A Randomized Control Trial to Evaluate the Efficacy of Autologous Blood Injection versus Local Corticosteroid Injection for Treatment of Lateral Epicondylitis

Abstract

Background & Objectives ABSTRACT Lateral epicondylitis, is a common problem encountered in the orthopaedic practice. It is a common practice to give local corticosteroid infiltration for tennis elbow. Histopathological reports have shown that lateral epicondylitis is not an inflammatory process but a degenerative condition termed ‘tendinosis’. Beneficial effects of local corticosteroid infiltration have sound lack of scientific rationale, since surgical specimens show lack of any inflammatory process. In recent studies no statistically significant or clinically relevant results in favor of corticosteroid injections were found. Recently an injection of “autologous blood injection” has been reported to be effective for both intermediate and long term outcomes for the treatment of lateral epicondylitis. It is hypothesized that blood contains platelet derived growth factor induce fibroblastic mitosis and chemotactic polypeptides such as transforming growth factor cause fibroblasts to migrate and specialize and have been found to induce healing cascade. The objective of the study is to evaluate the efficacy and role of autologous blood injection versus local corticosteroid injection in the management of lateral epicondylitis of humerus. Materials and Methods A prospective, randomized study was done in K.L.E’s Dr. Prabhakar Kore hospital. 60 patients were included in the study. 30 patients received 2 milliliter autologous blood drown from contra lateral cubital vein + 1 milliliter 0.5% Bupivacaine, and 30 patients received 2 milliliters local corticosteroid ( Methyl prednisolone acetate 80 mg ) + 1 milliliter 0.5% Bupivacaine at the lateral epicondyle. VIII Outcome is measured using ‘Pain score’ and ‘Nirschl staging of lateral epicondylitis’. Mann-Whitney U test ( non parametric test ) is applied to calculate the significance of results. Results Follow-up done for total 6 months divided in to intervals at 1week, 4week, 12 week and 6 month. At 1 st week and 4 th week the corticosteroid injection group showed a statistically significant decrease in pain compared to autologous blood injection group. At 12 th week and 6 months follow up autologous blood injection group showed statistically significant decrease in pain compared to corticosteroid injection group. At the end of 6 months 46.66% patients in Corticosteroid injection group and 90% patients in autologous blood injection group were completely relieved of pain. In Corticosteroid injection group till 4 weeks there was significant improvement with 63.3% of patients completely relieved of pain. Many of these patients reported recurrences at 12 weeks and 6 month follow up. The rate of recurrence was 36.8% at the end of 6 months. In autologous blood injection group at 4 IX th week follow up, 16.66% of patients were completely free of pain. At the end of 6 months follow up, 90% of patients were completely free of pain. There was no recurrence. Interpretation & Conclusion Autologous blood injection technique for lateral epicondylitis offers a better treatment with least side effects, cost effective and with minimum recurrence rate.