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Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections
  1. Leon Creaney1,
  2. Andrew Wallace3,
  3. Mark Curtis4,
  4. David Connell2
  1. 1BUPA Health and Wellbeing, Barbican, London, UK
  2. 2Royal National Orthopaedic Hospital, Stanmore, UK
  3. 3Hospital of St John and Elizabeth, London, UK
  4. 4Kingston Hospital NHS Trust, Kingston, UK
  1. Correspondence to Dr Leon Creaney, BUPA Health and Wellbeing, 3 White Lyon Court, London EC2Y 8EA, UK; leoncreaney{at}


Background Growth factor technologies are increasingly used to enhance healing in musculoskeletal injuries, particularly in sports medicine. Two such products; platelet-rich plasma (PRP) and autologous blood, have a growing body of supporting evidence. No previous trial has directly compared the efficacy of these two methods.

Hypothesis Growth factor administration improves tissue regeneration in patients who have failed to respond to conservative therapy.

Study design A prospective, double-blind, randomised trial.

Methods Elbow tendinopathy patients who had failed conservative physical therapy were divided into two patient groups: PRP injection (N=80) and autologous blood injection (ABI) (N=70). Each patient received two injections at 0 and 1 month. Patient-related tennis elbow evaluation (PRTEE) was recorded by a blinded investigator at 0, 1, 3 and 6 months. The main outcome measure was PRTEE, a validated composite outcome for pain, activities of daily living and physical function, utilising a 0–100 scale.

Results At 6 months the authors observed a 66% success rate in the PRP group versus 72% in the ABI group, p=NS. There was a higher rate of conversion to surgery in the ABI group (20%) versus the PRP group (10%).

Conclusion In patients who are resistant to first-line physical therapy such as eccentric loading, ABI or PRP injections are useful second-line therapies to improve clinical outcomes. In this study, up to seven out of 10 additional patients in this difficult to treat cohort benefit from a surgery-sparing intervention.

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  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Royal National Orthopaedic Hospital Ethics Committee.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.