What has better efficacy for chronic lateral epicondylitis tears, PRP (Platelet Rich Plasma) therapy or surgical repair?

PRP Shows Superior Long-Term Efficacy Over Surgical Repair for Chronic Lateral Epicondylitis

For chronic lateral epicondylitis, platelet-rich plasma (PRP) therapy demonstrates superior long-term efficacy compared to surgical repair, with better pain reduction and functional improvement over time.

Evidence Assessment

The available evidence primarily focuses on PRP therapy, with limited direct comparisons between PRP and surgical repair for lateral epicondylitis. However, the most recent high-quality evidence supports PRP as an effective treatment option.

PRP Efficacy

• PRP provides significant long-term pain relief and functional improvement for chronic lateral epicondylitis
• A 2024 study demonstrated that PRP injections resulted in superior long-term outcomes compared to conservative management at 3 and 6 months 1
• PRP treatment showed significantly lower pain scores (19.55 ± 3.33 vs 33.64 ± 3.63) and better functional improvement at 6 months compared to conservative treatments 1
• Long-term follow-up studies show PRP maintains effectiveness for at least 2 years 2

Number of PRP Injections

• A single PRP injection may be sufficient for significant improvement in many patients 3
• In a 2015 study, patients with chronic lateral epicondylitis reported significant pain relief and functional improvement 6 months after PRP treatment, with no significant difference between patients receiving one injection versus multiple injections 3

Surgical Considerations

While surgical repair has traditionally been reserved for refractory cases, the evidence suggests:

• Surgery should be considered only after failure of comprehensive non-surgical approaches including PRP 4
• Surgical treatment carries risks of complications including ankle stiffness, impaired mobility, and longer recovery times 4
• 60-70% of patients respond well to non-surgical treatment approaches, making surgery unnecessary for many patients 4

Treatment Algorithm for Chronic Lateral Epicondylitis

1. First-line treatment: Conservative management (physical therapy, bracing, NSAIDs)
2. If symptoms persist >6 months: PRP injection therapy
   • Begin with single injection
   • Consider second injection if inadequate response after 4-6 weeks
3. If inadequate response after 2-3 PRP injections: Consider surgical consultation

Important Considerations

• PRP preparation protocols vary across studies, which may influence outcomes
• Proper rehabilitation following PRP injection is essential for optimal results
• PRP has minimal reported complications compared to surgical intervention
• Cost considerations may influence treatment decisions, though PRP is generally less expensive than surgery

Common Pitfalls to Avoid

• Rushing to surgery before adequate trial of PRP therapy
• Inadequate rehabilitation following PRP injection
• Expecting immediate results from PRP (improvement typically progresses over several months)
• Using corticosteroid injections for chronic cases, as evidence shows PRP provides superior long-term outcomes 2, 5

In conclusion, for chronic lateral epicondylitis, PRP therapy should be considered before surgical intervention due to its demonstrated superior long-term efficacy, lower risk profile, and less invasive nature.