A randomised control trial to evaluate the efficacy of autologous blood injection versus local corticosteroid injection for treatment of lateral epicondylitis

Abstract

Objectives: Local corticosteroid infiltration is a common practice of treatment for lateral epicondylitis. In recent studies no statistically significant or clinically relevant results in favour of corticosteroid injections were found. The injection of autologous blood has been reported to be effective for both intermediate and long-term outcomes. It is hypothesised that blood contains growth factors, which induce the healing cascade.

Methods: A total of 60 patients were included in this prospective randomised study: 30 patients received 2 ml autologous blood drawn from contralateral upper limb vein + 1 ml 0.5% bupivacaine, and 30 patients received 2 ml local corticosteroid + 1 ml 0.5% bupivacaine at the lateral epicondyle. Outcome was measured using a pain score and Nirschl staging of lateral epicondylitis. Follow-up was continued for total of six months, with assessment at one week, four weeks, 12 weeks and six months.

Results: The corticosteroid injection group showed a statistically significant decrease in pain compared with autologous blood injection group in both visual analogue scale (VAS) and Nirschl stage at one week (both p < 0.001) and at four weeks (p = 0.002 and p = 0.018, respectively). At the 12-week and six-month follow-up, autologous blood injection group showed statistically significant decrease in pain compared with corticosteroid injection group (12 weeks: VAS p = 0.013 and Nirschl stage p = 0.018; six months: VAS p = 0.006 and Nirschl p = 0.006). At the six-month final follow-up, a total of 14 patients (47%) in the corticosteroid injection group and 27 patients (90%) in autologous blood injection group were completely relieved of pain.

Conclusions: Autologous blood injection is efficient compared with corticosteroid injection, with less side-effects and minimum recurrence rate.

Keywords: Autologous blood injection; Elbow; Injection; Lateral epicondylitis; Local corticosteroid; RCT.

Fig. 1

Clinical photograph showing the injection of autologous blood at the lateral epicondyle.

Fig. 2

Graph showing the mean visual analogue scale (VAS) of pain in both groups before treatment and at one week, four weeks, 12 weeks and six months post-injection.

Fig. 3

Graph showing the mean Nirschl stage in both groups before treatment and at one week, four weeks, 12 weeks and six months post-injection.