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A study of efficacy with local methyl prednisolone acetate injection versus autologous blood injection in the treatment of lateral epicondylitis

ABSTRACT  
Background & Objectives 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 
compare the functional outcome of local Methyl prednisolone acetate injection versus 
Autologous Blood injection in lateral epicondylitis. Materials and Methods A prospective, randomized study was done in R L Jalappa Genaeral Hospital. 
60 patients were included in the study. 30 patients received 2 milliliter autologous blood 
and 30 patients received 2 milliliters local corticosteroid (Methyl prednisolone acetate 80 
mg) at the lateral epicondyle. Outcome is measured using ‘Pain score’ . 
Student t test is applied to calculate the significance of results. 
Results Follow-up done for total 6 months divided in to intervals at 2week,2 month 
and 6 month. At 2nd week the corticosteroid injection group showed a statistically 
significant decrease in pain compared to autologous blood injection group. At 2nd month 
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 2nd month there was significant improvement with 
63.3% of patients completely relieved of pain. Many of these patients reported 
recurrences at 6th month follow up. The rate of recurrence was 36.8% at the end of 6 
months. In autologous blood injection group at 2nd month 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.