Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
J Orthop Traumatol. 2024 Jul 4;25(1):34. doi: 10.1186/s10195-024-00772-4.
Because lateral epicondylitis is a common musculoskeletal disorder that affects the forearm's extensor tendons, an effective therapeutic approach should reverse the degeneration and promote regeneration. This study aimed to compare the efficacies of autologous blood (AB) injection, corticosteroid (CS) injection, and a combined injection of both in treating lateral epicondylitis (LE), hypothesizing that the combined approach might offer immediate symptom resolution and a lower recurrence.
A total of 120 patients diagnosed with lateral epicondylitis were systematically distributed among three distinct therapeutic injection groups. Those in the AB group were administered 1 ml of autologous venous blood mixed with 2 ml of 2% prilocaine HCl. Participants in the CS category were given 1 ml of 40 mg methylprednisolone acetate mixed with 2 ml of 2% prilocaine HCl. Meanwhile, patients in the combined group received a mixture containing 1 ml each of autologous venous blood and 40 mg methylprednisolone acetate along with 1 ml of 2% prilocaine HCl. Prior to receiving their respective injections, a comprehensive assessment of all participants was carried out. Follow-up assessments were subsequently conducted on days 15, 30, and 90 utilizing metrics of the patient-rated tennis elbow evaluation (PRTEE) and measurements of hand grip strength (HGS).
One patient dropped out from the combined group, and 119 patients completed the trial. No complications were recorded during the course of follow-up. By day 15, all groups had demonstrated significant PRTEE improvement, with CS showing the most pronounced reduction (p = 0.001). However, the benefits of CS had deteriorated by day 30 and had deteriorated further by day 90. The AB and AB + CS groups demonstrated sustained improvement, with AB + CS revealing the most effective treatment, achieving a clinically significant improvement in 97.4% of the patients. The improved HGS parallelled the functional enhancements, as it was more substantial in the AB and AB + CS groups (p = 0.001), corroborating the sustained benefits of these treatments.
The study concluded that while AB and CS individually offer distinct benefits, a combined AB + CS approach optimizes therapeutic outcomes, providing swift and sustained functional improvement with a lower recurrence rate. These findings have substantial clinical implications, suggesting a balanced, multimodal treatment strategy for enhanced patient recovery in LE.
Randomized clinical trial, level 1 evidence.
NCT06236178.
由于外侧肱骨上髁炎是一种常见的影响前臂伸肌腱的肌肉骨骼疾病，因此有效的治疗方法应该能够逆转退行性变并促进再生。本研究旨在比较自体血（AB）注射、皮质类固醇（CS）注射和两者联合注射治疗外侧肱骨上髁炎（LE）的疗效，假设联合治疗可能会立即缓解症状并降低复发率。
共有 120 名被诊断为外侧肱骨上髁炎的患者被系统地分配到三个不同的治疗性注射组中。AB 组患者接受 1ml 自体静脉血与 2ml 2%普鲁卡因混合。CS 组患者接受 1ml 40mg 醋酸甲泼尼龙与 2ml 2%普鲁卡因混合。同时，联合组患者接受含有 1ml 自体静脉血和 40mg 醋酸甲泼尼龙以及 1ml 2%普鲁卡因的混合物。在接受各自的注射之前，对所有参与者进行了全面评估。随后在第 15、30 和 90 天利用患者自评网球肘评估（PRTEE）和手部握力（HGS）测量对所有参与者进行了随访评估。
联合组有 1 名患者脱落，119 名患者完成了试验。在随访过程中未记录到任何并发症。到第 15 天，所有组的 PRTEE 均有显著改善，CS 组的改善最为明显（p=0.001）。然而，CS 的益处到第 30 天已经恶化，到第 90 天进一步恶化。AB 和 AB+CS 组均表现出持续改善，AB+CS 组治疗效果最为显著，97.4%的患者达到了临床显著改善。手部握力的改善与功能增强平行，AB 和 AB+CS 组更为明显（p=0.001），证实了这些治疗方法的持续益处。
本研究表明，虽然 AB 和 CS 单独使用均有明显益处，但 AB+CS 联合使用可优化治疗效果，提供快速而持续的功能改善，且复发率较低。这些发现具有重要的临床意义，提示在 LE 中采用平衡的多模式治疗策略可促进患者康复。
随机临床试验，一级证据。
NCT06236178。
