18 and 70 years. Patients needed a fair grasp of written and spoken English, and had to be willing to follow treatment and follow-up [11].

The exclusions were long. A shot within the past 6 months ruled you out. So did a course of exercise-based therapy within the past 3 months. So did neck or other arm pain that had stopped usual work or play, or needed treatment, in the last 6 months. Signs of other main sources of outer elbow pain ruled you out. So did a history of fractures within the past 10 years, elbow surgery, cancer, or an inflammatory or arthritic disorder. Any condition that might rule out a shot or exercise counted too. So did pregnancy or breastfeeding [11]. The published trial report lists the same core exclusions [10].

Read that list against a typical referral patient. A patient who already had a steroid shot is out. A patient with an inflammatory or arthritic disorder is out. A patient with neck pain feeding into arm symptoms is out. A patient over 70 is out. The 96% one-year recovery rate in the placebo group is a real number. It describes that filtered group.

Xu 2024 pooled only previously untreated patients

The entry rules of the 2024 PRP-versus-steroid meta-analysis are printed plainly. Studies were included if they were RCTs. They had to focus on people 18 years of age or older “with previously untreated LE”. The treatment group got PRP and the comparison group got steroid. The article was in English, and the study came out after January 2000 [12]. Studies were left out if they were letters, editorials, reviews, case reports or basic science studies. They were also left out if function or pain results were missing, or if data were incomplete [12].

“Previously untreated” is the key phrase. PRP’s long-term edge in that review was measured in patients near their first treatment. It was not measured in patients arriving after a failed shot, a failed course of therapy, or years of symptoms.

What the pooled populations describe

The Cochrane review describes its 2,337 participants by age, sex and symptom length. Mean ages ranged from 36 to 53 years across trials. 56% were female in the 22 studies that reported sex. Symptoms lasted from 1 to 22 months in the 13 studies that reported it. Single trials ranged from 25 to 230 participants [9]. People with outer elbow pain from a sudden injury were left out [9].

Those are the group details we have. Picture a patient of 68 with type 2 diabetes, five years of symptoms and two prior steroid shots. That patient is outside the reported range on age and on symptom length. And that patient falls outside the entry rules of several single 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 looked at 31 case-control and cross-sectional studies. Tendon problems were more common in people with diabetes (17 studies, OR 3.67, 95% CI 2.71 to 4.97). Diabetes was more common in people with tendon problems (5 studies, OR 1.28, 95% CI 1.10 to 1.49). People with both had diabetes longer 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 a link across tendon problems in general, drawn from studies that watch rather than test. It shows that tendon in diabetes differs in structure and in how often problems show up. It does not show how a diabetic tendon responds to a shot. That is because no randomized trial has asked that question in this condition.

What is contested in lateral epicondylitis specifically

Here the evidence truly conflicts, and pretending otherwise would be dishonest. One case-control study took 4,998 tennis elbow patients and matched each to a control by age, sex and general practice. That made 4,998 controls, drawn from a United Kingdom primary care database. Several factors were linked to lateral epicondylitis. They were rotator cuff problems (OR 4.95), De Quervain’s disease (OR 2.48), carpal tunnel syndrome (OR 1.50), oral steroid therapy (OR 1.68) and a past smoking history (OR 1.20). Diabetes mellitus, current smoking, trigger finger, rheumatoid arthritis, alcohol intake and obesity were not [14].

A 2022 review reports the opposite on body weight. It lists 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 lingers after 12 months [3]. That sits awkwardly beside the 70% to 90% figure quoted below. It reflects a different question being asked.

The honest summary is this. Whether metabolic problems raise the risk of getting tennis elbow is unsettled. A separate question is whether they change the tissue’s ability to repair once the tendon is damaged. A third question is whether they change the response to a shot. 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 group does not prove failure in the patients who were screened out. It does not prove success in them either. What it shows 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. Saying it would be the mirror image of the mistake this page is trying to avoid. What we do say is this. The trials most often cited to close the question left out, or did not measure, the metabolic traits that may govern tendon repair. So the negative conclusion is weaker in those patients than the headline suggests.

What single-modality trials cannot test

Every trial above tested one shot, usually given once, on its own. That is the right design for testing a single factor. It is the wrong design for describing care that is staged or combined.

None of these trials tested an orthobiologic given after the metabolic problems were treated. None tested an orthobiologic paired with a structured, supervised loading program as one plan with a shared goal. None tested repeat doses guided by how the patient responded. None compared preparations head to head at set platelet counts and white cell content. The Cochrane review says those are not standardized across the research [9].

Follow-up is the other built-in limit. The JSES International review notes that most studies ended at 12 months. So there is little data on how long any non-surgical option lasts [1]. How long results last past a year is unmeasured for nearly everything in this field.

Does tennis elbow go away on its own?

Within one year of treatment, 70% to 90% of tennis elbow patients either get better on their own or respond to conservative care [2]. That baseline is the most important number in this research. It explains a lot of the null results above.

When a control group recovers that reliably, any shot faces a very high bar to show added benefit. A trial must also be large to detect a difference at all. It also means that time, managing load, and a structured strength program are not a stalling tactic. In an unselected group, they are the treatment with the best supporting evidence.

When escalation is discussed

The research says patients become candidates for surgery when disabling pain lasts more than six months despite non-surgical care [2]. Regen.MD does provide surgery when conservative care has truly run its course, and Dr. Gurpreet Singh Padda, MD, MBA, MHP is a surgeon — but surgery follows conservative care. It does not lead it.

Between those two ends sits the choice most patients really face. Is a time-limited trial of an orthobiologic shot, paired with a rehab program, a fair next step for them?

How this evidence is used in a Clinical Evaluation

We start by confirming the diagnosis and finding which structure is causing the pain. Then we review what conservative care has been done and for how long. Only then is an orthobiologic worth asking about. We frame it as a monitored trial with set goals and a set stopping point. It is not a promised outcome.

We present the evidence above to patients as it reads. Placebo-controlled data have not shown a benefit for PRP or autologous blood over a control shot [1][9]. Comparison data favor PRP over steroid past six months, in patients never treated before. And the steroid it beat did worse at one year than placebo [10][12]. When a patient falls outside the groups studied, we say so. We do not borrow a conclusion that was never measured in them.

Our terrain-first approach also looks at the metabolic conditions a tendon must heal in. That is because tissue trying to repair in a hostile setting acts differently, no matter what is injected into it. Observational tendon data support that idea [13]. A randomized trial has not yet tested it 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. In one randomized trial, steroid brought recovery or much improvement in 71% of patients at 4 weeks versus 10% with placebo. At one year it was 83% versus 96%, and the pain came back in 54% versus 12%.
• In pooled placebo-controlled data in adults with tennis elbow, PRP and autologous blood showed no difference from controls for pain or function. A 32-trial Cochrane review concluded they probably give little or no meaningful benefit.
• Against steroid instead of placebo, pooled data favor PRP at six months and beyond on pain, DASH and Mayo Elbow Performance Score. But that was only in patients never treated before, with results that varied a lot. And steroid itself does worse than placebo at one year.
• The trials left out a lot of people. One left out diabetes mellitus, hypothyroidism and rheumatoid arthritis by name. One left out a shot within the past six months, inflammatory or arthritic disorders, and age over 70. One took only symptoms shorter than six months. One pooled only patients never treated before.
• A null result in a selected group does not prove failure in the patients who were screened out. It does not prove success in them either. It shows that the question was not asked.
• Within one year, 70% to 90% of tennis elbow patients get better on their own or respond to conservative care. That is a very high bar for any shot to beat, and a reason to finish conservative care first.

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.

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